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Which thyroid cancer patients need periodic stimulation tests?

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Recurrences are frequent in thyroid cancer patients and long-term follow-up is therefore necessary. We evaluated the yield of rhTSH stimulation in three groups of patients, classified according to the UICC/TNM risk stratification and the results of first follow-up testing.

Methods

The study population comprised 129 patients referred for rhTSH testing. All had undergone first follow-up testing after thyroid hormone withdrawal (off-T4) within 1 year of 131I ablation. Negative first follow-up testing was defined as Tg <2 ng/ml and no neck uptake on 131I diagnostic whole-body scan. Seventy-five patients had stage I thyroid cancer and negative first follow-up testing (group A), 19 had stage I disease and positive first follow-up testing (group B), and 35 had stage II–IV disease (group C). RhTSH stimulation was performed an average of 6 years after first follow-up testing.

Results

131I diagnostic scanning after rhTSH was negative in all 75 group A patients. Only one group A patient had detectable Tg after rhTSH injection (1.5 ng/ml), but Tg had also been detected at baseline in this patient (1.45 ng/ml). Given the absence of a response to stimulation, suggesting an interference, Tg was reassessed with a different technique and proved to be undetectable (<0.1 ng/ml). Stimulation with rhTSH in group B showed residual Tg in seven patients and residual 131I uptake in the thyroid bed in two patients, but none of these patients had signs of disease progression. Five group C patients (14%) had a positive rhTSH test result, and this was suggestive of disease progression in at least two cases.

Conclusion

The first follow-up testing is essential for prognostic classification after 131I ablation of thyroid cancer. In stage I patients, undetectable Tg and negative 131I scan 1 year after ablation define a large population of subjects who have a very low risk of recurrence and who do not require further stimulation tests. In contrast, periodic rhTSH stimulation tests appear useful in higher-risk patients.

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Acknowledgments

The authors are grateful to professor Philippe Bouchard, Head of the Endocrinology Department and President of the SFE “Société Française d’Endocrinologie”, and to R. Lawrence Sullivan, Jr., MD, at O’Connor Hospital, San Jose, California.

They would also like to thank Nicole Allegrini and all the laboratory staff and technicians of the Nuclear Medicine Department.

The study did not receive any financial support.

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Authors and Affiliations

  1. Service de Médecine Nucléaire, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75571, Paris cedex 12, France

    Paolo Zanotti-Fregonara, Alexandre Khoury, Isabelle Keller, Thierry Kiffel, Jean-Yves Devaux & Elif Hindié

  2. Endocrinology Department, St. Antoine Hospital, Paris, France

    Françoise Duron & Sophie Christin-Maître

  3. Nuclear Medicine Department, St. Louis Hospital, Paris, France

    Marie Elisabeth Toubert

Authors
  1. Paolo Zanotti-Fregonara
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  2. Alexandre Khoury
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  3. Françoise Duron
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  4. Isabelle Keller
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  5. Sophie Christin-Maître
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  6. Thierry Kiffel
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  7. Marie Elisabeth Toubert
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  8. Jean-Yves Devaux
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  9. Elif Hindié
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Corresponding author

Correspondence to Elif Hindié.

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Zanotti-Fregonara, P., Khoury, A., Duron, F. et al. Which thyroid cancer patients need periodic stimulation tests?. Eur J Nucl Med Mol Imaging 34, 541–546 (2007). https://doi.org/10.1007/s00259-006-0279-z

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  • DOI: https://doi.org/10.1007/s00259-006-0279-z

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