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ABSTRACT: To evaluate retrospectively the additive clinical value of combined thyroglobulin (Tg) and antithyroglobulin antibody (TgAb) measurements to define recurrent and persistent disease in patients with differentiated thyroid cancer.
181 patients with differentiated thyroid cancer were included in the study. The nonstable disease group (recurrent and persistent disease) had 61 patients with 24-36 months follow-up period. The stable disease group (without recurrence or persistence) had 120 patients with 21-28 months follow-up period. We compared Tg and combined Tg-TgAb levels on the sixth month after the ablation between two groups.
Optimal threshold values for Tg, TgAb measurements were calculated statistically as 4.45 ng/ml and 27.8 IU/ml. Optimal sensitivity and specificity for 4.45 ng/ml Tg levels were 52.5 and 91.7%. We also evaluated different Tg threshold values. We found sensitivity was 54.2% and specificity 86.7% for 2 ng/ml and sensitivity was 40.7% and specificity 96.7% for 10 ng/ml Tg levels. By the odds ratio (OR) rule, the obtained sensitivity and specificity were 68.3 and 90% (if Tg>10 ng/ml or TgAb>27.8 IU/ml), 78.3 and 90% (if Tg>4.45 ng/ml or TgAb>27.8 IU/ml), and 80% and 85% (if Tg>2 ng/ml or TgAb>27.8 IU/ml). Sensitivity increased with statistical significance from 52.5 to 78.3% (P<0.001) and decreased with statistical insignificance from 91.7 to 90% (P>0.05) for the optimal thresholds.
Combined Tg-TgAb values were found more useful than only Tg for recurrent and persistent diseases. Combined Tg and TgAb measurements seemed to be a useful marker.
Nuclear Medicine Communications 10/2008; 29(10):880-4. · 1.40 Impact Factor
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ABSTRACT: Papillary microcarcinoma of the thyroid is a specific subgroup of papillary thyroid carcinoma (PTC) and account for up to 30% of all PTC. According to the World Health Organization, papillary microcarcinoma of the thyroid (PMC) is defined as a papillary thyroid carcinoma measuring <or=10 mm in the greatest dimension. The relative rate of PMC is increasing in patients with differentiated thyroid carcinoma (DTC) mainly due to more frequent use and improvement of ultrasonography and fine-needle aspiration biopsy, and also more accurate histopathological examination of surgical specimens. The high incidence of PMC found in autopsy studies (up to 35%) suggests that most of them have a benign behavior. The locoregional recurrence has been reported in up to 20% of PMC patients and several cases of distant metastases have also been described. The 'ideal' therapeutic approach in PMC patients remains a subject of debate among endocrinologists and surgeons. Treatment of PMC in different departments varies from partial thyroidectomy to total thyroidectomy and radioiodine treatment. The main question in this group of patients is "How should PMC patients be treated?" The aim of this study was to investigate retrospectively the frequency and clinical behavior of PMC of the thyroid gland in our department and also to identify the optimal treatment of this group of patients.
For this retrospective study, we evaluated 120 patients with PMC in our department (between 1997 and 2005). The mean age of patients at diagnosis was 43 +/- 13 years (range 17-67 years). The female to male ratio was 87.5% (105 females, 15 males). The mean follow-up period of patients in this study was 45 months (16-84 months). Surgical treatment of patients with PMC in our department consisted of a bilateral total thyroidectomy in 25 patients (21%), and a bilateral near total thyroidectomy in 95 patients (79%). In the evaluation of our patients, multifocal PMC had a relative frequency of 15% (18/120 patients). The patients were informed about the different therapeutic strategies and the possible necessity for more frequent radioiodine treatment to eliminate thyroid remnants. All of the patients in our retrospective study had radioiodine (RAI) ablation therapy for residual thyroid tissue.
All patients received an RAI treatment dose which ranged from 75-150 mCi (2.7-5.5 GBq). Our criteria for ablation are as follows: negative I-131 WBS and very low serum Tg levels (<1 ng/mL). In 112/120 patients (93.3%), the thyroid remnant was ablated with a single dose of I-131 75-150 mCi (2.7-5.5 GBq). A second radioiodine treatment was necessary in 8 patients (7%), because of locoregional recurrence (required mean cumulative doses of 8.2-11 GBq I-131). Locoregional reccurence occurred in 2 patients with unifocal tumor, without capsular invasion or lymph node metastases and in 6 patients with multifocal tumor and/or in patients with capsular invasion or lymph node metastases. After a second radioiodine treatment, all of these 8 patients were ablated. All 120 patients remained free from disease (negative I-131 whole body scan, unmeasurable thyroglobulin levels) after a median follow-up period of 45 months and there was no recorded disease-related mortality.
