Recent studies have provided new information regarding the optimal surveillance protocols for low-risk patients with differentiated thyroid cancer (DTC). This article summarizes the main issues brought out in a consensus conference of thyroid cancer specialists who analyzed and discussed this new data. There is growing recognition of the value of serum thyroglobulin (Tg) as part of routine surveillance. An undetectable serum Tg measured during thyroid hormone suppression of TSH (THST) is often misleading. Eight studies show that 21% of 784 patients who had no clinical evidence of tumor with baseline serum Tg levels usually below 1 micro g/liter during THST had, in response to recombinant human TSH (rhTSH), a rise in serum Tg to more than 2 micro g/liter. When this happened, 36% of the patients were found to have metastases (36% at distant sites) that were identified in 91% by an rhTSH-stimulated Tg above 2 micro g/liter. Diagnostic whole body scanning, after either rhTSH or thyroid hormone withdrawal, identified only 19% of the cases of metastases. Ten studies comprising 1599 patients demonstrate that a TSH-stimulated Tg test using a Tg cutoff of 2 micro g/liter (either after thyroid hormone withdrawal or 72 h after rhTSH) is sufficiently sensitive to be used as the principal test in the follow-up management of low-risk patients with DTC and that the routine use of diagnostic whole body scanning in follow-up should be discouraged. On the basis of the foregoing, we propose a surveillance guideline using TSH-stimulated Tg levels for patients who have undergone total or near-total thyroidectomy and (131)I ablation for DTC and have no clinical evidence of residual tumor with a serum Tg below 1 micro g/liter during THST.

Vitamin D insufficiency contributes to bone loss and fracture risk. Low 25-hydroxyvitamin D (25OHD) levels are common in elderly people and in housebound and hospitalized patients. This study was conducted to assess wintertime 25OHD levels in relation to self-reported vitamin D supplement use in an outpatient thyroid clinic population. We assessed the medical history, vitamin D intake from milk and supplements, and serum 25OHD levels in 231 women and 41 men who attended a Thyroid Clinic between January and March, 1999. Of the 272 outpatients, 13.6% had 25OHD levels <40 nmol/l and 53.3% had levels below 80 nmol/l. Fewer than 15% of the patients consumed more than 200 IU per day of vitamin D from milk. Vitamin D supplement use was a positive determinant of serum 25OHD concentration (P < 0.001). For example, among the largest homogenous subset of patients, Caucasian women (n = 137), 30% of the unsupplemented women, and 65% of those taking 400 lU/day of vitamin D had levels of 25OHD as high as 80 nmol/l. Other significant determinants of 25OHD levels were race, weight, milk intake, and recent southern travel. Thyroid disorder, serum TSH level, and age were not predictors of serum 25OHD concentration. In conclusion, at their current dietary vitamin D intake levels, most patients at this latitude will need vitamin D supplements in the wintertime.

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