Advertisement

Journal of Endocrinological Investigation

, Volume 25, Issue 6, pp 526–531 | Cite as

Impact of cervical lymph node dissection on serum TG and the course of disease in TG-positive, radioactive iodine whole body scan-negative recurrent/persistent papillary thyroid cancer

  • A. S. AlzahraniEmail author
  • H. Raef
  • A. Sultan
  • S. Al Sobhi
  • S. Ingemansson
  • M. Ahmed
  • A. Al Mahfouz
Original Article

Abstract

In the management of papillary thyroid cancer (PTC), surgery is indicated for locoregional recurrent/persistent disease. In this study, we examined the effect of such surgery on serum TG and the course of the disease in 21 patients with PTC (mean age 38.5 yr), who after the initial surgery and radioactive iodine (RAI) ablation developed high TG (>10 ng/ml) and negative 123I whole body scan (DxWBS). All patients had neck persistent/recurrent PTC that was confirmed by ultrasound-guided fine needle aspiration. Prior to neck re-exploration, radiological studies (chest X-rays, CT scan of the chest, and fluoro-18-deoxyglucose positron emission tomography [FDG-PET]) showed no evidence of distant metastases. TG autoantibodies were negative in 19 patients. Second surgery consisted of unilateral (13 patients) or bilateral (8 patients) modified neck dissection. The mean±SE TG prior to neck re-exploration was 184.8±79.0 ng/ml and declined after surgery to 127.5±59.0 ng/ml (p=0.25). The corresponding TSH values were 150.6±23.0 and 143.4±20.0 mU/l, respectively (p=0.34). After a mean follow-up of 20.7±3 months, TG increased to 168±68.0 ng/ml. This increase, however, was NS (p=0.67). The corresponding TSH values were 143.4±20.0 and 132.0±22.0 mU/l (p=0.27). Following second surgery, only 4 patients achieved remission, the other 17 patients received one or more of the following therapies; RAI (10 patients), third surgery (5 patients), and/or external radiation (7 patients). Thirteen patients continued to have persistent disease and 4 patients showed progressive course of their disease (distant metastases or grossly palpable neck disease). In conclusion, second surgery for recurrent/persistent PTC leads to remission in only a minority of cases but the course of the disease tends to be stable in most cases.

