Skip to main content

Advertisement

SpringerLink
Log in

High thyroglobulin and negative whole-body scan: no long-term benefit of empiric radioiodine therapy

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

Around 10–27% of patients will present elevated thyroglobulin (Tg) levels and negative diagnostic whole-body scan (dxWBS) during differentiated thyroid cancer (DTC) follow-up. Empiric radioactive iodine (RAI) therapy in this context is controversial due to the lack of good quality studies in the context. The main purpose of this study is to compare long-term response to therapy status and overall survival between empiric RAI treated and untreated DTC patients.

Methods

A retrospective study comparing differentiated thyroid cancer patients with negative diagnostic whole-body scan and elevated thyroglobulin levels submitted or not to empiric radioactive iodine therapy in a thyroid cancer referral center. The main outcome measures were ATA Response to Therapy Stratification at 6–12 months after RAI ablative dose, at 6–18 months after negative dxWBS and last follow-up visits.

Results

Overall, 120 DTC patients with stimulated Tg >10 ng/ml and negative dxWBS were included in this study. Overall, 53 patients were submitted to empiric RAI and 67 were in the control group. No difference was observed in ATA Response to Therapy Stratification after RAI ablation or at the end of follow-up between groups. Also, no difference was found in terms of Tg changes response. After more than 10 years of follow-up, 17 patients died (13 from treated and 4 from untreated group).

Conclusions

Empiric RAI treatment was not associated with better long-term ATA response to therapy status or overall survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. B.R. Haugen, E.K. Alexander, K.C. Bible et al. 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 26, 1–133 (2015).

    Article  Google Scholar 

  2. M.W. Ashcraft, Van, A.J. Herle, The comparative value of serum thyroglobulin measurements and iodine 131 total body scans in the follow-up study of patients with treated differentiated thyroid cancer. Am. J. Med. 71, 806–814 (1981).

    Article  CAS  Google Scholar 

  3. S. Shinohara, M. Kikuchi, A. Suehiro et al. Characteristics and prognosis of patients with thyroglobulin-positive and radioactive iodine whole-body scan-negative differentiated thyroid carcinoma. Jpn. J. Clin. Oncol. 45, 427–432 (2015).

    Article  Google Scholar 

  4. C. Durante, N. Haddy, E. Baudin et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J. Clin. Endocrinol. Metab. 91, 2892–2899 (2006).

    Article  CAS  Google Scholar 

  5. M. Duren, A.E. Siperstein, W. Shen, Q.Y. Duh, E. Morita, O.H. Clark, Value of stimulated serum thyroglobulin levels for detecting persistent or recurrent differentiated thyroid cancer in high- and low-risk patients. Surgery 126, 13–19 (1999).

    Article  CAS  Google Scholar 

  6. F. Pacini, L. Agate, R. Elisei et al. Outcome of differentiated thyroid cancer with detectable serum Tg and negative diagnostic (131)I whole body scan: comparison of patients treated with high (131)I activities versus untreated patients. J. Clin. Endocrinol. Metab. 86, 4092–4097 (2001).

    Article  CAS  Google Scholar 

  7. F. Vaisman, D. Momesso, D.A. Bulzico et al. Spontaneous remission in thyroid cancer patients after biochemical incomplete response to initial therapy. Clin. Endocrinol. 77, 132–138 (2012).

    Article  CAS  Google Scholar 

  8. V. Fatourechi, I.D. Hay, H. Javedan, G.A. Wiseman, B.P. Mullan, C.A. Gorman, Lack of impact of radioiodine therapy in tg-positive, diagnostic whole-body scan-negative patients with follicular cell-derived thyroid cancer. J. Clin. Endocrinol. Metab. 87, 1521–1526 (2002).

    Article  CAS  Google Scholar 

  9. S.C. Clement, R.P. Peeters, C.M. Ronckers et al. Intermediate and long-term adverse effects of radioiodine therapy for differentiated thyroid carcinoma-a systematic review. Cancer Treat. Rev. 41, 925–934 (2015).

    Article  CAS  Google Scholar 

  10. S.K.A. Suss, C.O. Mesa Jr., G.A. Carvalho et al. Clinical outcomes of low and intermediate risk differentiated thyroid cancer patients treated with 30mCi for ablation or without radioactive iodine therapy. Arch. Endocrinol. Metab. 62, 149–156 (2018).

    PubMed  Google Scholar 

  11. A.F. Cailleux, E. Baudin, J.P. Travagli, M. Ricard, M. Schlumberger, Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer? J. Clin. Endocrinol. Metab. 85, 175–178 (2000).

    Article  CAS  Google Scholar 

  12. E.L. Mazzaferri, R.T. Kloos, Is diagnostic iodine-131 scanning with recombinant human TSH useful in the follow-up of differentiated thyroid cancer after thyroid ablation? J. Clin. Endocrinol. Metab. 87, 1490–1498 (2002).

