Journal of Clinical Endocrinology & Metabolism, Vol 80, 1488-1492, Copyright © 1995 by Endocrine Society

ARTICLES

Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan

JD Pineda, T Lee, K Ain, JC Reynolds and J Robbins
Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.

Seventeen patients with papillary thyroid cancer whose serum thyroglobulin (Tg) levels were elevated when hypothyroid, but whose diagnostic whole body scans were negative, were treated with 150-300 mCi 131I. All patients had total thyroidectomy and 131I ablation for thyroid remnants. Before the study, 9 patients had 131I therapy for tumor recurrence and/or metastases, and 5 patients had excisions of nonfunctioning metastasis. Radiological studies did not reveal evidence of metastases. In the initial evaluation, Tg levels ranged from 8-480 ng/mL (24 pmol/L to 1.5 nmol/L), and posttherapy whole body scans (RxWBS) revealed undiagnosed local recurrence and/or metastases in 16 of 17 patients. Follow-up from 6 months to 5 yr is available in 16 patients. RxWBS after a second treatment was positive in 8 of 13 patients, and after a third treatment in 5 of 5 patients, although in 3 cases, uptake in distant metastasis had disappeared. In 8 patients, Tg fell to 5 ng/mL or less. In 1 patient, RxWBS became negative, but Tg remained elevated; subsequent treatment revealed local and mediastinal uptake, but previous lung uptake had disappeared. In 8 patients, RxWBS remains positive, and elevated Tg persists. A total of 35 RxWBS were performed; 29 were positive. Follow-up Tg concentrations decreased in 81% of patients after the first treatment, in 90% after the second treatment, and in 100% of the patients after the third treatment. Tg (mean +/- SE) decreased from 74 +/- 33 ng/mL in the first evaluation to 62 +/- 32 ng/mL in the second study and 32 +/- 20 ng/mL in the third study. The therapeutic effectiveness of 131I treatment in patients with elevated Tg and negative diagnostic whole body scans is indicated by the conversion to negative RxWBS, the statistically significant decrease in the mean Tg level, and the reduction of serum Tg to 5 ng/mL or less in 50% of patients. Further experience with this therapeutic approach is required to evaluate its effectiveness in improving prognosis and survival.

This article has been cited by other articles:

				S. E. Finkelstein, P. W. Grigsby, B. A. Siegel, F. Dehdashti, J. F. Moley, and B. L. Hall Combined [18F]Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography (FDG-PET/CT) for Detection of Recurrent, 131I-Negative Thyroid Cancer Ann. Surg. Oncol., January 1, 2008; 15(1): 286 - 292. [Abstract] [Full Text] [PDF]

				A. Shammas, B. Degirmenci, J. M. Mountz, B. M. McCook, B. Branstetter, B. B. Bencherif, J. M. Joyce, S. E. Carty, H. A. Kuffner, and N. Avril 18F-FDG PET/CT in Patients with Suspected Recurrent or Metastatic Well-Differentiated Thyroid Cancer J. Nucl. Med., February 1, 2007; 48(2): 221 - 226. [Abstract] [Full Text] [PDF]

				A. Quon, N. J. Fischbein, I. R. McDougall, Q.-T. Le, B. W. Loo Jr., H. Pinto, and M. J. Kaplan Clinical Role of 18F-FDG PET/CT in the Management of Squamous Cell Carcinoma of the Head and Neck and Thyroid Carcinoma J. Nucl. Med., January 1, 2007; 48(1_suppl): 58S - 67S. [Abstract] [Full Text] [PDF]

				M. Ahmed, M. Aslam, J. Ahmed, H. A. Faraz, A. Almahfouz, A. A. Arifi, H. Raef, and F. A. Dayel Renal metastases from thyroid cancer masquerading as renal angiomyolipoma on ultrasonography. J. Ultrasound Med., November 1, 2006; 25(11): 1459 - 1464. [Full Text] [PDF]

				F. Pacini, M. Schlumberger, H. Dralle, R. Elisei, J. W A Smit, W. Wiersinga, and the European Thyroid Cancer Taskforce European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur. J. Endocrinol., June 1, 2006; 154(6): 787 - 803. [Full Text] [PDF]

