Clinical Significance of Observation without Repeated Radioiodine Therapy in Differentiated Thyroid Carcinoma Patients with Positive Surveillance Whole-Body Scans and Negative Thyroglobulin.
10.3904/kjim.2010.25.4.408
- Author:
Dong Jun LIM
1
;
Joo Hyun O
;
Min Hee KIM
;
Ji Hyun KIM
;
Hyuk Sang KWON
;
Sung Hoon KIM
;
Moo Il KANG
;
Bong Yun CHA
;
Kwang Woo LEE
;
Ho Young SON
Author Information
1. Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea. hys@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Iodine radioisotopes;
Thyroglobulin;
Thyroid neoplasms;
Whole body scan
- MeSH:
Adult;
Aged;
Female;
Humans;
Iodine Radioisotopes/pharmacokinetics/*therapeutic use;
Male;
Middle Aged;
Thyroglobulin/*blood;
Thyroid Neoplasms/blood/radionuclide imaging/*radiotherapy;
*Whole Body Imaging
- From:The Korean Journal of Internal Medicine
2010;25(4):408-414
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Currently, there is no consensus on the necessity of repeated radioiodine therapy (RAI) in patients who show iodine uptake in the thyroid bed on a diagnostic whole-body scan (DxWBS) despite undetectable thyroglobulin (Tg) levels after remnant ablation. The present study investigated the clinical outcomes of scan-positive, Tg-negative patients (WBS+Tg-) who did or did not receive additional RAI. METHODS: We retrospectively reviewed 389 differentiated thyroid carcinoma patients who underwent a total thyroidectomy and received high-dose RAI from January 2003 through December 2005. The patients were classified according to surveillance DxWBS findings and TSH-stimulated Tg levels 6 to 12 months after the initial RAI. RESULTS: Forty-four of the 389 patients (11.3%) showed thyroid bed uptake on a DxWBS despite negative Tg levels (WBS+Tg-). There was no difference in clinical and pathological parameters between WBS+Tg- and WBS-Tg- patients, except for an increased frequency of thyroiditis in the WBS+Tg- group. Among the 44 WBS+Tg- patients, 27 subjects were treated with additional RAI; 25 subjects showed no uptake in subsequent DxWBS. Two patients were evaluated only by ultrasonography (US) and displayed no persistent/recurrent disease. The other 17 patients received no further RAI; Eight patients and two patients showed no uptake and persistent uptake, respectively, on subsequent DxWBS. Six patients presented negative subsequent US findings, and one was lost to follow-up. Over the course of 53.2 +/- 10.1 months, recurrence/persistence was suspicious in two patients in the treatment group. CONCLUSIONS: There were no remarkable differences in clinical outcomes between observation and treatment groups of WBS+Tg- patients. Observation without repeated RAI may be an alternative management option for WBS+Tg- patients.
