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Management of Differentiated Thyroid Carcinoma Patients with Negative Whole-Body Radioiodine Scans and Elevated Serum Thyroglobulin Levels

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Summary

The situation of a high serum Tg concentration and a negative DxWBS is common in patients with DTC and requires a careful search for tumor while excluding factitial causes for an elevated serum Tg or a negative RxWBS. Empiric 131I therapy should be considered only after certain criteria are fulfilled, such as negative neck ultrasonography, and should be done only after impeccable patient preparation. There are certain situations in which empiric therapy usually should not be given. This includes tumors that previously have failed to concentrate 131I even after the patient has been carefully prepared for the treatment. No prospective randomized studies have been done to substantiate the long-term effect of treatment of these patients, but studies now show that serum Tg levels consistently decline after uptake is seen on the RxWBS after empiric 131I therapy, and that tumor may regress to the point that mortality rates are improved in some patients.

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Authors and Affiliations

  1. Department of Internal Medicine, The Ohio State University, Columbus, OH

    Ernest L. Mazzaferri MD, MACP

  2. Department of Medicine, University of Florida, Gainesville, FL, USA

    Ernest L. Mazzaferri MD, MACP

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  1. Ernest L. Mazzaferri MD, MACP
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Editors and Affiliations

  1. The Ohio State University, Columbus, OH, USA

    Ernest L. Mazzaferri MD, MACP (Emeritus Professor) (Emeritus Professor)

  2. University of Florida, Gainsville, FL, USA

    Ernest L. Mazzaferri MD, MACP (Emeritus Professor) (Emeritus Professor)

  3. Department of Radiotherapy, Royal Marsden Hospital, London, UK

    Clive Harmer FRCR, FRCP (Head of Thyroid Unit) (Head of Thyroid Unit)

  4. Northern Centre for Cancer Treatment, Newcastle upon Tyne, UK

    Ujjal K. Mallick MS, FRCR (Vice-Chair) (Vice-Chair)

  5. Thyroid Cancer Subgroup, National Cancer Research Institute, UK

    Ujjal K. Mallick MS, FRCR (Vice-Chair) (Vice-Chair)

  6. Northern Cancer Network Thyroid Cancer Group, UK

    Ujjal K. Mallick MS, FRCR (Vice-Chair) (Vice-Chair)

  7. Department of Medicine, University of Newcastle upon Tyne, UK

    Pat Kendall-Taylor MD, FRCP (Emeritus Professor) (Emeritus Professor)

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Mazzaferri, E.L. (2006). Management of Differentiated Thyroid Carcinoma Patients with Negative Whole-Body Radioiodine Scans and Elevated Serum Thyroglobulin Levels. In: Mazzaferri, E.L., Harmer, C., Mallick, U.K., Kendall-Taylor, P. (eds) Practical Management of Thyroid Cancer. Springer, London. https://doi.org/10.1007/1-84628-013-3_20

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