				E. L. Mazzaferri Empirically Treating High Serum Thyroglobulin Levels J. Nucl. Med., July 1, 2005; 46(7): 1079 - 1088. [Full Text] [PDF]

				C. Ma, J. Xie, and A. Kuang Is Empiric 131I Therapy Justified for Patients with Positive Thyroglobulin and Negative 131I Whole-Body Scanning Results? J. Nucl. Med., July 1, 2005; 46(7): 1164 - 1170. [Abstract] [Full Text] [PDF]

				R. J. Robbins and M. J. Schlumberger The Evolving Role of 131I for the Treatment of Differentiated Thyroid Carcinoma J. Nucl. Med., January 1, 2005; 46(1_suppl): 28S - 37S. [Abstract] [Full Text] [PDF]

				C. E. Palme, Z. Waseem, S. N. Raza, S. Eski, P. Walfish, and J. L. Freeman Management and Outcome of Recurrent Well-Differentiated Thyroid Carcinoma Arch Otolaryngol Head Neck Surg, July 1, 2004; 130(7): 819 - 824. [Abstract] [Full Text] [PDF]

				M. Toubeau, C. Touzery, P. Arveux, G. Chaplain, G. Vaillant, A. Berriolo, J.-M. Riedinger, C. Boichot, A. Cochet, and F. Brunotte Predictive Value for Disease Progression of Serum Thyroglobulin Levels Measured in the Postoperative Period and After 131I Ablation Therapy in Patients with Differentiated Thyroid Cancer J. Nucl. Med., June 1, 2004; 45(6): 988 - 994. [Abstract] [Full Text] [PDF]

				R. Elisei, A. Vivaldi, L. Agate, E. Molinaro, C. Nencetti, L. Grasso, A. Pinchera, and F. Pacini Low Specificity of Blood Thyroglobulin Messenger Ribonucleic Acid Assay Prevents Its Use in the Follow-Up of Differentiated Thyroid Cancer Patients J. Clin. Endocrinol. Metab., January 1, 2004; 89(1): 33 - 39. [Abstract] [Full Text] [PDF]

				F. Pacini, E. Molinaro, M. G. Castagna, L. Agate, R. Elisei, C. Ceccarelli, F. Lippi, D. Taddei, L. Grasso, and A. Pinchera Recombinant Human Thyrotropin-Stimulated Serum Thyroglobulin Combined with Neck Ultrasonography Has the Highest Sensitivity in Monitoring Differentiated Thyroid Carcinoma J. Clin. Endocrinol. Metab., August 1, 2003; 88(8): 3668 - 3673. [Abstract] [Full Text] [PDF]

				C. M. Preissner, D. J. O'Kane, R. J. Singh, J. C. Morris, and S. K. G. Grebe Phantoms in the Assay Tube: Heterophile Antibody Interferences in Serum Thyroglobulin Assays J. Clin. Endocrinol. Metab., July 1, 2003; 88(7): 3069 - 3074. [Abstract] [Full Text] [PDF]

				D Grammatopoulos, Y Elliott, S C Smith, I Brown, R J Grieve, E W Hillhouse, M A Levine, and M D Ringel Measurement of thyroglobulin mRNA in peripheral blood as an adjunctive test for monitoring thyroid cancer Mol. Pathol., June 1, 2003; 56(3): 162 - 166. [Abstract] [Full Text] [PDF]

				E. L. Mazzaferri, R. J. Robbins, C. A. Spencer, L. E. Braverman, F. Pacini, L. Wartofsky, B. R. Haugen, S. I. Sherman, D. S. Cooper, G. D. Braunstein, et al. A Consensus Report of the Role of Serum Thyroglobulin as a Monitoring Method for Low-Risk Patients with Papillary Thyroid Carcinoma J. Clin. Endocrinol. Metab., April 1, 2003; 88(4): 1433 - 1441. [Abstract] [Full Text] [PDF]

