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Day 3 thyroglobulin ≤1 ng/ml after recombinant human TSH just prior to radioactive iodine is predictive of low risk for persistent/recurrent disease in patients with papillary thyroid carcinoma

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Abstract

We evaluated the negative predictive value (NPV) of thyroglobulin obtained 24 h after the second recombinant human TSH (rhTSH) ampoule (Tg-D3), before ablation with 131I, for persistent/recurrent disease (PRD) in low/intermediate risk patients with papillary thyroid carcinoma. One hundred and one patients with Tg-D3 ≤1 ng/ml without anti-Tg antibodies (TgAb) were selected. Post-therapy whole-body scanning was negative for metastases in 98 (97 %) patients, and three patients showed discrete ectopic cervical uptake, but no corresponding disease was detected by neck ultrasound or computed tomography. One year after ablation, 98 (97 %) patients were free of the disease. Three patients had stimulated Tg >1 ng/ml, but no metastases were detected by the imaging methods. During follow-up (median 50 months), tumor recurrence was observed in only one patient. Thus, the NPV of Tg-D3 ≤1 ng/ml for PRD was 99 %. Among the 101 patients with Tg-D3 ≤1 ng/ml, Tg obtained 48 h after ablation (Tg-D5) continued to be ≤1 ng/ml in 56, and 45 had Tg-D5 >1 ng/ml. None of these 45 patients had PRD. In conclusion, Tg-D3 ≤1 ng/ml had a high NPV for PRD in patients without TgAb or known persistent disease and who are not at high risk. In these patients, Tg-D5 >1 ng/ml is more likely to reflect actinic damage to the remnant thyroid tissue rather than persistence of significant normal or tumor tissue.

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The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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Authors and Affiliations

  1. Postgraduate Program and Endocrinology Service, Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Rua Domingos Vieira, 590, Santa Efigênia, Belo Horizonte, MG, 30150-240, Brazil

    Pedro W. Rosario, Thássio Leonardo Siman & Maria R. Calsolari

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  1. Pedro W. Rosario
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  2. Thássio Leonardo Siman
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  3. Maria R. Calsolari
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Correspondence to Pedro W. Rosario.

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Rosario, P.W., Siman, T.L. & Calsolari, M.R. Day 3 thyroglobulin ≤1 ng/ml after recombinant human TSH just prior to radioactive iodine is predictive of low risk for persistent/recurrent disease in patients with papillary thyroid carcinoma. Endocrine 49, 170–174 (2015). https://doi.org/10.1007/s12020-014-0425-5

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  • DOI: https://doi.org/10.1007/s12020-014-0425-5

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