Abstract
Residual thyroid tissue after total thyroidectomy in differentiated thyroid cancers is considered an independent risk factor for recurrence. Guidelines recommend following up patients after surgery with thyroglobulin (Tg), neck ultrasonography, and occasionally whole-body radioactive scan. However, the results of serum thyroglobulin and whole-body radioiodine scan are often discordant. The present study was undertaken to determine the levels of serum-stimulated thyroglobulin to complement the findings of residual thyroid tissue in the radioactive whole-body scan. One hundred twenty-six patients had undergone a radioiodine (131 I) whole-body scan (WBS) during the study duration, and 121 were available for analysis. The thyroglobulin level (measured by the CLIA method) was recorded at the time of these scans. The data was analysed to determine the level of stimulated thyroglobulin correlating with residual thyroid tissue, locoregional, and distant metastasis as assessed by WBS. The presence of residual thyroid tissue was noted in an overwhelmingly high 94% of cases. Twenty-four of the 28 patients with stimulated Tg < 2 ng/dl had residual thyroid tissue on a WBS. The discordancy rate (positive moderate — large WBS and negative serum thyroglobulin) of 64.28% was seen. Using ROC the serum thyroglobulin cut-offs levels for the loco-regional disease were found to be 27.705 ng/dl and 94.770 ng/dl for distant metastasis. The results highlight the fact that serum Tg levels cannot be used as an accurate predictor of the extent of the remnant thyroid tissue. Irrespective of the quality of surgery, which was analysed based on the centre and surgical specialty, over 90% of cases had residual thyroid tissue on WBS. The use of only stimulated Tg levels for follow-up may be inaccurate. Serum Tg is a useful test along with radioactive whole-body scans to distinguish local disease, loco-regional disease, and distant metastasis.
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References
Bal CS, Padhy AK (2015) Radioiodine remnant ablation: a critical review. World J Nucl Med 14(3):144–155. https://doi.org/10.4103/1450-1147.163240
Haugen BR, Alexander EK, Bible KC et al (2016) 2015 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):1–133. https://doi.org/10.1089/thy.2015.0020
Indrasena BS (2017) Use of thyroglobulin as a tumour marker. World J Biol Chem 8(1):81–85. https://doi.org/10.4331/wjbc.v8.i1.81
Silva F, Martin RJ, Figueroa J, Rincón F, Román D (2016) Variability of serum thyroglobulin levels in post- thyroidectomy patients with well-differentiated thyroid cancer: the ATA guidelines. P R Health Sci J 35(3):142–146
Vishal Rao US, Koya S, Gandla S et al (2018) Small-sized thyroid cancers-a single institutional experience in India. Indian J Surg Oncol 9(1):35–38. https://doi.org/10.1007/s13193-017-0673-y
Mathew IE, Mathew A (2017) Rising thyroid cancer incidence in Southern India: an epidemic of overdiagnosis? J Endocrine Soc 1(5):480–487
Fratkin MJ, Newsome HH, Sharpe AR, Tatum JL (1983) Cervical distribution of iodine 131 following total thyroidectomy for thyroid cancer. Arch Surg 118(7):864–867
Salvatori MA, Raffaelli MA, Castaldi PA, Treglia GI, Rufini V, Perotti GE, Lombardi CP, Rubello D, Ardito GU, Bellantone R (2007) Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma. Eur J Surgical Oncol 33(5):648–654
Zucchelli G, Iervasi A, Ferdeghini M, Iervasi G (2009) Serum thyroglobulin measurement in the follow-up of patients treated for differentiated thyroid cancer. Q J Nucl Med Mol Imaging 53(5):482
Silva F, Martin RJ, Figueroa J, Rincón F, Román D (2016) Variability of serum thyroglobulin levels in post thyroidectomy patients with well differentiated thyroid cancer and the ATA guidelines. P R Health Sci J 35(3):142–146
Phan HT, Jager PL, van der Wal JE, Sluiter WJ, Plukker JT, Dierckx RA, Wolffenbuttel BH, Links TP (2008) The follow-up of patients with differentiated thyroid cancer and undetectable thyroglobulin (Tg) and Tg antibodies during ablation. Eur J Endocrinol 158(1):77–83
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IRB ethical clearance has been obtained for the study (ECR/386/Inst/KA/2013/RR-19).
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Prasad, R., Rao, V., Subash, A. et al. Residual Thyroid Tissue on Postoperative Diagnostic 131 I Radioactive Whole-Body Scan After Surgery in Differentiated Thyroid Cancer: A Tertiary Referral Centre Experience. Indian J Surg Oncol 13, 109–114 (2022). https://doi.org/10.1007/s13193-021-01357-x
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DOI: https://doi.org/10.1007/s13193-021-01357-x