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Role of Initial Iodine- 131 Whole-Body Scan and Serum Thyroglobulin in Differentiated Thyroid Carcinoma Metastases

Servizio Speciale di Medicina Nucleare—Clinica Medica II—University "La Sapienza," Rome, Italy

Correspondence: For correspondence or reprints contact: Giuseppe Ronga, MD, Medicina Nucleare, II Clinica Medica, Policlinico Umberto I, 00161, Roma, Italy.

ABSTRACT

We evaluated the role of first ¹³¹I-whole-body scan and of first serum thyroglobulin (Tg) measurement after surgery in the early diagnosis of metastases from differentiated thyroid carcinoma (DTC). Methods: In 269 patients with metastases from DTC, we retrospectively evaluated the results of first whole-body scan (performed 40 days after surgery with diagnostic or therapeutic ¹³¹I dose) and in 69 of them we also evaluated the result of first Tg measurement (performed the day before the first whole-body scan) in relation to the presence, localization and type of metastases. Results: In all patients, the first whole-body scan was positive for the thyroid remnant, and in 54.3% of patients it was also positive for metastases. In the remaining 45.7% of patients, metastases were detected during the follow-up. First Tg levels were >60 ng/ml in 66.7% of patients with metastases. First whole-body scan detected metastases in 47.8% of patients with Tg values <60 ng/ml, while Tg values were >60 ng/ml in 61.3% of patients with first whole-body scan negative for metastases. The combined results of both first whole-body scan and first Tg measurement allowed the early detection of metastases in 82.6% of patients. Whole-body scan detected distant metastases more frequently than local lymph node metastases (p < 0.01). Conclusion: In more than 80% of patients, metastases were suspected or diagnosed as early as 40 days after surgery in the presence of residual thyroid tissue by combined evaluation of results of first whole-body scan and Tg measurement.

Key Words: differentiated thyroid carcinoma • thyroglobulin • iodine-131 whole-body scan

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