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- Title
Is a second recombinant human thyrotropin stimulation test useful? The value of postsurgical undetectable stimulated thyroglobulin level at the time of remnant ablation on clinical outcome.
- Authors
Prior‐Sánchez, Inmaculada; Barrera Martín, Ana; Moreno Ortega, Estefanía; Vallejo Casas, Juan A.; Gálvez Moreno, María Á.
- Abstract
Objective The management of patients with differentiated thyroid cancer ( DTC) has changed in recent years, and monitoring depends on the risk of persistent/recurrent disease. The objective was to assess the prognostic value of a single stimulated thyroglobulin (Tg) measured at the time of the first radioiodine therapy (Stim-Tg1), and the utility of a second stimulated Tg measurement performed 6-12 months later (Stim-Tg2). We also examined the role of neck ultrasound ( US) in the early diagnosis of recurrence. Design This was a retrospective observational cohort study conducted in a tertiary referral hospital. Of 213 evaluated patients with DTC, 169 were finally included. Methods Measurement of Stim-Tg1, Stim-Tg2 and neck US. Results Stim-Tg1 was undetectable in 71 of 169 patients (42%). All of them (71/71) continued to have negative Stim-Tg2. Seventy of 71 had an excellent response to the first treatment. Sixty-eight of 71 had no evidence of disease after an average follow-up of 7·2 years. In patients with detectable Stim-Tg1 (98/169; 58%), Stim-Tg2 became negative in 40. The negative predictive value ( NPV) of Stim-Tg1 was 0·96. The optimal Stim-Tg1 cut-off level for identifying persistence was 3·65 ng/ml. Recurrence was detected in 14 patients. Neck US was useful for identifying local recurrence (13/14; 92·85%). Conclusions Stim-Tg1 is a reliable marker with a high NPV. A second stimulation test should be avoided in patients with negative Stim-Tg1. In patients with biochemical persistence, Stim-Tg2 is useful for confirming/ruling out final status. Neck US plays a valuable role in the early diagnosis of recurrence.
- Subjects
THYROID cancer patients; THYROGLOBULIN; CANCER patients; NECK diseases; ULTRASONIC imaging; THYROTROPIN; DIAGNOSIS
- Publication
Clinical Endocrinology, 2017, Vol 86, Issue 1, p97
- ISSN
0300-0664
- Publication type
Article
- DOI
10.1111/cen.13140