Gutiérrez Cardo A L, Rodríguez Rodríguez J R, Borrego Dorado I, Navarro González E, Tirado Hospital J L, Vázquez Albertino R
Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
Rev Esp Med Nucl. 2007 May-Jun;26(3):138-45.
To verify the existence of patients with treated differentiated thyroid cancer (DTC) with negative 131I whole-body scanning (WBS) and high serum thyroglobulin (Tg) in the follow-up who evolve towards normalization without other therapy interventions.
Retrospective revision of the periodic examinations established in the protocol for patients with DTC, analyzing the levels of Tg found with IRMA annually in those with hormonal treatment and every 1-5 years in absence of previous hormonal treatment to WBS. Minimum surveillance of 2 years. Those who had elevated levels of Tg and WBS and other negative imaging tests in their course were selected. The characteristics of the patients selected were analysed in those whose Tg levels evolved to normalization without specific medical or surgical treatment (Group I) and those who did not reach normalization of Tg (Group II).
A total of 130 patients (17.93 %) with high levels of Tg and negative WBS were detected. Group I: 31 patients (4.28 %), 11 men and 20 women; average age at the moment of the diagnosis of 33.4 years (rank: 5-60); average surveillance: 12.4 years (+/- 7.4).
27 papillary and 4 follicular carcinoma. Average ablation dose: 3.260 GBq (88,1 mCi); average total I131 dose: 6.850 GBq (185.13 mCi). Tg normalization average time: 8.2 years. Group II: 99 patients (13.65 %), 27 men and 72 women. Average age of 40.4 years (rank: 7-76). Average surveillance: 9.8 years.
86 papillary and 13 follicular carcinoma. Average ablation dose: 3.266 GBq (88.28 mCi); average total 131I dose: 9.363 GBq (253,06 mCi). Two of the patients in group I had negative PET-FDG. There were 13 patients in whom progressive reduction of the levels of thyroglobulin without reaching normalization with negative PET-FDG was detected.
In patients with radiated DTC, deferred normalization of the levels of the serum thyroglobulin is possible. Empirical treatments cannot be considered the only factor that contributes to this result, which can occur without the administration of high-doses of 131I.
验证在随访过程中，接受过治疗的分化型甲状腺癌（DTC）患者，其131I全身扫描（WBS）结果为阴性但血清甲状腺球蛋白（Tg）水平高，且在未进行其他治疗干预的情况下甲状腺球蛋白水平恢复正常的情况是否存在。
回顾性分析DTC患者诊疗方案中规定的定期检查，分析接受激素治疗患者每年通过免疫放射分析（IRMA）检测到的Tg水平，以及未接受过WBS激素治疗的患者每1 - 5年检测到的Tg水平。最少随访2年。选取病程中Tg水平升高、WBS及其他影像学检查结果为阴性的患者。分析所选患者的特征，将Tg水平在未进行特定药物或手术治疗的情况下恢复正常的患者分为I组，未恢复正常的患者分为II组。
共检测到130例（17.93%）Tg水平高且WBS阴性的患者。I组：31例（4.28%），男性11例，女性20例；诊断时平均年龄33.4岁（范围：5 - 60岁）；平均随访时间：12.4年（±7.4年）。
27例乳头状癌和4例滤泡状癌。平均消融剂量：3.260GBq（88.1mCi）；平均131I总剂量：6.850GBq（185.13mCi）。Tg恢复正常的平均时间：8.2年。II组：99例（13.65%），男性27例，女性72例。平均年龄40.4岁（范围：7 - 76岁）。平均随访时间：9.8年。
86例乳头状癌和13例滤泡状癌。平均消融剂量：3.266GBq（88.28mCi）；平均131I总剂量：9.363GBq（253.06mCi）。I组中有2例患者PET - FDG检查结果为阴性。有13例患者检测到甲状腺球蛋白水平逐渐降低但未恢复正常，PET - FDG检查结果为阴性。
在接受放射性碘治疗的DTC患者中，血清甲状腺球蛋白水平有可能延迟恢复正常。经验性治疗不能被认为是导致这一结果的唯一因素，在未给予高剂量131I的情况下也可能出现这种情况。
