| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Section of Endocrinology, Department of Endocrinology and Metabolism, University of Pisa (E.M., M.G.C., L.A., R.E., C.C., F.L., D.T., L.G., A.P.), 56124 Pisa, Italy; and Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism, and Biochemistry, University of Siena (F.P.), 53100 Siena, Italy
Address all correspondence and requests for reprints to: F. Pacini, M.D., Department of Endocrinology, Via Paradisa, 2, 56124 Pisa, Italy. E-mail: fpacini{at}endoc.med.unipi.it.
Recombinant human TSH (rhTSH)-stimulated thyroglobulin (Tg) measurement and 131I whole body scan (WBS) have been validated as informative tests in the postsurgical follow-up of differentiated thyroid carcinoma. We report the diagnostic accuracy of Tg measurement and diagnostic WBS, alone or in combination, after rhTSH stimulation in a retrospective, consecutive series of patients undergoing follow-up for differentiated thyroid cancer. Routine procedures also include neck ultrasound in every patient and post-therapy WBS when indicated. We studied 340 consecutive patients with differentiated thyroid carcinoma, previously treated with near-total thyroidectomy and 131I thyroid ablation, scheduled for routine diagnostic tests. At baseline on L-T4-suppressive therapy, 294 patients had undetectable (<1 ng/ml) serum Tg and negative anti-Tg autoantibodies (TgAb), 25 patients had undetectable serum Tg and positive TgAb, and 21 patients had detectable serum Tg and negative TgAb. These patients were tested for the presence of active disease by rhTSH stimulation. The results of our study showed that rhTSH-stimulated Tg alone had a diagnostic sensitivity of 85% for detecting active disease and a negative predictive value (NPV) of 98.2%. After adding the results of neck ultrasound, sensitivity increased to 96.3%, and the NPV to 99.5%. rhTSH-stimulated WBS had a sensitivity of only 21% and a NPV of 89%. The combination of rhTSH-stimulated Tg and WBS had a sensitivity of 92.7% and a NPV of 99%. We conclude that the rhTSH-stimulated Tg test combined with neck ultrasonography has the highest diagnostic accuracy in detecting persistent disease in the follow-up of differentiated thyroid carcinoma. A detectable level of serum Tg on L-T4, its conversion from undetectable to detectable after rhTSH, and/or a suspicious finding at ultrasound will allow the identification of patients requiring therapeutic procedures without the need for diagnostic WBS.
This work was supported in part by grants from Associazione Italiana Ricerca sul Cancro, European Communities INCO-Copernicus Project IC-15-CT-980314, and Ministero dell’Università e della Ricerca Scientifica e Tecnologica 2002.
M.C.G. is the recipient of a fellowship from Federazione Italiana Ricerca sul Cancro.
Abbreviations: CT, Computed tomography; FNAC, fine needle aspiration cytology; NPV, negative predictive value; rhTSH, recombinant human TSH; Tg, thyroglobulin; TgAb, Tg autoantibodies; WBS, whole body scan.
This article has been cited by other articles:
 |
|
 |
|
  N. A. Johnson and M. E. Tublin Postoperative Surveillance of Differentiated Thyroid Carcinoma: Rationale, Techniques, and Controversies Radiology, November 1, 2008; 249(2): 429 - 444. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. T. Kloos Approach to the Patient with a Positive Serum Thyroglobulin and a Negative Radioiodine Scan after Initial Therapy for Differentiated Thyroid Cancer J. Clin. Endocrinol. Metab., May 1, 2008; 93(5): 1519 - 1525. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Castagna, L. Brilli, T. Pilli, A. Montanaro, C. Cipri, C. Fioravanti, F. Sestini, M. Capezzone, and F. Pacini Limited Value of Repeat Recombinant Human Thyrotropin (rhTSH)-Stimulated Thyroglobulin Testing in Differentiated Thyroid Carcinoma Patients with Previous Negative rhTSH-Stimulated Thyroglobulin and Undetectable Basal Serum Thyroglobulin Levels J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 76 - 81. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Shin, B.-K. Han, E. Y. Ko, and S. S. Kang Sonographic Findings in the Surgical Bed After Thyroidectomy: Comparison of Recurrent Tumors and Nonrecurrent Lesions J. Ultrasound Med., October 1, 2007; 26(10): 1359 - 1366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Leboulleux, E. Girard, M. Rose, J. P. Travagli, N. Sabbah, B. Caillou, D. M. Hartl, N. Lassau, E. Baudin, and M. Schlumberger Ultrasound Criteria of Malignancy for Cervical Lymph Nodes in Patients Followed Up for Differentiated Thyroid Cancer J. Clin. Endocrinol. Metab., September 1, 2007; 92(9): 3590 - 3594. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schlumberger, A. Hitzel, M. E. Toubert, C. Corone, F. Troalen, M. H. Schlageter, F. Claustrat, S. Koscielny, D. Taieb, M. Toubeau, et al. Comparison of Seven Serum Thyroglobulin Assays in the Follow-Up of Papillary and Follicular Thyroid Cancer Patients J. Clin. Endocrinol. Metab., July 1, 2007; 92(7): 2487 - 2495. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. S. Heller Do All Cancers Need to Be Treated? The Role of Thyroglobulin in the Management of Thyroid Cancer: The 2006 Hayes Martin Lecture Arch Otolaryngol Head Neck Surg, July 1, 2007; 133(7): 639 - 643. [Full Text] [PDF]
