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Follow-Up Regimen of Differentiated Thyroid Carcinoma in Thyroidectomized Patients After Thyroid Hormone Withdrawal

Departments of Nuclear Medicine and Endocrinology, University Hospital Nijmegen, Nijmegen, The Netherlands

Correspondence: For correspondence or reprints contact: Wim J.G. Oyen, MD, PhD, Department of Nuclear Medicine, University Hospital Nijmegen, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

ABSTRACT

For differentiated, nonmedullary thyroid carcinoma, postsurgical ablation of thyroid remnants and treatment of residual tumor and metastases with ¹³¹I is a potentially curative therapy. The aim of this study was to optimize the diagnostic protocol for the follow-up of thyroidectomized patients. Methods: Two hundred fifty-four patients (187 females, 67 males; mean age, 45 y; range, 8–83 y) were studied retrospectively for a mean follow-up period of 2.7 y (range, 1–12.5 y). An evaluation study consisted of a low-dose ¹³¹I diagnostic procedure under hyperthyroid conditions (thyroid-stimulating hormone > 30 µU/mL), ²⁰¹Tl scintigraphy, and measurement of thyroglobulin (Tg) under hypothyroid conditions. A total of 254 preablation studies (1 study per patient) and 586 follow-up studies (average number of studies, 2.3 per patient) were evaluated. Results: Before ablation, low-dose ¹³¹I screening was useful to estimate the size of the thyroid remnant. Low Tg levels (<10 pmol/L) indicated the absence of metastases. After ablation, undetectable Tg levels indicated the absence of tumor recurrence. When Tg levels were high (>10 pmol/L), local recurrence or metastases were always observed, providing the basis for additional high-dose ¹³¹I therapy. In these patients, ²⁰¹Tl imaging did not provide a significant contribution to patient management. In the case of autoantibodies against Tg, both low-dose ¹³¹I screening and ¹³¹Tl scintigraphy may be advocated to allow an aggressive diagnostic work-up. Conclusion: Tg plays a key role in follow-up and in making decisions to treat patients with differentiated thyroid carcinoma. The role of ²⁰¹Tl imaging is very limited. In patients with negative low-dose ¹³¹I screening, ²⁰¹Tl scintigraphy can be considered when Tg is elevated or cannot be evaluated because of autoantibodies against Tg. Under such circumstances, administration of a therapeutic ¹³¹I dose without ²⁰¹Tl imaging can be considered.

Key Words: thyroid carcinoma • diagnosis • therapy • ¹³¹I • ²⁰¹Tl • thyroglobulin

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