Abstract
A 61-year-old asymptomatic female patient having no risk factors for thyroid carcinoma underwent neck ultrasound. Following a diagnosis of papillary thyroid cancer (PTC) by fine needle aspiration biopsy, the patient underwent total thyroidectomy and right lateral neck lymph node dissection. Histopathological examination of the surgical specimen revealed two PTC foci in the right thyroidal lobe that were 4 cm and 0.1 cm in diameter. The patient received radioiodine ablation treatment (RAT) with 5550 MBq (150 mCi) iodine-131 (I-131) 3 months after the operation. Six months after RAT, diagnostic whole-body scintigraphy was performed with endogenous TSH stimulation with 185 MBq I-131. Serum TSH-stimulated Tg levels were 66.55 ng/mL, and I-131 scintigraphy revealed the absence of any pathological uptake. Neck ultrasound (US) and computed tomography (CT) of the thorax were normal. A 18F-FDG PET/BT was planned to search for possible recurrent disease, but it was determined normal. Serum thyroglobulin levels gradually increased to 89.79 ng/mL during the 8-year follow-up period. Several neck USGs, thorax CTs, and one additional 18F-FDG PET/CT were performed. Finally, cranial CT and Tc-99m MDP bone scintigraphy were performed. No residual or metastatic tissue detected so far.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Matthews TJ, Chua E, Gargya A, Clark J, Gao K, Elliott M. Elevated serum thyroglobulin levels at the time of ablative radioactive iodine therapy indicate a worse prognosis in thyroid cancer: an Australian retrospective cohort study. J Laryngol Otol. 2016;130:50–3. https://doi.org/10.1017/S0022215116008331.
Park HJ, Jeong GC, Kwon SY, Min JJ, Bom HS, Park KS, et al. Stimulated serum thyroglobulin level at the time of first dose of radioactive iodine therapy is the most predictive factor for therapeutic failure in patients with papillary thyroid carcinoma. Nucl Med Mol Imaging. 2014;48:255–61. https://doi.org/10.1007/s13139-014-0282-4.
Stevic I, Dembinski TC, Pathak KA, Leslie WD. Transient early increase in thyroglobulin levels post-radioiodine ablation in patients with differentiated thyroid cancer. Clin Biochem. 2015;48:658–61. https://doi.org/10.1007/s13139-014-0282-4.
Wiebel JL, Esfandiari NH, Papaleontiou M, Worden FP, Haymart MR. Evaluating positron emission tomography use in differentiated thyroid cancer. Thyroid. 2015;25:1026–32. https://doi.org/10.1089/thy.2015.0062.
Hempel JM, Kloeckner R, Krick S, Pinto Dos Santos D, Schadmand-Fischer S, Boeßert P, et al. Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer. Cancer Imaging. 2016;3:37. https://doi.org/10.1186/s40644-016-0096-y.
Riola-Parada C, García-Cañamaque L, Pérez-Dueñas V, Garcerant-Tafur M, Carreras-Delgado JL. Simultaneous PET/MRI vs PET/CT in oncology. A systematic review. Rev Esp Med Nucl Imagen Mol. 2016;35:306–12. https://doi.org/10.1016/j.remn.2016.06.001.
Miyauchi A, Kudo T, Miya A, Kobayashi K, Ito Y, Takamura Y, et al. Prognostic impact of serum thyroglobulin doubling-time under thyrotropin suppression in patients with papillary thyroid carcinoma who underwent total thyroidectomy. Thyroid. 2011;21:707–16. https://doi.org/10.1089/thy.2010.0355.
Rössing RM, Jentzen W, Nagarajah J, Bockisch A, Görges R. Serum thyroglobulin doubling time in progressive thyroid cancer. Thyroid. 2016;26:1712–8. https://doi.org/10.1089/thy.2016.0031.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–159. https://doi.org/10.1089/thy.2015.0020.
Leboulleux S, El Bez I, Borget I, Elleuch M, Déandreis D, Al Ghuzlan A, et al. Postradioiodine treatment whole-body scan in the era of 18-fluorodeoxyglucose positron emission tomography for differentiated thyroid carcinoma with elevated serum thyroglobulin levels. Thyroid. 2012;22:832–8. https://doi.org/10.1089/thy.2012.0081.
Vrachimis A, Stegger L, Wenning C, Noto B, Burg MC, Konnert JR, Allkemper T, et al. (68)Ga DOTATATE PET/MRI and [(18)F]FDG PET/CT are complementary and superior to diffusion-weighted MR imaging for radioactive-iodine-refractory differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2016;43:1765–72. https://doi.org/10.1007/s00259-016-3378-5.
Elboğa U, Ozkaya M, Sayiner ZA, Çelen YZ. Lu-177 labelled peptide treatment for radioiodine refractory differentiated thyroid carcinoma. BMJ Case Rep. 2016. https://doi.org/10.1136/bcr-2015-213627.
Dercle L, Deandreis D, Terroir M, Leboulleux S, Lumbroso J, Schlumberger M. Evaluation of (124)I PET/CT and (124)I PET/MRI in the management of patients with differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2016;43:1006–10. https://doi.org/10.1007/s00259-016-3334-4.
Santhanam P, Taieb D, Solnes L, Marashdeh W, Ladenson PW. Utility of I 124 PET/CT in identifying radioiodine avid lesions in differentiated thyroid cancer; a systematic review and meta-analysis. Clin Endocrinol. 2017;86(5):645–51. https://doi.org/10.1111/cen.13306.
Kuker R, Sztejnberg M, Gulec S. I-124 imaging and dosimetry. Mol Imaging Radionucl Ther. 2016;5:66–73. https://doi.org/10.4274/2017.26.suppl.07.
Binse I, Poeppel TD, Ruhlmann M, Gomez B, Umutlu L, Bockisch A, et al. Imaging with (124)I in differentiated thyroid carcinoma: is PET/MRI superior to PET/CT? Eur J Nucl Med Mol Imaging. 2016;43:1011–7. https://doi.org/10.1007/s00259-015-3288-y.
Vrachimis A, Burg MC, Wenning C, Allkemper T, Weckesser M, Schäfers M, et al. [(18)F]FDG PET/CT outperforms [(18)F]FDG PET/MRI in differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2016;43:212–20. https://doi.org/10.1007/s00259-015-3195-2.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Soydal, Ç., Özkan, E. (2019). A Patient with Papillary Thyroid Carcinoma and Biochemical Incomplete Response with Gradually Increasing Tg Values and Negative Imaging Studies. In: Özülker, T., Adaş, M., Günay, S. (eds) Thyroid and Parathyroid Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-78476-2_46
Download citation
DOI: https://doi.org/10.1007/978-3-319-78476-2_46
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-78475-5
Online ISBN: 978-3-319-78476-2
eBook Packages: MedicineMedicine (R0)