    Article  CAS  Google Scholar 

  13. R.C. Smallridge, N. Diehl, V. Bernet, Practice trends in patients with persistent detectable thyroglobulin and negative diagnostic radioiodine whole body scans: a survey of American Thyroid Association members. Thyroid 24, 1501–1507 (2014).

    Article  CAS  Google Scholar 

  14. W.G. Kim, J.S. Ryu, E.Y. Kim et al. Empiric high-dose 131-iodine therapy lacks efficacy for treated papillary thyroid cancer patients with detectable serum thyroglobulin, but negative cervical sonography and 18F-fluorodeoxyglucose positron emission tomography scan. J. Clin. Endocrinol. Metab. 95, 1169–1173 (2010).

    Article  CAS  Google Scholar 

  15. J.H. Yim, W.B. Kim, E.Y. Kim et al. Adjuvant radioactive therapy after reoperation for locoregionally recurrent papillary thyroid cancer in patients who initially underwent total thyroidectomy and high-dose remnant ablation. J. Clin. Endocrinol. Metab. 96, 3695–3700 (2011).

    Article  CAS  Google Scholar 

  16. M. Klain, L. Pace, E. Zampella et al. Outcome of patients with differentiated thyroid cancer treated with 131-iodine on the basis of a detectable serum thyroglobulin level after initial treatment. Front. Endocrinol. 10, 146 (2019)

    Article  Google Scholar 

  17. M.M. Sabra, R.K. Grewal, H. Tala, S.M. Larson, R.M. Tuttle, Clinical outcomes following empiric radioiodine therapy in patients with structurally identifiable metastatic follicular cell-derived thyroid carcinoma with negative diagnostic but positive post-therapy 131I whole-body scans. Thyroid 22, 877–883 (2012).

    Article  CAS  Google Scholar 

  18. K.M. van Tol, P.L. Jager, E.G. de Vries et al. Outcome in patients with differentiated thyroid cancer with negative diagnostic whole-body scanning and detectable stimulated thyroglobulin. Eur. J. Endocrinol. 148, 589–596 (2003).

    PubMed  Google Scholar 

  19. W.J. Simpson, T. Panzarella, J.S. Carruthers, M.K. Gospodarowicz, S.B. Sutcliffe, Papillary and follicular thyroid cancer: impact of treatment in 1578 patients. Int. J. Radiat. Oncol. Biol. Phys. 14, 1063–1075 (1988).

    Article  CAS  Google Scholar 

  20. S. Leboulleux 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 22, 832–838 (2012).

    Article  CAS  Google Scholar 

  21. R.J. Robbins et al. Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F] fluoro-2-deoxy-D-glucose-positron emission tomography scanning. J. Clin. Endocrinol. Metab. 91, 498–505 (2006).

    Article  CAS  Google Scholar 

  22. M. Schlumberger et al. Definition and management of radioactive iodine-refractory differentiated thyroid cancer. Lancet Diabetes Endocrinol. 2, 356–358 (2014)

    Article  Google Scholar 

  23. M. Chao, J. Xie, A. Kuang, Is empiric 131I therapy justified for patients with positive thyroglobulin and negative 131I whole-body scanning results? J. Nucl. Med. 46, 1164–1170 (2005)

    Google Scholar 

  24. C. Rubino, F. de Vathaire, M.E. Dottorini et al. Second primary malignancies in thyroid cancer patients. Br. J. cancer 89, 1638–1644 (2003).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Endocrine Oncology Unit, Brazilian National Cancer Institute - INCA, Rio de Janeiro/RJ, Brazil

    Mariana Yoshii Tramontin, Gabriela Maia Nobre, Paulo Alonso Garcia Alves, Fernanda Accioly de Andrade, Fernanda Vaisman, Rossana Corbo & Daniel Bulzico

  2. Nuclear Medicine Service, Brazilian National Cancer Institute - INCA, Rio de Janeiro/RJ, Brazil

    Marcia Lopes, Michel Pontes Carneiro, Rossana Corbo & Daniel Bulzico

  3. Nuclear Medicine Service, Pedro Ernesto University Hospital, Rio de Janeiro State University - HUPE/UERJ, Rio de Janeiro/RJ, Brazil

    Michel Pontes Carneiro

Authors
  1. Mariana Yoshii Tramontin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabriela Maia Nobre
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcia Lopes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michel Pontes Carneiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paulo Alonso Garcia Alves
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fernanda Accioly de Andrade
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fernanda Vaisman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rossana Corbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daniel Bulzico
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mariana Yoshii Tramontin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and were approved by the Institutional Review Board (approval number 73/09).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tramontin, M.Y., Nobre, G.M., Lopes, M. et al. High thyroglobulin and negative whole-body scan: no long-term benefit of empiric radioiodine therapy. Endocrine 73, 398–406 (2021). https://doi.org/10.1007/s12020-021-02647-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-021-02647-8

Keywords

Search

Navigation