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DOI: 10.3413/nukmed-0189
Value of diagnostic radioiodine scintigraphy and thyroglobulin measurements after rhTSH injection
Stellenwert der diagnostischen Radioiodtherapie und Thyreoglobulinbestimmung nach rhTSH-GabePublication History
Received:
02 June 2008
accepted:
24 June 2008
Publication Date:
19 January 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/200901/lookinside/thumbnails/10-3413-nukmed-0189_de-1.jpg)
Summary
Measurements of thyroglobulin (Tg) levels 72 h after administration of recombinant human thyrotropin (rhTSH) are recommended by the manufacturer in the follow-up of patients with differentiated thyroid carcinoma (DTC). In our department, Tg measurements are performed both 24 h and 72 h after administration of rhTSH, together with 72 h post rhTSH 131I whole body scintigraphy (WBS). The objective of this study is to compare the diagnostic usefulness of Tg measurements 24 and 72 h after rhTSH administration, and 131I WBS. Patients and methods: 181 patients were included who had been referred to our Nuclear Medicine Department for follow-up after 131I ablation of DTC. Tg measurements 24 h (Tg24) and 72 h (Tg72) after rhTSH, and 131I WBS, were done in all patients. The lower detection limit of Tg was 0,2 μg/l. Results: 47 patients (26%) had detectable Tg levels: in 4/47 cases (8%) only Tg24 was detectable (always <1 μg/l), and in 6/47 cases (11%), only Tg72 was detectable. In 10/47 patients with detectable Tg-levels, Tg24 and Tg72 tested equally. In 27/47 cases, Tg24 was lower, and in 10/47 higher, than Tg72. Two patients with one or two positive Tg-test results also had a positive 131I WBS. In 8 patients (14%) only the 131I WBS was positive; an anatomical substrate for such a Tgnegative positive WBS was confirmed in only 2 patients. Conclusion: Tg-measurement 72 hours after rhTSH injection reveals all clinically relevant detectable Tg-levels. Diagnostic 131I scintigraphy may be omitted, even in highrisk patients.
Zusammenfassung
Die Messung von Thyreoglobulin (Tg) im Follow-up von Patienten mit differenzierten Schilddrüsenkarzinomen (DTC) sollte laut Hersteller 72 Stunden nach Verabreichung von rekombinantem humanem Thyrotropin (rhTSH) erfolgen. In unserer Abteilung erfolgen Tg-Messungen 24 und 72 h nach rhTSH-Gabe zusammen mit einer 72h-post-rhTSH 131I Ganzkörperszintigraphie (GKS). Ziel dieser Studie ist der Vergleich des diagnostischen Nutzens der Tg-Messungen 24 und 72 h nach rhTSH und 131I-GKS. Patienten und Methoden: 181 Patienten, die in unsere nuklearmedizinische Abteilung zum Follow-up nach 131I Ablation von DTC überwiesen worden waren, nahmen an dieser Studie teil. In allen Patienten wurden Tg-Messungen 24 h (Tg24) und 72 h (Tg72) nach rhTSH und 131I-GKS durchgeführt. Die untere Nachweisgrenze der Tg-Bestimmung war 0,2 μg/l. Ergebnisse: 47 Patienten (26%) hatten nachweisbare Tg-Werte: in 4/47 Fällen (8%) war nur Tg24 nachweisbar (immer <1 μg/l), und in 6/47 Fällen (11%), war nur Tg72 nachweisbar. In 10/47 Patienten mit nachweisbaren Tg-Werten waren Tg24 und Tg72 gleichwertig. In 27/47 Fällen war Tg24 niedriger, in 10/47 höher als Tg72. Zwei Patienten mit einem oder zwei positiven Tg-Testergebnissen zeigten auch eine positive 131I GKS. In 8 Patienten (14%) war nur die 131I GKS-positiv; ein anatomisches Korrelat für eine solche Tg-Negative, positive GKS wurde in nur 2 Patienten gefunden. Schlussfolgerung: Tg-Messung 72 Stunden nach Injektion von rhTSH zeigt alle klinisch relevanten, nachweisbaren Tg-Werte. Auf diagnostische 131I Ganzkörperszintigraphie kann verzichtet werden, auch bei Patienten mit hohem Risiko.
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References
- 1 Cooper DS, Doherty GM, Haugen BR. et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16: 109-142.
- 2 Haugen BR, Pacini F, Reiners C. et al. A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab 1999; 84: 3877-3885.
- 3 Haugen BR, Ridgway EC, McLaughlin BA. et al. Clinical comparison of whole-body radioiodine scan and serum thyroglobulin after stimulation with recombinant human thyrotropin. Thyroid 2002; 12: 37-43.
- 4 Luster M, Felbinger R, Dietlein M. et al. Thyroid hormone withdrawal in patients with differentiated thyroid carcinoma: a one hundred thirty-patient pilot survey on consequences of hypothyroidism and a pharmacoeconomic comparison to recombinant thyrotropin administration. Thyroid 2005; 15: 1147-1155.
- 5 Mazzaferri EL, Robbins RJ, Spencer CA. et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 2003; 88: 1433-1441.
- 6 Mernagh P, Campbell S, Dietlein M. et al. Cost-effectiveness of using recombinant human TSH prior to radioiodine ablation for thyroid cancer, compared with treating patients in a hypothyroid state: the German perspective. Eur J Endocrinol 2006; 155: 405-414.
- 7 Niederkohr RD, McDougall IR. Reproducibility ofwhole-body 131I scan and serum thyrotropin and stimulated thyroglobulin values in patients studied twice after injection of recombinant human thyrotropin. Eur J Nucl Med Mol Imaging 2007; 34: 363-367.
- 8 Pacini F, Agate L, Elisei R. et al. Outcome of differentiated thyroid cancer with detectable serum Tg and negative diagnostic 131I whole body scan: comparison of patients treated with high 131I activities versus untreated patients. J Clin Endocrinol Metab 2001; 86: 4092-4097.
- 9 Pacini F, Molinaro E, Castagna MG. et al. Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma. J Clin Endocrinol and Metab 2003; 88: 3668-3673.
- 10 Pacini F, Molinaro E, Lippi F. et al. Prediction of disease status by recombinant human TSH-stimulated serum Tg in the postsurgical follow-up of differentiated thyroid carcinoma. J Clin Endocrinol Metab 2001; 86: 5686-5690.
- 11 Robbins RJ, Chon JT, Fleisher M. et al. Is the serum thyroglobulin response to recombinant human thyrotropin sufficient, by itself, to monitor for residual thyroid carcinoma?. J Clin Endocrinol Metab 2002; 87: 3242-3247.
- 12 Robbins RJ, Tuttle RM, Sharaf RN. et al. Preparation by recombinant human thyrotropin or thyroid hormone withdrawal are comparable for the detection of residual differentiated thyroid carcinoma. J Clin Endocrinol Metab 2001; 86: 619-625.
- 13 Schlumberger M, Berg G, Cohen O. et al. Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective. Eur J Endocrinol 2004; 150: 105-112.
- 14 Schroeder PR, Haugen BR, Pacini F. et al. A comparison of short-term changes in health-related quality of life in thyroid carcinoma patients undergoing diagnostic evaluation with recombinant human thyrotropin compared with thyroid hormone withdrawal. J Clin Endocrinol Metab 2006; 91: 878-884.
- 15 Verburg FA, de Keizer B, Lips CJ. et al. Prognostic significance of successful ablation with radioiodine of differentiated thyroid cancer patients. Eur J Endocrinol 2005; 152: 33-37.