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Possible Explanations for Patients with Discordant Findings of Serum Thyroglobulin and ¹³¹I Whole-Body Scanning^*

¹ Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
² Department of Stomatology, Linyi People’s Hospital, Linyi, Shandong Province, China
³ Department of Nuclear Medicine, The First Affiliated Hospital, Kunming University, Kunming, Yunnan Province, China

The long-term monitoring of patients with differentiated thyroid carcinoma (DTC) is essential throughout the patient’s life after total or near-total thyroidectomy followed by ¹³¹I remnant ablation and thyroid hormone suppression of thyroid-stimulating hormone (TSH). Sensitive surveillance for DTC recurrence and metastases includes radioiodine diagnostic whole-body scanning (DWBS) and measurement of serum thyroglobulin (Tg) after endogenous or exogenous TSH stimulation. Serum Tg levels during thyroid hormone withdrawal (Tg-off) are usually well correlated with the results of DWBS. In general, undetectable Tg levels with negative DWBS (DWBS^–) suggest complete remission, whereas detectable or elevated Tg concentrations are suggestive of the presence of ¹³¹I uptake in local or distant metastases. However, DTC patients with discordant results of Tg measurement and ¹³¹I WBS have been observed in the follow-up study. Negative ¹³¹I DWBS and a positive Tg test (DWBS^– Tg⁺) are found in most of these cases. Positive ¹³¹I DWBS and a negative Tg test (DWBS⁺ Tg^–), though of uncommon occurrence, has also been demonstrated in a small but significant number of cases. With this scenario, one should first attempt to uncover a cause for possibly false-negative or false-positive ¹³¹I WBS or serum Tg. Explanations for the discordance are speculative but should be scrutinized when confronted with discrepant data in a given patient.

Key Words: differentiated thyroid carcinoma • thyroglobulin • ¹³¹I • whole-body scanning

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