Skip to main content
SpringerLink
Log in

Prognostic implication of thyroglobulin and quantified whole body scan after initial radioiodine therapy on early prediction of ablation and clinical response for the patients with differentiated thyroid cancer

  • Original article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

To investigate predictors for successful ablation and disease-free status after high-dose radioiodine therapy in patients with differentiated thyroid cancer.

Methods

We enrolled 173 consecutive patients with differentiated thyroid cancer between November 2001 and December 2004 retrospectively (female 145, 46 ± 12 years). All patients underwent total thyroidectomy and I-131 ablative therapy (IAT) (3.7–5.4 GBq). The success or failure of ablation was assessed 6–9 months after the IAT with reference to undetectable thyroglobulin (Tg) and negative I-131 whole body scan (WBS). Afterward, the decision for disease-free status was evaluated using Tg and WBS (follow-up period after 1st IAT 7–81 months, median 43 months, criteria of disease-free: less than 10 ng/ml TSH-stimulated Tg or less than 2 ng/ml TSH-unstimulated Tg and/or negative WBS). Clinical and tumoral factors such as sex, age, pathologic type, the size of tumor, quantified cervical uptake in WBS1, pattern in WBS1, ablative therapy dose, AJCC stage, lymph node (LN) stage, Tg just before IAT (Tg1), and ablation status were assessed using logistic regression analyses.

Results

There were 93 successful ablations (54 %). Significant predictors for the ablation failure were Tg1 (OR = 8.42; 95 % CI = 2.76–25.69; p < 0.0001), LN metastasis (OR = 3.05; 95 % CI = 1.11–8.37; p = 0.031), and quantified cervical uptake in WBS1 (OR = 4.95; 95 % CI = 1.07–22.88; p = 0.041). One hundred fifty-five patients were determined as disease-free after follow-up. All the eighteen patients with persistent disease were identified as ablation failure after first IAT. Significant predictors for the disease-free status were Tg1 (OR = 0.98; 95 % CI = 0.97–0.99; p = 0.028), tumor size (OR = 0.53; 95 % CI = 0.28–0.96; p = 0.044), and quantified cervical uptake in WBS1 (OR = 0.87; 95 % CI = 0.76–0.98; p = 0.024).

Conclusions

The thyroglobulin and quantified cervical uptake in whole body scan are significant predictors for the successful ablation and disease-free status after follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418–28.

    Article  PubMed  CAS  Google Scholar 

  2. Maxon HR 3rd, Smith HS. Radioiodine-131 in the diagnosis and treatment of metastatic well differentiated thyroid cancer. Endocrinol Metab Clin N Am. 1990;19:685–718.

    Google Scholar 

  3. Samaan NA, Schultz PN, Hickey RC, Goepfert H, Haynie TP, Johnston DA, et al. The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab. 1992;75:714–20.

    Article  PubMed  CAS  Google Scholar 

  4. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338:297–306.

    Article  PubMed  CAS  Google Scholar 

  5. Sherman SI, Tielens ET, Sostre S, Wharam MD Jr, Ladenson PW. Clinical utility of posttreatment radioiodine scans in the management of patients with thyroid carcinoma. J Clin Endocrinol Metab. 1994;78:629–34.

    Article  PubMed  CAS  Google Scholar 

  6. Toubeau M, Touzery C, Arveux P, Chaplain G, Vaillant G, Berriolo A, et al. Predictive value for disease progression of serum thyroglobulin levels measured in the postoperative period and after I-131 ablation therapy in patients with differentiated thyroid cancer. J Nucl Med. 2004;45:988–94.

    PubMed  CAS  Google Scholar 

  7. Pacini F, Schlumberger M, Harmer C, Berg GG, Cohen O, Duntas L, et al. Post-surgical use of radioiodine (I-131) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report. Eur J Endocrinol. 2005;153:651–9.

    Article  PubMed  CAS  Google Scholar 

  8. Verburg FA, de Keizer B, Lips CJ, Zelissen PM, de Klerk JM. Prognostic significance of successful ablation with radioiodine of differentiated thyroid cancer patients. Eur J Endocrinol. 2005;152:33–7.

    Article  PubMed  CAS  Google Scholar 

  9. Cailleux AF, Baudin E, Travagli JP, Ricard M, Schlumberger M. Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer? J Clin Endocrinol Metab. 2000;85:175–8.

    Article  PubMed  CAS  Google Scholar 

  10. Menendez Torre E, Lopez Carballo MT, Rodriguez Erdozain RM, Forga Llenas L, Goni Iriarte MJ, Barberia Layana JJ. Prognostic value of thyroglobulin serum levels and I-131 whole-body scan after initial treatment of low-risk differentiated thyroid cancer. Thyroid. 2004;14:301–6.

    Article  PubMed  Google Scholar 

  11. Baudin E, Do Cao C, Cailleux AF, Leboulleux S, Travagli JP, Schlumberger M. Positive predictive value of serum thyroglobulin levels, measured during the first year of follow-up after thyroid hormone withdrawal, in thyroid cancer patients. J Clin Endocrinol Metab. 2003;88:1107–11.

    Article  PubMed  CAS  Google Scholar 

  12. Kim TY, Kim WB, Kim ES, Ryu JS, Yeo JS, Kim SC, et al. Serum thyroglobulin levels at the time of I-131 remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2005;90:1440–5.

