Abstract
Persistently detectable serum thyroglobulin (Tg) without residual normal thyroid after a total thyroidectomy for papillary thyroid carcinoma (PTC) indicates biochemically persistent disease, even in patients without detectable lesions on imaging studies. Increasing serum Tg levels reflect progression of the disease. For distant organ metastases, radioactive iodine (RAI) therapy followed by thyroid-stimulating hormone (TSH) suppression is the first-line treatment. Several molecular-targeted agents appeared recently as a new modality for RAI-refractory metastases. However, it is difficult to decide whether and when such agents should be administered in individual patients. The evaluation of the tumor volume and progressiveness of the disease is important in making this treatment decision. A short Tg-doubling time (Tg-DT) is a very strong predictor of both carcinoma recurrence and carcinoma-related death superior to the conventional factors. Patients with a Tg-DT <1 year are likely to die of carcinoma, while metastases are not immediately life-threatening for those with a Tg-DT >2 years. We must carefully weigh the advantages and disadvantages of using molecular-targeted agents, because they usually are associated with severe adverse events. Shortening of Tg-DT over time may occur, which suggests appearance of more aggressive metastasis or aggressive change of the tumor nature.
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Ito, Y., Miyauchi, A. (2021). A Patient with Papillary Thyroid Carcinoma and Biochemical Evidence of Disease at Follow-Up Visits and Increasing Serum Tg Values at Follow-Up Assessments. In: Grani, G., Cooper, D.S., Durante, C. (eds) Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-61919-0_14
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