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Targeted Systemic Therapy May Be Promising in Radioiodine-Refractory Differentiated Thyroid Cancer

  • Zehra Özcan
  • Ülkem Yararbaş
Chapter

Abstract

During the follow-up of a patient with differentiated thyroid carcinoma, Tg elevation without iodine uptake on WB scan was noted. She received an empiric dose of radioiodine to evaluate the possible Tg production site; however, no evidence of uptake was found. PET/CT scan showed pulmonary nodules, some of which were FDG avid. Finally, sorafenib treatment was initiated which is currently at the 22nd month of the follow-up.

Keywords

Advanced thyroid cancer Rising thyroglobulin Negative iodine scan Targeted therapy Tyrosine kinase inhibitors Sorafenib 

References

  1. 1.
    Haugen BR, Sawka AM, Alexander EK, Bible KC, Caturegli P, Doherty GM, et al. American Thyroid Association guidelines on the management of thyroid nodules and differentiated thyroid cancer task force review and recommendation on the proposed renaming of encapsulated follicular variant papillary thyroid carcinoma without invasion to noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Thyroid. 2017;27:481–3.  https://doi.org/10.1089/thy.2016.0628.CrossRefPubMedGoogle Scholar
  2. 2.
    Ma C, Kuang A, Xie J, Ma T. Possible explanations for patients with discordant findings of serum thyroglobulin and 131I whole-body scanning. J Nucl Med. 2005;46:1473–80.PubMedGoogle Scholar
  3. 3.
    Pineda JD, Lee T, Ain K, Robbins J. Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan. J Clin Endocrinol Metab. 1995;80:1488–92.PubMedGoogle Scholar
  4. 4.
    de Keizer B, Koppeschaar HP, Zelissen PM, et al. Efficacy of high therapeutic doses of iodine-131 in patients with differentiated thyroid cancer and detectable serum thyroglobulin. Eur J Nucl Med. 2001;28:198–202.CrossRefGoogle Scholar
  5. 5.
    Pacini L, Agate R, Elisei M. Outcome of differentiated thyroid cancer with detectable serum Tg and negative 131I whole body scan: comparison of patients treated with high 131I activities versus untreated patients. J Clin Endocrinol Metab. 2001;86:4092–7.CrossRefGoogle Scholar
  6. 6.
    Koh JM, Kim ES, Ryu JS, et al. Effects of therapeutic doses of 131I in thyroid papillary carcinoma patients with elevated thyroglobulin level and negative 131I whole-body scan: comparative study. Clin Endocrinol. 2003;58:421–7.CrossRefGoogle Scholar
  7. 7.
    Kabasakal L, Selçuk NA, Shafipour H, Ozmen O, Onsel C, Uslu I. Treatment of iodine-negative thyroglobulin-positive thyroid cancer: differences in outcome in patients with macrometastases and patients with micrometastases. Eur J Nucl Med Mol Imaging. 2004;31:1500–4.CrossRefGoogle Scholar
  8. 8.
    Ma C, Xie J, Kuang A. Is empiric 131I therapy justified for patients with positive thyroglobulin and negative 131I whole-body scanning results? J Nucl Med. 2005;46:1164–70.PubMedGoogle Scholar
  9. 9.
    Chao M. Management of differentiated thyroid cancer with rising thyroglobulin and negative diagnostic radioiodine whole body scan. Clin Oncol (R Coll Radiol). 2010;22:438–47.  https://doi.org/10.1016/j.clon.2010.05.005.CrossRefGoogle Scholar
  10. 10.
    Vural GU, Akkas BE, Ercakmak N, Basu S, Alavi A. Prognostic significance of FDG PET/CT on the follow-up of patients of differentiated thyroid carcinoma with negative 131I whole-body scan and elevated thyroglobulin levels: correlation with clinical and histopathologic characteristics and long-term follow-up data. Clin Nucl Med. 2012;37:953–9.  https://doi.org/10.1097/RLU.0b013e31825b205.CrossRefPubMedGoogle Scholar
  11. 11.
    Ozkan E, Aras G, Kucuk NO. Correlation of 18F-FDG PET/CT findings with histopathological results in differentiated thyroid cancer patients who have increased thyroglobulin or antithyroglobulin antibody levels and negative 131I whole-body scan results. Clin Nucl Med. 2013;38:326–31.  https://doi.org/10.1097/RLU.0b013e318286827b.CrossRefPubMedGoogle Scholar
  12. 12.
    Pacini F. Which patient with thyroid cancer deserves systemic therapy and when? Best Pract Res Clin Endocrinol Metab. 2017;31:291–4.  https://doi.org/10.1016/j.beem.2017.08.001.CrossRefPubMedGoogle Scholar
  13. 13.
    Thomas L, Lai SY, Dong W, Feng L, Dadu R, Regone RM, Cabanillas ME. Sorafenib in metastatic thyroid cancer: a systematic review. Oncologist. 2014;19:251–8.  https://doi.org/10.1634/theoncologist.2013-0362.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Viola D, Valeria L, Molinaro E Agate L, Bottici V, Biagini A, et al. Treatment of advanced thyroid cancer with targeted therapies: ten years of experience. Endocr Relat Cancer. 2016;23:R185–205.CrossRefGoogle Scholar
  15. 15.
    Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, et al. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014;384:319–28.  https://doi.org/10.1016/S0140-6736(14)60421-9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Benekli M, Yalcin S, Ozkan M, Elkiran ET, Sevinc A, Cabuk D, et al. Efficacy of sorafenib in advanced differentiated and medullary thyroid cancer: experience in a Turkish population. Onco Targets Ther. 2014;15:1–5.  https://doi.org/10.2147/OTT.S70670.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Zehra Özcan
    • 1
  • Ülkem Yararbaş
    • 1
  1. 1.Department of Nuclear MedicineEge University School of MedicineIzmirTurkey

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