    Article  PubMed  CAS  Google Scholar 

  13. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:109–42.

    Article  PubMed  Google Scholar 

  14. Robbins RJ, Chon JT, Fleisher M, Larson SM, Tuttle RM. Is the serum thyroglobulin response to recombinant human thyrotropin sufficient, by itself, to monitor for residual thyroid carcinoma? J Clin Endocrinol Metab. 2002;87:3242–7.

    Article  PubMed  CAS  Google Scholar 

  15. Lind P, Kohlfurst S. Respective roles of thyroglobulin, radioiodine imaging, and positron emission tomography in the assessment of thyroid cancer. Semin Nucl Med. 2006;36:194–205.

    Article  PubMed  Google Scholar 

  16. Lee HJ, Rha SY, Jo YS, Kim SM, Ku BJ, Shong M, et al. Predictive value of the preablation serum thyroglobulin level after thyroidectomy is combined with postablation I-131 whole body scintigraphy for successful ablation in patients with differentiated thyroid carcinoma. Am J Clin Oncol. 2007;30:63–8.

    Article  PubMed  Google Scholar 

  17. Pacini F, Capezzone M, Elisei R, Ceccarelli C, Taddei D, Pinchera A. Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum Tg levels after initial treatment. J Clin Endocrinol Metab. 2002;87:1499–501.

    Article  PubMed  CAS  Google Scholar 

  18. Bernier MO, Morel O, Rodien P, Muratet JP, Giraud P, Rohmer V, et al. Prognostic value of an increase in the serum thyroglobulin level at the time of the first ablative radioiodine treatment in patients with differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2005;32:1418–21.

    Article  PubMed  CAS  Google Scholar 

  19. Muratet JP, Giraud P, Daver A, Minier JF, Gamelin E, Larra F. Predicting the efficacy of first iodine-131 treatment in differentiated thyroid carcinoma. J Nucl Med. 1997;38:1362–8.

    PubMed  CAS  Google Scholar 

  20. Rosario PW, Maia FF, Cardoso LD, Barroso A, Rezende L, Padrao EL, et al. Correlation between cervical uptake and results of postsurgical radioiodine ablation in patients with thyroid carcinoma. Clin Nucl Med. 2004;29:358–61.

    Article  PubMed  Google Scholar 

  21. Rosario PW, Reis JS, Barroso AL, Rezende LL, Padrao EL, Fagundes TA. Efficacy of low and high I-131 doses for thyroid remnant ablation in patients with differentiated thyroid carcinoma based on post-operative cervical uptake. Nucl Med Commun. 2004;25:1077–81.

    Article  PubMed  Google Scholar 

  22. Beierwaltes WH, Rabbani R, Dmuchowski C, Lloyd RV, Eyre P, Mallette S. An analysis of “ablation of thyroid remnants” with I-131 in 511 patients from 1947–1984: experience at University of Michigan. J Nucl Med. 1984;25:1287–93.

    PubMed  CAS  Google Scholar 

  23. Sisson JC. Applying the radioactive eraser: I-131 to ablate normal thyroid tissue in patients from whom thyroid cancer has been resected. J Nucl Med. 1983;24:743–5.

    PubMed  CAS  Google Scholar 

  24. Logue JP, Tsang RW, Brierley JD, Simpson WJ. Radioiodine ablation of residual tissue in thyroid cancer: relationship between administered activity, neck uptake and outcome. Br J Radiol. 1994;67:1127–31.

    Article  PubMed  CAS  Google Scholar 

  25. Samuel AM, Rajashekharrao B. Radioiodine therapy for well-differentiated thyroid cancer: a quantitative dosimetric evaluation for remnant thyroid ablation after surgery. J Nucl Med. 1994;35:1944–50.

    PubMed  CAS  Google Scholar 

  26. Snyder J, Gorman C, Scanlon P. Thyroid remnant ablation: questionable pursuit of an ill-defined goal. J Nucl Med. 1983;24:659–65.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This research was supported partly by a grant from the National Cancer Center (0910030) and by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MEST) (2011-0019794). The authors declare that they have no conflict of interest. The authors thank Mr. Woo Jae Won, and Mr. Young Seok Kim for their excellent technical and generous support.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Korea Cancer Center Hospital, Seoul, Korea

    Ilhan Lim

  2. Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, 809 Madu Ilsan Goyang, Goyang, Gyeonggi, 411-769, Korea

    Seok-ki Kim

  3. Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Gyeonggi, Korea

    Seung-sik Hwang

  4. Department of Internal Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea

    Sun Wook Kim

  5. Department of Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea

    Ki Wook Chung, Han Sung Kang & Eun Sook Lee

Authors
  1. Ilhan Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seok-ki Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seung-sik Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sun Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ki Wook Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Han Sung Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eun Sook Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seok-ki Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lim, I., Kim, Sk., Hwang, Ss. et al. Prognostic implication of thyroglobulin and quantified whole body scan after initial radioiodine therapy on early prediction of ablation and clinical response for the patients with differentiated thyroid cancer. Ann Nucl Med 26, 777–786 (2012). https://doi.org/10.1007/s12149-012-0640-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-012-0640-1

Keywords

Search

Navigation