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This version published online on October 11, 2005
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-1185
A more recent version of this article appeared on January 1, 2006
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Submitted on May 26, 2005
Accepted on October 3, 2005

Comparative evaluation of rhTSH-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

Massimo Torlontano*, Umberto Crocetti, Giovanni Augello, Leonardo D'Aloiso, Nazario Bonfitto, Antonio Varraso, Franca Dicembrino, Sergio Modoni, Vincenzo Frusciante, Anna Di Giorgio, Rocco Bruno, Sebastiano Filetti, and Vincenzo Trischitta

Units of Endocrinology (M.T., U.C., G.A., L.D'A., V.T.), Thoracic Surgery (N.B.), Nuclear Medicine (A.V., F.D., S.M., V.F.), Clinical Chemistry (A. D G.), IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Unit of Endocrinology, Tinchi-Pisticci Hospital (R.B.), Department of Clinical Sciences, University "La Sapienza", Roma (S.F., V.T.)

* To whom correspondence should be addressed. E-mail: m.torlontano{at}tin.it.

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

2. Objective. To investigate the role of neck ultrasonography (US), whole body scintigraphy (WBS) and serum thyroglobulin levels (Tg) after rhTSH in the follow-up of "very low"-risk PTMC patients.

3. Design. Five year observational study based on a 6-12 month follow-up after near total thyroidectomy.

4. Setting. Ambulatory patients.

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

6. Main outcome measures. WBS and Tg both after rhTSH and neck US.

7. Results. RhTSH-Tg was ≤1 ng/ml in 45 (Tg-) and >1 in 35 (Tg+) patients. WBS showed no pathological uptake in any patient. US identified node metastases in 2 Tg (+) and 1 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.

8. 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; 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.
Key words: "very low"-risk • thyroid cancer • recombinant human TSH




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