Key-words

Thyroid cancer thyroidectomy TG radioiodine scan 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ozata M., Suzuki S., Miyamoto T., Liu R.T., Fierro-Renoy F., DeGroot L.J. Serum thyroglobulin in the follow-up of patients with treated differentiated thyroid cancer. J. Clin. Endocrinol. Metab. 1994, 79: 98–105.PubMedGoogle Scholar
  2. 2.
    Singer P.A., Cooper D.S., Daniels G.H., et al. Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. Arch. Intern. Med. 1996, 156: 2165–2172.PubMedCrossRefGoogle Scholar
  3. 3.
    Schlumberger M.J. Papillary and follicular thyroid carcinoma. N. Engl. J. Med. 1998, 338: 297–306.PubMedCrossRefGoogle Scholar
  4. 4.
    Pacini F., Elisei R., Fugazzola L., et al. Post-surgical follow-up of differentiated thyroid cancer. J. Endocrinol. Invest. 1995, 18: 165–166.PubMedCrossRefGoogle Scholar
  5. 5.
    Pacini F., Lari R., Mazzeo S., Grasso L., Taddei D., Pinchera A. Diagnostic value of a single serum thyroglobulin determination on and off thyroid suppressive therapy in the follow-up of patients with differentiated thyroid cancer. Clin. Endocrinol. (Oxf.) 1985, 23: 405–411.CrossRefGoogle Scholar
  6. 6.
    Pacini F., Lippi F., Formica N., et al. Therapeutic doses of iodine-131 reveal undiagnosed metastases in thyroid cancer patients with detectable serum thyroglobulin levels. J. Nucl. Med. 1987, 28: 1888–1891.PubMedGoogle Scholar
  7. 7.
    Ronga G., Fiorentino A., Fragasso G., Fringuelli F.M., Todino V. Complementary role of whole body scan and serum thyroglobulin determination in the follow-up of differentiated thyroid carcinoma. Ital. J. Surg. Sci. 1986, 16: 11–15.PubMedGoogle Scholar
  8. 8.
    Brendel A.J., Lambert B., Guyot M., et al. Low levels of serum thyroglobulin after withdrawal of thyroid suppression therapy in the follow up of differentiated thyroid carcinoma. Eur. J. Nucl. Med. 1990, 16: 35–38.PubMedCrossRefGoogle Scholar
  9. 9.
    Pineda J.D., Lee T., Ain K., Reynolds J.C., Robbins J. Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan. J. Clin. Endocrinol. Metab. 1995, 80: 1488–1492.PubMedGoogle Scholar
  10. 10.
    Schlumberger M., Mancusi F., Baudin E., Pacini F. 131I therapy for elevated thyroglobulin levels. Thyroid 1997, 7: 273–276.PubMedCrossRefGoogle Scholar
  11. 11.
    McDougall I.R. 131-I treatment of 131I negative whole body scan, and positive thyroglobulin in differentiated thyroid carcinoma: what is being treated? Thyroid 1997, 7: 669–672.PubMedCrossRefGoogle Scholar
  12. 12.
    Wartofsky L., Sherman S.I., Gopal J., Schlumberger M., Hay I.D. The use of radioactive iodine in patients with papillary and follicular thyroid cancer. J. Clin. Endocrinol. Metab. 1998, 83: 4195–4203.PubMedCrossRefGoogle Scholar
  13. 13.
    Clark O.H., Hoelting T. Management of patients with differentiated thyroid cancer who have positive serum thy-roglobulin levels and negative radioiodine scans. Thyroid 1994, 4: 501–505.PubMedCrossRefGoogle Scholar
  14. 14.
    Mazzaferri E.L. Treating high thyroglobulin with radioio-dine: a magic bullet or a shot in the dark? J. Clin. Endo-crinol. Metab. 1995, 80: 1485–1487.CrossRefGoogle Scholar
  15. 15.
    Schlumberger M., Arcangioli O., Pierkarski J.D., Tubiana M., Parmentier C. Detection and treatment of lung metastases of differentiated thyroid carcinoma in patients with normal chest x-rays. J. Nucl. Med. 1988, 29: 1790–1794.PubMedGoogle Scholar
  16. 16.
    Franceschi M., Kusic Z., Franceschi D., Lukinac L., Roncevic S. Thyroglobulin determination, neck ultrasonography and iodine-131 whole-body scintigraphy in differentiated thyroid carcinoma. J. Nucl. Med. 1996, 37: 446–451.PubMedGoogle Scholar
  17. 17.
    Boland G.W., Lee M.J., Mueller P.R., Mayo-Smith W., Dawson S.L., Simeone J.F. Efficacy of sonographically guided biopsy of thyroid masses and cervical lymph nodes Am. J. Roentgenol. 1993, 161: 1053–1056.CrossRefGoogle Scholar
  18. 18.
    Simeone J.F., Daniels G.H., Hall D.A., et al. Sonography in the follow-up of 100 patients with thyroid carcinoma. Am. J. Roentgenol. 1987, 148: 45–49.CrossRefGoogle Scholar
  19. 19.
    Travagli J.P., Cailleux A.F., Ricard M., et al. Combination of radioiodine (131-I) and probe-guided surgery for persistent or recurrent thyroid carcinoma. J. Clin. Endocrinol. Metab. 1998, 83: 2675–2680.PubMedCrossRefGoogle Scholar
  20. 20.
    Pacini F., Fugazzola L., Lippi F., et al. Detection of thy-roglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J. Clin. Endocrinol. Metab. 1992, 74: 1401–1404.PubMedGoogle Scholar
  21. 21.
    Arturi F., Russo D., Giuffrida D., et al. Early diagnosis by genetic analysis of differentiated thyroid cancer metastases in small lymph nodes. J. Clin. Endocrinol. Metab. 1997, 82: 1638–1641.PubMedCrossRefGoogle Scholar
  22. 22.
    Wang W., Larson S.M., Fazzari M., et al. Prognostic value of [18] fluorodeoxyglucose positron emission tomograph-ic scanning in patients with thyroid cancer. J. Clin. Endocrinol. Metab. 2000, 85: 1107–1113.PubMedGoogle Scholar
  23. 23.
    Mandel S.J., Shankar L.K., Benard F., Yamamoto A., Alavi A. Superiority of iodine-123 compared with iodine-131 scanning for thyroid remnants in patients with differentiated thyroid cancer. Clin. Nucl. Med. 2001, 26: 6–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Alzahrani A.S., Bakheet S., Al Mandil M., Al-Hajjaj A., Almahfouz A., Al Haj A. 123I Isotope as a diagnostic agent in the follow-up of patients with differentiated thyroid cancer: comparison with post 131I therapy whole body scanning. J. Clin. Endocrinol. Metab. 2001, 86: 5294–5300.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2002

Authors and Affiliations

  • A. S. Alzahrani
    • 1
    Email author
  • H. Raef
    • 1
  • A. Sultan
    • 1
  • S. Al Sobhi
    • 1
  • S. Ingemansson
    • 2
  • M. Ahmed
    • 1
  • A. Al Mahfouz
    • 1
  1. 1.Department of MedicineKing Faisal Specialist Hospital and Research CentreRiyadhKingdom of Saudi Arabia
  2. 2.Department of SurgeryKing Faisal Specialist Hospital and Research CentreRiyadhKingdom of Saudi Arabia

Personalised recommendations