|
|
|
|
|
|
R. C. Smallridge, S. E. Meek, M. A. Morgan, G. S. Gates, T. P. Fox, S. Grebe, and V. Fatourechi Monitoring Thyroglobulin in a Sensitive Immunoassay Has Comparable Sensitivity to Recombinant Human TSH-Stimulated Thyroglobulin in Follow-Up of Thyroid Cancer Patients J. Clin. Endocrinol. Metab., January 1, 2007; 92(1): 82 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Triponez, L. Poder, R. Zarnegar, R. Goldstein, K. Roayaie, V. Feldstein, J. Lee, E. Kebebew, Q.-Y. Duh, and O. H. Clark Hook Needle-Guided Excision of Recurrent Differentiated Thyroid Cancer in Previously Operated Neck Compartments: A Safe Technique for Small, Nonpalpable Recurrent Disease J. Clin. Endocrinol. Metab., December 1, 2006; 91(12): 4943 - 4947. [Abstract] [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]
|
|
|
|
|
|
F. Pacini, P. W. Ladenson, M. Schlumberger, A. Driedger, M. Luster, R. T. Kloos, S. Sherman, B. Haugen, C. Corone, E. Molinaro, et al. Radioiodine Ablation of Thyroid Remnants after Preparation with Recombinant Human Thyrotropin in Differentiated Thyroid Carcinoma: Results of an International, Randomized, Controlled Study J. Clin. Endocrinol. Metab., March 1, 2006; 91(3): 926 - 932. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Torlontano, U. Crocetti, G. Augello, L. D'Aloiso, N. Bonfitto, A. Varraso, F. Dicembrino, S. Modoni, V. Frusciante, A. Di Giorgio, et al. Comparative Evaluation of Recombinant Human Thyrotropin-Stimulated Thyroglobulin Levels, 131I Whole-Body Scintigraphy, and Neck Ultrasonography in the Follow-Up of Patients with Papillary Thyroid Microcarcinoma Who Have Not Undergone Radioiodine Therapy J. Clin. Endocrinol. Metab., January 1, 2006; 91(1): 60 - 63. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Pacini, M. Schlumberger, C. Harmer, G. G Berg, O. Cohen, L. Duntas, F. Jamar, B. Jarzab, E. Limbert, P. Lind, et al. Post-surgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report Eur. J. Endocrinol., November 1, 2005; 153(5): 651 - 659. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Stockigt Ambiguous Thyroglobulin Assay Results in the Follow-Up of Differentiated Thyroid Carcinoma J. Clin. Endocrinol. Metab., October 1, 2005; 90(10): 5904 - 5905. [Full Text] [PDF]
|
|
|
|
|
|
S. Leboulleux, C. Rubino, E. Baudin, B. Caillou, D. M. Hartl, J.-M. Bidart, J.-P. Travagli, and M. Schlumberger Prognostic Factors for Persistent or Recurrent Disease of Papillary Thyroid Carcinoma with Neck Lymph Node Metastases and/or Tumor Extension beyond the Thyroid Capsule at Initial Diagnosis J. Clin. Endocrinol. Metab., October 1, 2005; 90(10): 5723 - 5729. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. T. Kloos and E. L. Mazzaferri A Single Recombinant Human Thyrotropin-Stimulated Serum Thyroglobulin Measurement Predicts Differentiated Thyroid Carcinoma Metastases Three to Five Years Later J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5047 - 5057. [Abstract] [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]
|
|
|
|
|
|
R. J. Robbins, S. Srivastava, A. Shaha, R. Ghossein, S. M. Larson, M. Fleisher, and R. M. Tuttle Factors Influencing the Basal and Recombinant Human Thyrotropin-Stimulated Serum Thyroglobulin in Patients with Metastatic Thyroid Carcinoma J. Clin. Endocrinol. Metab., December 1, 2004; 89(12): 6010 - 6016. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Costagliola, M. Bonomi, N. G. Morgenthaler, J. Van Durme, V. Panneels, S. Refetoff, and G. Vassart Delineation of the Discontinuous-Conformational Epitope of a Monoclonal Antibody Displaying Full in Vitro and in Vivo Thyrotropin Activity Mol. Endocrinol., December 1, 2004; 18(12): 3020 - 3034. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Rouxel, G. Hejblum, M.-O. Bernier, P.-Y. Boelle, F. Menegaux, G. Mansour, C. Hoang, A. Aurengo, and L. Leenhardt Prognostic Factors Associated with the Survival of Patients Developing Loco-Regional Recurrences of Differentiated Thyroid Carcinomas J. Clin. Endocrinol. Metab., November 1, 2004; 89(11): 5362 - 5368. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Mazzaferri A Randomized Trial of Remnant Ablation--In Search of an Impossible Dream? J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3662 - 3664. [Full Text] [PDF]
|
|
|
|
|
|
M. Torlontano, M. Attard, U. Crocetti, S. Tumino, R. Bruno, G. Costante, G. D'Azzo, D. Meringolo, E. Ferretti, R. Sacco, et al. Follow-Up of Low Risk Patients with Papillary Thyroid Cancer: Role of Neck Ultrasonography in Detecting Lymph Node Metastases J. Clin. Endocrinol. Metab., July 1, 2004; 89(7): 3402 - 3407. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. S. do Rosario, T. A. Fagundes, F. F. R. Maia, A. C. H. M. Franco, M. B. Figueiredo, and S. Purisch Sonography in the Diagnosis of Cervical Recurrence in Patients With Differentiated Thyroid Carcinoma J. Ultrasound Med., July 1, 2004; 23(7): 915 - 920. [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]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Endocrinology | Endocrine Reviews | J. Clin. End. & Metab. |
| Molecular Endocrinology | Recent Prog. Horm. Res. | All Endocrine Journals |
