Many of the patients with thyroid cancer thyroid has complete resection, lymph node dissection, has also had been cleared of residual iodine
Many of the patients with thyroid cancer thyroid has complete resection, lymph node dissection, has also had been cleared of residual iodine in the treatment of thyroid, thyroid globulin can not find out, that is we often say that the "graduate". Is it true that all of the patients with thyroid cancer after graduation will need to be evaluated with Tg and imaging after stopping the optimal dose of a?
Diagnostic dose of iodine scintigraphy (diagnostic whole body scan, DxWBS) when used in patients with differentiated thyroid carcinoma (DTC) follow-up, for the purpose of assessing whether a clear iodine -131 success and no iodine uptake of recurrent or metastatic lesions. So, do all DTC patients need to stop the drug for this test?
The 2015 ATA guidelines pointed out: the risk of recurrent lower risk DTC patients with iodine -131 radioiodine or adjuvant therapy, such as inhibition of Tg level determination not (no TgAb interference Tg< 0.2ng/ml), neck ultrasound negative patients, DxWBS can provide more incremental information, not for DxWBS. For patients with high risk or high risk of recurrence of high risk of DTC, you can choose to stop the review, excluding recurrence or metastasis. DxWBS negative does not represent patients with therapeutic dose imaging (treatment whole body scan, RxWBS) negative, because of low DxWBS activity, low sensitivity. When the first RxWBS positive findings, or Tg (+) RxWBS (-) patients, if there is a downward trend in the follow-up of Tg, DxWBS can not be directly treated again.
If not DxWBS, will not miss a small number of patients with incomplete removal of the thyroid gland?
If the inhibitory state of Tg level has not been determined (without TgAb interference under Tg< 0.2ng/ml), the patient has reached the success criteria for a clear, no longer need to receive a clear treatment. If the RxWBS thyroid residue, may not clear a successful and competitive inhibition metastasis uptake or cover of cervical lymph node metastasis lesions, regardless of the risk stratification of patients, follow-up can be DxWBS. On the other hand, even if the high-risk patients, radioiodine and adjuvant therapy when the iodine absorption rate of < 2%, stimulated Tg< 2ng/ml, TgAb, RxWBS showed no interference, no less residual thyroid thyroid bed area, positive DxWBS and negative neck ultrasonography no incremental information, these patients can not DxWBS. If there is no positive finding of DxWBS, no need to repeat DxWBS in 6-12 months, the follow-up should focus on the changes of Tg, TgAb, combined with other imaging examinations for dynamic risk assessment.
Reference 1 Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016; 26:1-133.
2 Rosario PW, Furtado Mde S, Mineiro Filho AF, et al. Value of diagnostic radioiodine whole-body scanning after initial therapy in patients with differentiated thyroid cancer at intermediate and high risk for recurrence. Thyroid. 2012; 22: 1165-1169.
3 Gonzalez Carvalho JM Gö rlich D, Schober, O, et al. Evaluation of 131I scintigraphy and stimulated thyroglobulin levels in the follow up of patients with DTC: a retrospective analysis of patients. Eur J Nucl Med 1420 Mol Imaging. 2016 DOI 10.1007/s00259-016-3581-4.
4 de Meer SG, Vriens MR, Zelissen PM, et al.The of diagnostic whole-body scintigraphy patients with high-risk differentiated thyroid J Nucl Med. cancer., radioiodine (52:56 - 59) in,,