Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems

Pitoia, Fabián; Bueno, Maria F.; Abelleira, Erika; Salvai, María Eugenia; Bergoglio, Liliana; Luster, Markus; Nièpomniszcze, Hugo

doi:10.1590/s0004-27302013000400004

Cited by 2 publications

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“…The clinical significance of minimally detectable serum Tg levels is still unclear, especially when this situation occurs after TSH stimulation [22,23,24,25]. In a recent investigation, we concluded that clinical outcomes in patients with an indeterminate response or a biochemical incomplete response after initial treatment are very good; only 16% developed structurally identifiable disease during the first 4 years of follow-up [50]. This is very similar to our current findings, in which 11 of 40 patients (27%) had a biochemical persistence and only 4 (36%) presented with structural persistence, which can be expected because of the inclusion of the intermediate- and high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Recombinant Human Thyroid-Stimulating Hormone-Aided Remnant Ablation Achieves a Response to Treatment Comparable to That with Thyroid Hormone Withdrawal in Patients with Clinically Relevant Lymph Node Metastases

2014

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It has already been shown that remnant ablation in patients with thyroid cancer and lymph node (LN) metastases has similar results when patients are prepared after recombinant human thyroid-stimulating hormone (rhTSH) therapy or thyroid hormone withdrawal (THW). Due to the current changes in the risk-of-recurrence classifications, we decided to evaluate the initial response to treatment and the outcome at medium-term follow-up in 40 consecutive patients with clinically relevant lymph nodes who received radioiodine remnant ablation after rhTSH therapy (n = 20) or THW (n = 20). Each patient received either 100 or 150 mCi 131-I for ablation based on TNM status, and the mean amounts of 131-I used in the 2 groups were not significantly different. An excellent response to treatment was observed in 45% of the patients prepared after rhTSH therapy compared to 20% of those prepared after THW (p = 0.08). Three patients (2 in the THW group and 1 in the rhTSH group) who had N1a in the initial surgery presented with structural persistence as an initial response to treatment. One patient in the THW group had a follow-up of the persistent disease with no surgical treatment, and 2 others received a lateral LN dissection. When the status at final follow-up was considered (median follow-up 3.3 years, range 3-4.2), 60% of the patients ablated after rhTSH therapy were considered with no evidence of disease, compared to 30% of those who underwent THW. The frequency of structural persistence (metastatic LN) was similar in the 2 groups (15 vs. 25%), and the distribution of the responses at final follow-up was not statistically significantly different (p = 0.12). We conclude that preparation after rhTSH therapy seems to be as effective as after THW for patients with clinically relevant LN metastases.

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