				E. Baudin, C. D. Cao, A. F. Cailleux, S. Leboulleux, J. P. Travagli, and M. Schlumberger Positive Predictive Value of Serum Thyroglobulin Levels, Measured during the First Year of Follow-Up after Thyroid Hormone Withdrawal, in Thyroid Cancer Patients J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 1107 - 1111. [Abstract] [Full Text] [PDF]

				F. Santini, V. Bottici, R. Elisei, L. Montanelli, S. Mazzeo, F. Basolo, A. Pinchera, and F. Pacini Cytotoxic Effects of Carboplatinum and Epirubicin in the Setting of an Elevated Serum Thyrotropin for Advanced Poorly Differentiated Thyroid Cancer J. Clin. Endocrinol. Metab., September 1, 2002; 87(9): 4160 - 4165. [Abstract] [Full Text] [PDF]

				F. Pacini, M. Capezzone, R. Elisei, C. Ceccarelli, D. Taddei, and A. Pinchera Diagnostic 131-Iodine Whole-Body Scan May Be Avoided in Thyroid Cancer Patients Who Have Undetectable Stimulated Serum Tg Levels After Initial Treatment J. Clin. Endocrinol. Metab., April 1, 2002; 87(4): 1499 - 1501. [Abstract] [Full Text] [PDF]

				V. Fatourechi, I. D. Hay, H. Javedan, G. A. Wiseman, B. P. Mullan, and C. A. Gorman Lack of Impact of Radioiodine Therapy in Tg-Positive, Diagnostic Whole-Body Scan-Negative Patients with Follicular Cell-Derived Thyroid Cancer J. Clin. Endocrinol. Metab., April 1, 2002; 87(4): 1521 - 1526. [Abstract] [Full Text] [PDF]

				F. Savagner, P. Rodien, P. Reynier, V. Rohmer, J.-C. Bigorgne, and Y. Malthiery Analysis of Tg Transcripts by Real-Time RT-PCR in the Blood of Thyroid Cancer Patients J. Clin. Endocrinol. Metab., February 1, 2002; 87(2): 635 - 639. [Abstract] [Full Text] [PDF]

				C. Regalbuto, M. Buscema, S. Arena, R. Vigneri, S. Squatrito, and V. Pezzino False-Positive Findings on 131I Whole-Body Scans Because of Posttraumatic Superficial Scabs J. Nucl. Med., February 1, 2002; 43(2): 207 - 209. [Abstract] [Full Text] [PDF]

				F. Pacini, E. Molinaro, F. Lippi, M. G. Castagna, L. Agate, C. Ceccarelli, D. Taddei, R. Elisei, M. Capezzone, and A. Pinchera Prediction of Disease Status by Recombinant Human TSH-Stimulated Serum Tg in the Postsurgical Follow-Up of Differentiated Thyroid Carcinoma J. Clin. Endocrinol. Metab., December 1, 2001; 86(12): 5686 - 5690. [Abstract] [Full Text] [PDF]

				A. S. Alzahrani, S. Bakheet, M. Al Mandil, A. Al-Hajjaj, A. Almahfouz, and A. Al Haj 123I Isotope as a Diagnostic Agent in the Follow-Up of Patients with Differentiated Thyroid Cancer: Comparison with Post 131I Therapy Whole Body Scanning J. Clin. Endocrinol. Metab., November 1, 2001; 86(11): 5294 - 5300. [Abstract] [Full Text] [PDF]

				F. Pacini, L. Agate, R. Elisei, M. Capezzone, C. Ceccarelli, F. Lippi, E. Molinaro, and A. Pinchera Outcome of Differentiated Thyroid Cancer with Detectable Serum Tg and Negative Diagnostic 131I Whole Body Scan: Comparison of Patients Treated with High 131I Activities Versus Untreated Patients J. Clin. Endocrinol. Metab., September 1, 2001; 86(9): 4092 - 4097. [Abstract] [Full Text] [PDF]

				E. L. Mazzaferri and R. T. Kloos Current Approaches to Primary Therapy for Papillary and Follicular Thyroid Cancer J. Clin. Endocrinol. Metab., April 1, 2001; 86(4): 1447 - 1463. [Full Text]

