The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical Significance of Observation without Repeated Radioiodine Therapy in Differentiated Thyroid Carcinoma Patients with Positive Surveillance Whole-Body Scans and Negative Thyroglobulin

  • Lim, Dong-Jun (Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • O, Joo-Hyun (Department of Nuclear Medicine, The Catholic University of Korea School of Medicine) ;
  • Kim, Min-Hee (Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Kim, Ji-Hyun (Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Kwon, Hyuk-Sang (Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Kim, Sung-Hoon (Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Kang, Moo-Il (Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Cha, Bong-Yun (Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Lee, Kwang-Woo (Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Son, Ho-Young (Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea School of Medicine)
  • Received : 2010.03.01
  • Accepted : 2010.08.31
  • Published : 2010.12.01
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Abstract

Background/Aims: Currently, there is no consensus on the necessity of repeated radioiodine therapy (RAI) in patients who show iodine uptake in the thyroid bed on a diagnostic whole-body scan (DxWBS) despite undetectable thyroglobulin (Tg) levels after remnant ablation. The present study investigated the clinical outcomes of scan-positive, Tg-negative patients (WBS+Tg-) who did or did not receive additional RAI. Methods: We retrospectively reviewed 389 differentiated thyroid carcinoma patients who underwent a total thyroidectomy and received high-dose RAI from January 2003 through December 2005. The patients were classified according to surveillance DxWBS findings and TSH-stimulated Tg levels 6 to 12 months after the initial RAI. Results: Forty-four of the 389 patients (11.3%) showed thyroid bed uptake on a DxWBS despite negative Tg levels (WBS+Tg-). There was no difference in clinical and pathological parameters between WBS+Tg- and WBSTg-patients, except for an increased frequency of thyroiditis in the WBS+Tg- group. Among the 44 WBS+Tgpatients, 27 subjects were treated with additional RAI; 25 subjects showed no uptake in subsequent DxWBS. Two patients were evaluated only by ultrasonography (US) and displayed no persistent/recurrent disease. The other 17 patients received no further RAI; Eight patients and two patients showed no uptake and persistent uptake, respectively, on subsequent DxWBS. Six patients presented negative subsequent US findings, and one was lost to follow-up. Over the course of $53.2{\pm}10.1$ months, recurrence/persistence was suspicious in two patients in the treatment group. Conclusions: There were no remarkable differences in clinical outcomes between observation and treatment groups of WBS+Tg- patients. Observation without repeated RAI may be an alternative management option for WBS+Tg- patients.

Keywords

References

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