Saghari Mohsen, Gholamrezanezhad Ali, Mirpour Sahar, Eftekhari Mohammad, Takavar Abbas, Fard-Esfahani Armaghan, Fallahi Babak, Beiki Davood
Research Institute of Nuclear Medicine, Tehran University of Medical Sciences, Iran.
Nucl Med Commun. 2006 Jul;27(7):567-72. doi: 10.1097/00006231-200607000-00004.
In the management of patients with differentiated thyroid carcinoma, serum thyroglobulin levels are often well correlated with whole-body radioiodine scanning (WBS) results. However, occasionally, a mismatched result - increased thyroglobulin with negative WBS - is observed. Radioiodine therapy has been suggested as a therapeutic choice with controversial results.
We studied 32 differentiated thyroid carcinoma patients with elevated thyroglobulin level and negative WBS who had been treated with high-dose radioiodine. With a mean follow-up of 25.6 months (all follow-ups >11 months), thyroglobulin and thyroid-stimulating hormone levels, WBS, clinical, radiographic and pathological findings following treatment were recorded.
The mean pre-therapy off-treatment thyroglobulin was 152 +/- 119.0 ng.ml(-1). Although there was a mild trend towards an increase in thyroglobulin in the first post-treatment year, the difference was not significant. At the end of the follow-ups, 22 patients (68.7%) were categorized as non-responders to radioiodine therapy (any change or elevation of thyroglobulin or radiological and pathological evidences of progression), four patients (12.5%) as partial responders (transient reduction but not a normalization of thyroglobulin) and six patients (18.7%) as responders (normalization of thyroglobulin with no evidence of remnant disease). In nine of 10 partial and complete responders, reduction or normalization of thyroglobulin had occurred in the first post-treatment year.
We recommend that in differentiated thyroid carcinoma patients with elevated thyroglobulin and negative WBS, at least one course of radioiodine therapy should be undertaken and if reduction or normalization of serum thyroglobulin is not achieved, repeated courses of radioiodine therapy are not logical and other therapeutic methods should be applied.
在分化型甲状腺癌患者的管理中，血清甲状腺球蛋白水平通常与全身放射性碘扫描（WBS）结果密切相关。然而，偶尔会观察到结果不匹配的情况——甲状腺球蛋白升高而WBS结果为阴性。放射性碘治疗已被建议作为一种治疗选择，但结果存在争议。
我们研究了32例分化型甲状腺癌患者，这些患者甲状腺球蛋白水平升高且WBS结果为阴性，均接受了高剂量放射性碘治疗。平均随访25.6个月（所有随访时间均>11个月），记录治疗后甲状腺球蛋白和促甲状腺激素水平、WBS、临床、影像学和病理学检查结果。
治疗前停用甲状腺激素后的甲状腺球蛋白平均水平为152±119.0 ng/ml（-1）。尽管治疗后的第一年甲状腺球蛋白有轻微升高趋势，但差异不显著。随访结束时，22例患者（68.7%）被归类为放射性碘治疗无反应者（甲状腺球蛋白有任何变化或升高，或有影像学和病理学进展证据），4例患者（12.5%）为部分反应者（甲状腺球蛋白短暂降低但未恢复正常），6例患者（18.7%）为反应者（甲状腺球蛋白恢复正常且无残留疾病证据）。在10例部分反应者和完全反应者中，有9例在治疗后的第一年甲状腺球蛋白降低或恢复正常。
我们建议，对于甲状腺球蛋白升高且WBS结果为阴性的分化型甲状腺癌患者，应至少进行一个疗程的放射性碘治疗，如果血清甲状腺球蛋白未降低或恢复正常，重复进行放射性碘治疗是不合理的，应采用其他治疗方法。
