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Source of rising thyroglobulin level in the patient with recurrent thyroid cancer (TC) and a negative diagnostic iodine whole body scan

¹ Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Objectives: When a whole body diagnostic iodine scan fails to localize a source of rising Tg in the patient with recurrent TC, other diagnostic tests such as high resolution neck US and FDG-PET, or post-therapy iodine scan are utilized. To assess the efficacy of the diagnostic test in detecting the origin and location of the rising Tg level in the patients with recurrent TC with a negative iodine scan.

Methods: We evaluated all diagnostic tests obtained on the 32 patients who had a negative diagnostic iodine scan and rising Tg to asses the nature and origin of rising Tg. Diagnostic tests included high resolution neck ultrasound, FDG-PET scan, post-therapy iodine scan and CT scan. Age ranges from 25 to 72 yr-old (mean age of 46). Serum Tg level ranges from 2.9 to 3000 ng.

Results: All patients had a FDG-PET scan and PET positive was found in 11/32(34%)patients. 24 patients had neck US; 17 of 24 patients had positive in thyroid bed and cervical lymph node, but 47% (8/17 US positive) were a false-positive. Of 32 patients, 27 patients received an empirical radioiodine treatment and 5 had a surgical re-exploration. Post-therapy iodine scan was positive for recurrence in 5 of 27 (10%). 7 patients with a negative post-therapy iodine scan was PET positive. All combined diagnostic scans showed a positive in 21 of 32 (62%) for recurrence: thyroid bed recurrence in 5; cervical node recurrence in 11; mediastinal nodes in 3; distant metastases in 2.

Conclusions: By utilizing combined diagnostic scans, the source of rising thyroglobulin could be determined in the 62% of (21/32) patients who had a negative iodine scan but rising Tg. The most of time, 76%(16/21), source of recurrence is originated from recurrence in the thyroid bed and cervical lymph nodes.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Kim, S. Articles by Intenzo, C. PubMed Articles by Kim, S. Articles by Intenzo, C.