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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

Units of Endocrinology (M.T., U.C., G.A., L.D., V.T.), Thoracic Surgery (N.B.), Nuclear Medicine (A.V., F.D., S.M., V.F.), and Clinical Chemistry (A.D.G.), Istituto di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza, 71013 S. Giovanni Rotondo, Italy; Unit of Endocrinology (R.B.), Tinchi-Pisticci Hospital, 75020 Matera, Italy; and Department of Clinical Sciences(S.F., V.T.), University "La Sapienza," 00161 Rome, Italy

Address all correspondence and requests for reprints to: Massimo Torlontano, M.D., via A. Massa 42, 71013 San Giovanni Rotondo (FG), Italy. E-mail: m.torlontano{at}tin.it.

Context: Although the prognosis of papillary thyroid microcarcinoma (PTMC) is usually excellent, the optimal follow-up strategy has never been investigated.

Objective: The objective of the study was to investigate the role of neck ultrasonography (US), whole-body scintigraphy (WBS), and serum thyroglobulin levels (Tg) after recombinant human (rh) TSH in the follow-up of very low-risk PTMC patients.

Design: The study was a 5-yr observational study based on a 6- to 12-month follow-up after near total thyroidectomy.

Setting: The study population consisted of ambulatory patients.

Patients: Eighty consecutive patients diagnosed with PTMC, who had not undergone postoperative radioiodine treatment because of unifocal tumor without lymph node metastases and who did not have anti-Tg antibodies, were included.

Main Outcome Measures: WBS and Tg after both rhTSH and neck US were measured.

Results: rhTSH-Tg was 1 ng/ml or less in 45 (Tg–) and more than 1 in 35 (Tg+) patients. WBS showed no pathological uptake in any patient. US identified node metastases in two Tg (+) and one Tg (–) patients. rhTSH-Tg levels positively correlated with thyroid bed iodine uptake (r = 0.40, P < 0.0001). To date (32 ± 13 months after surgery), all node-negative patients have undetectable Tg levels on LT₄ treatment and negative US.

Conclusions: For the initial follow-up of PTMC patients without risk factors and anti-Tg antibodies and who did not undergo radioiodine treatment: 1) WBS is useless; 2) US is highly sensitive in detecting node metastases; and 3) detectable rhTSH-Tg levels mainly depend on small normal tissue remnants. In this subgroup of PTMC patients, neck US might be regarded as a primary tool for the initial follow-up.

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