The treatment of patients with PMC should be no different from the treatment of patients with PTC, and thyroidectomy followed by radioiodine therapy may be a possible option for treatment of papillary microcarcinoma.
Clinical Nuclear Medicine 04/2007; 32(4):279-81. · 3.67 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the potential contribution of Tc-99m-MIBI scintigraphy to the follow-up of patients with differentiated thyroid carcinoma, who had elevated Tg levels and negative I-131 whole-body scan results.
In this retrospective study, we evaluated 28 patients with differentiated thyroid carcinoma, who had total or near total thyroidectomy followed by an ablative dose of I-131 at various time intervals (15 women, 13 men; mean age 43 +/- 17 years). All patients were treated with T4 suppression. After a mean follow-up period of 6.1 years (range 3-15) all patients were determined to have a high serum Tg concentrations (>2 ng/ml) and previous negative I-131 WBS results. All patients were examined for metastatic sites using Tc-99m-MIBI scan. Scans were visually evaluated for detecting lymph node metastases and/or local recurrence, lung metastases and skeletal metastases.
Tc-99m-MIBI scan demonstrated lesions in 23 patients (83.3%). In five patients with negative Tc-99m-MIBI scan findings (FN results): Chest CT showed small-sized mediastinal LN metastases in 2 patients and lung metastases in another 2 patients (<1 cm). Neck CT showed small-sized cervical LN involvement in 1 patient. The sensitivity of detection for neck was 94.4%, for lung 63.6%, and for bone lesions 100%. For all scan sites taken together, the sensitivity of disease detection was 83.3%, the specificity was 50%, positive predictive value (PPV) was 96.2%, and finally negative predictive value (NPV) was 16.7%.
We concluded that Tc-99m-MIBI scan should be considered as a supplementary scintigraphic method for the follow-up of patients with high serum Tg levels and negative I-131 WBS results, and it can help clinicians in making the decision to treat these patients.
Annals of Nuclear Medicine 07/2006; 20(6):393-7. · 1.50 Impact Factor
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ABSTRACT: Autonomously functioning toxic adenomas are a common cause of hyperthyroidism. Although 131I seems to be a good therapeutic option with little postablative hypothyroidism for these patients, only a small number of recent studies have objectively evaluated changes in nodule size by ultrasonography following radioiodine therapy.
We prospectively followed 39 patients with a mean age of 51.2 (35-75) years for 12 months and the patients who remained toxic thereafter, until euthyroidism was provided. Thyroid function tests, sonographic volumes were determined initially and 3, 6 and 12 months after treatment. Radioiodine doses of 3.7 MBq.g(-1) thyroid tissue corrected to a 100% 24 h 131I uptake were given. Thirty patients received a single dose, two required two doses and three required three to five doses of 131I due to persistent thyrotoxicosis. Sonographic volumes of the diffuse parts of the glands decreased significantly by 18% from a mean+/-SD value of 50+/-27.6 ml to 41+/-27.4 ml by the end of the 12 months. A significant decrease (8.3%, P=0.002) was achieved in the first three months. Toxic adenomas decreased in size more efficiently (54%) from a mean of 26+/-24 ml to 12+/-10 ml during 12 months, but also most significantly (28.8%, P=0.003) in the first 3 months of the follow-up. Thirty of the patients (76.9%) became euthyroid at the end of 12 months of follow-up. Four patients (10.3%) became overtly hypothyroid during the follow-up.
Single or multiple doses of radioiodine can successfully treat toxic adenomas with a low rate of hypothyroidism and considerable nodule-volume reduction.
Nuclear Medicine Communications 12/2004; 25(11):1083-7. · 1.40 Impact Factor
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Clinical Nuclear Medicine 05/2002; 27(4):309-10. · 3.67 Impact Factor
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Clinical Nuclear Medicine 04/2002; 27(3):227-8. · 3.67 Impact Factor