				A. F. Cailleux, E. Baudin, J. P. Travagli, M. Ricard, and M. Schlumberger Is Diagnostic Iodine-131 Scanning Useful after Total Thyroid Ablation for Differentiated Thyroid Cancer? J. Clin. Endocrinol. Metab., January 1, 2000; 85(1): 175 - 178. [Abstract] [Full Text]

				B. R. Haugen, F. Pacini, C. Reiners, M. Schlumberger, P. W. Ladenson, S. I. Sherman, D. S. Cooper, K. E. Graham, L. E. Braverman, M. C. Skarulis, et al. A Comparison of Recombinant Human Thyrotropin and Thyroid Hormone Withdrawal for the Detection of Thyroid Remnant or Cancer J. Clin. Endocrinol. Metab., November 1, 1999; 84(11): 3877 - 3885. [Abstract] [Full Text]

				M. D. Ringel, P. L. Balducci-Silano, J. S. Anderson, C. A. Spencer, J. Silverman, Y. H. Sparling, G. L. Francis, K. D. Burman, L. Wartofsky, P. W. Ladenson, et al. Quantitative Reverse Transcription-Polymerase Chain Reaction of Circulating Thyroglobulin Messenger Ribonucleic Acid for Monitoring Patients with Thyroid Carcinoma J. Clin. Endocrinol. Metab., November 1, 1999; 84(11): 4037 - 4042. [Abstract] [Full Text]

				R. S. Haber The Diagnosis of Recurrent Thyroid Cancer--A New Approach J. Clin. Endocrinol. Metab., December 1, 1998; 83(12): 4189 - 4190. [Full Text]

				L. Wartofsky Management of Patients with Scan Negative, Thyroglobulin Positive Differentiated Thyroid Carcinoma J. Clin. Endocrinol. Metab., December 1, 1998; 83(12): 4195 - 4199. [Full Text]

				S. I. Sherman and J. Gopal Thyroglobulin Positive, RAI Negative Thyroid Cancers: The Role of Conservative Management J. Clin. Endocrinol. Metab., December 1, 1998; 83(12): 4199 - 4200. [Full Text]

				M. Schlumberger Use of Radioactive Iodine in Patients with Papillary and Follicular Thyroid Cancer: Towards A Selective Approach J. Clin. Endocrinol. Metab., December 1, 1998; 83(12): 4201 - 4203. [Full Text]

				M. D. Ringel, P. W. Ladenson, and M. A. Levine Molecular Diagnosis of Residual and Recurrent Thyroid Cancer by Amplification of Thyroglobulin Messenger Ribonucleic Acid in Peripheral Blood J. Clin. Endocrinol. Metab., December 1, 1998; 83(12): 4435 - 4442. [Abstract] [Full Text]

				J. P. Travagli, A. F. Cailleux, M. Ricard, E. Baudin, B. Caillou, C. Parmentier, and M. Schlumberger Combination of Radioiodine (131I) and Probe-Guided Surgery for Persistent or Recurrent Thyroid Carcinoma J. Clin. Endocrinol. Metab., August 1, 1998; 83(8): 2675 - 2680. [Abstract] [Full Text]

				M. J. Schlumberger Papillary and Follicular Thyroid Carcinoma N. Engl. J. Med., January 29, 1998; 338(5): 297 - 306. [Full Text] [PDF]

				C. Calzolari, P.-Y. Marquet, B. Pau, C. A. Spencer, and M. Takeuchi Thyroglobulin IRMA Pasteur Immunoassay: Sensitivity of the Assay and Interference from Thyroglobulin Autoantibodies • The authors of the above-mentioned article and editorial reply: Clin. Chem., February 1, 1997; 43(2): 413 - 415. [Full Text]

				A. Z. Rudavsky and L. M. Freeman Treatment of Scan-Negative, Thyroglobulin-Positive Metastatic Thyroid Cancer Using Radioiodine 131I and Recombinant Human Thyroid Stimulating Hormone J. Clin. Endocrinol. Metab., January 1, 1997; 82(1): 11 - 14. [Full Text] [PDF]