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Serum Thyroglobulin and Iodine-131 Whole-Body Scan in the Diagnosis and Assessment of Treatment for Metastatic Differentiated Thyroid Carcinoma

Department of Nuclear Medicine and Thyroid Clinic and Department of Otolaryngology, Head and Neck Surgery, Beilinson Medical Center, Petah Tiqva
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Correspondence: For correspondence or reprints contact: E. Lubin, MD, Dept. of Nuclear Medicine, Bellinson Medical Center, Petah Tiqva 49 100, Israel.

ABSTRACT

Because of the limitations of periodic ¹³¹I whole-body scans, including suspension of substitution therapy, questionable sensitivity and low yield in detecting metastases in patients who have undergone thyroidectomy, serum thyroglobulin and ¹³¹I whole-body scans were evaluated for sensitivity in detecting local, regional or distant metastases in 261 patients with differentiated thyroid carcinoma after total thyroidectomy and ablation. Methods: A noncompetitive immunoradiometric assay was used for serum thyroglobulin determination. An ¹³¹I whole-body scan was obtained after replacement therapy had been suspended for 6 wk or when TSH reached levels higher than 50 µU/ml. In patients who underwent radiological procedures with iodinated contrast media, the waiting period before the ¹³¹I whole-body scans as no less than 10 wk. Results: Of the 58 patients with proven metastases who were followed for 12 yr (mean 7 ± 3.3 yr), 51 (88.4%) had high serum thyroglobulin assays performed while under full replacement therapy and 32 (55%) showed clear ¹³¹I whole-body scan localization. There were no instances of positive whole-body scans and negative serum thyroglobulin. Conclusion: In patients treated with ¹³¹I, serum thyroglobulin assay was an excellent method to assess treatment. Patients with metastatic disease and negative wholebody scans with or without serum thyroglobulin exhibited a trend toward higher mortality. This trend may also indicate that the lack of ¹³¹I trapping and low thyroglobulin is a sign of metabolic dedifferentiation of otherwise histologically differentiated thyroid tumors.

Key Words: thyroid carcinoma • iodine-131 whole-body scans • serum thyroglobulin

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