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Papillary thyroid carcinomas with biochemical incomplete or indeterminate responses to initial treatment: repeat stimulated thyroglobulin assay to identify disease-free patients

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Abstract

Papillary thyroid cancer (PTC) patients treated with thyroidectomy and radioiodine remnant ablation (RRA) often have detectable TSH-stimulated thyroglobulin (Tg) levels without localizable disease after primary treatment. To assess the value of repeat stimulated Tg assays in these patients’ follow-up, we retrospectively analyzed 86 cases followed in 5 Italian thyroid-cancer referral centers. We enrolled 86 patients with PTCs treated with total/near-total thyroidectomy plus RRA between January 1,1990 and January 31, 2006. In all cases, the initial postoperative visit revealed stimulated serum Tg ≥1 ng/mL, negative Tg antibodies, and no structural evidence of disease. None received empiric radioiodine therapy. Follow-up (median: 9.6 years) included neck ultrasound and basal Tg assays (yearly) and at least 1 repeat stimulated Tg assay. Of the 86 patients analyzed (initial risk: low 63 %, intermediate 35 %, high 2 %), one (1 %) had ultrasound-detected lymph node disease and persistently elevated stimulated Tg levels at 3 years. In 17 (20 %), imaging findings were consistently negative, but the final stimulated Tg levels was still >1 ng/mL (median 2.07 ng/mL, range 1.02–4.7). The other 68 (80 %) appeared disease-free (persistently negative imaging findings with stimulated Tg levels ≤1 ng/mL). Mean intervals between first and final stimulated Tg assays were similar (5.2 and 4.8 years) in subgroups with versus without Tg normalization. Reclassification as disease-free was significantly more common when initial stimulated Tg levels were indeterminate (<10 ng/mL). In unselected PTC cohorts with incomplete/indeterminate biochemical responses to thyroidectomy and RRA, periodic remeasurement of stimulated Tg allows most patients to be classified as disease-free.

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Acknowledgments

The authors thank the members of the Italian Thyroid Cancer Observatory (ITCO) Foundation for their important contributions: Davide Bianchi (Bentivoglio); Antonella Carbone (Matera); Girolamo D’Azzò, Adele Maniglia (Palermo); Nadia Caraccio, Giuseppe Pasqualetti, Antonio Polini, Silvia Ursino (Pisa); Stefania Lupo, Katia Plasmati (Roma); and Umberto Crocetti, Leonardo D’Aloiso, Michela Massa (San Giovanni Rotondo). Writing support was provided by Marian Everett Kent, BSN.

Funding

The study was supported by research grants from the Umberto Di Mario Foundation and from the Banca d’Italia.

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    Authors and Affiliations

    1. Dipartimento di Medicina Interna e Specialità Mediche, Dipartimento di Scienze Chirurgiche, Università di Roma Sapienza, Viale del Policlinico, 155, 00161, Rome, Italy

      Livia Lamartina, Teresa Montesano, Fabiana Trulli, Giuseppe Ronga, Marianna Maranghi, Marco Biffoni, Sebastiano Filetti & Cosimo Durante

    2. Unità Operativa di Endocrinologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, 90146, Palermo, Italy

      Marco Attard

    3. Unità Operativa di Endocrinologia, Istituto di Ricovero e Cura a Carattere Scientifico, Casa Sollievo della Sofferenza, 71013, San Giovanni Rotondo, Italy

      Massimo Torlontano

    4. Unità di Endocrinologia, Ospedale di Tinchi-Pisticci, 75020, Matera, Italy

      Rocco Bruno

    5. Unità Operativa Semplice Dipartimentale di Endocrinologia, Ospedale di Bentivoglio, 40010, Bologna, Italy

      Domenico Meringolo

    6. Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, 56126, Pisa, Italy

      Fabio Monzani

    7. Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, 95123, Catania, Italy

      Salvatore Tumino

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    1. Livia Lamartina
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    2. Teresa Montesano
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    Livia Lamartina and Teresa Montesano have equally contributed to this paper.

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    Lamartina, L., Montesano, T., Trulli, F. et al. Papillary thyroid carcinomas with biochemical incomplete or indeterminate responses to initial treatment: repeat stimulated thyroglobulin assay to identify disease-free patients. Endocrine 54, 467–475 (2016). https://doi.org/10.1007/s12020-015-0823-3

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