Strategy of Pacini et al for Monitoring a Patient with a History of Differentiated Thyroid Carcinoma

 

Patient selection: history of differentiated thyroid carcinoma (follicular or papillary) treated by near total thyroidectomy and 131-I ablation

 

Findings identifying a patient who should undergo a diagnostic or therapeutic intervention:

(1) detectable serum thyroglobulin but without antithyroglobulin antibodies during L-thyroxine (L-T4) suppressive therapy

(2) conversion from undetectable serum thyroglobulin to detectable after recombinant human TSH (rhTSH) administration

(3) suspicious finding on ultrasonography of the neck (hypoechoic and dishomogeneous, rounded or bulging shape without central halo).

 

where:

• The threshold for detecting serum thyroglobulin was 1 ng/mL.

 

The above strategy may avoid the use of a 131-I whole body scan, which is specific but not very sensitive (21%). However, the whole body scan may still be useful in a patient who has been determined to be high risk for recurrent disease.