Is a second recombinant human thyrotropin stimulation test useful? The value of postsurgical undetectable stimulated thyroglobulin level at the time of remnant ablation on clinical outcome

Sanchez, Inmaculada Prior; Martín, A.; Ortega, E. Moreno; Casas, J.A. Vallejo; Moreno, María

doi:10.1111/cen.13140

Cited by 4 publications

(2 citation statements)

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“…Other studies supported the usefulness of neck ultrasound in the early diagnosis of recurrence, where one study reported a 31.5 times greater chance of recurrent disease if there were detectable abnormalities (i.e. masses, lymphadenopathy) by ultrasound in the thyroid bed (12, 17). Ultrasound has been advocated in the pre-operative evaluation of patients prior to their initial surgery, but adherence with this recommendation has been variable and there is significant variation in the quality of pre-operative neck ultrasound to evaluate for lymph node involvement (21).…”

Section: Discussionmentioning

confidence: 90%

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Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease?

Bates

Lamas

Randle

et al. 2018

Surgery

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Background Papillary thyroid carcinoma (PTC) has excellent survival, yet recurrence remains a challenge. We sought to determine the proportion of re-operations performed for persistent, rather than truly recurrent disease. Methods We conducted a retrospective review of a prospectively maintained database. Patients with PTC that had re-operation for disease from 2000–2016 were included. We defined recurrence as disease that developed after a patient had an undetectable thyroglobulin and negative ultrasound within one year of surgery. Results A total of 69 patients underwent 92 re-operations. On initial pathology: mean tumor size was 2.6cm; 50.7% were multifocal; and 42% had extra-thyroidal extension. Half (46%) of the patients underwent a central/lateral neck dissection at initial surgery and 76.8% were treated with post-operative radioactive iodine. The median time to first re-operation was 21 months (range, 1–292), and 41.8% occurred within 1 year. Only three operations met criteria for true “recurrence”, while 71 operations were categorized as persistence. Conclusion Many re-operations for PTC are for management of persistent disease. Over half of the patients required re-operation within the first two years, which strongly suggests that improvements in the pre-operative assessment and adequacy of initial surgery need to be made to improve the care of patients with thyroid cancer.

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Section: Discussionmentioning

confidence: 90%

“…Several studies have shown that undetectable post-operative Tg levels correspond with a low incidence of recurrence, while elevated Tg levels are associated with recurrence (12–15). Rosario and colleagues demonstrated that Tg levels often detected recurrent PTC, even prior to structurally detectable disease on ultrasound (16).…”

Section: Discussionmentioning

confidence: 99%