Podoba J
St. Elizabeth University College of Health and Social Work and Department of Endocrinology, St. Elizabeth Cancer Institute, Bratislava, Slovakia.
Bratisl Lek Listy. 2010;111(1):38-40.
Despite very good prognosis patients with previously treated well-differentiated thyroid cancer (DTC) require lifelong monitoring for recurrent disease. Apart from neck ultrasonography (USG) two diagnostic tests play a central role in follow-up of these patients: radioiodine whole body scanning and serum thyroglobulin (Tg) measurement. The diagnostic value of both tests is most accurate during thyroid stimulating hormone (TSH) stimulation. Temporary discontinuation of thyroid hormone therapy was previously the sole effective approach for TSH-stimulated testing. However, hormone withdrawal was associated with the morbidity of severe hypothyroidism. The introduction of recombinant human TSH (rhTSH)-stimulated testing offers an alternative way. Recent clinical trials have shown that measurement of the rhTSH-stimulated serum Tg concentration (rhTSH-Tg) alone is the most sensitive way to detect residual or recurrent thyroid cancer.
The aim of the study was to investigate rhTSH-Tg in patients considered to be cured with already finished radioiodine treatment 1-3 years ago (routine follow-up) and in patients more years after radioiodine therapy with a new indefinite (mild) suspicion for DTC recurrence and to report the first experience with this diagnostic procedure in Slovakia.
RhTSH-Tg was examined in 84 patients (72 women and 12 men) clinically free of disease, 1-3 years after finishing radioiodine therapy. Second group consisted of 4 patients (2 women and 2 men) 5, 9, 12 and 38 years after 1311 treatment with a mild suspicion of DTC recurrence.
RhTSH testing was well tolerated. No adverse events were detected. In the first group clinically free of disease undetectable rhTSH-Tg (< 0.2 ng/ml) was found in 77 patients (91.7%), Tg above diagnostic cutoff (> 2 ng/ml) in 4 patients (4.8%) and Tg in the range 0.6-2 ng/ml in 3 cases (3.6%). In all patients of second group previous indefinite suspicion of DTC recurrence was confirmed by the rhTSH-Tg rise (2.9-7.3 ng/ml).
In accordance with the literature rhTSH-Tg concentration in combination with neck USG has the highests sensitivity and negative predictive value in detecting residual or recurrent DTC (Tab. 1, Fig. 1, Ref. 14). Full Text (Free, PDF) www.bmj.sk.
尽管预后良好，但既往接受过治疗的高分化甲状腺癌（DTC）患者仍需终身监测疾病复发情况。除颈部超声检查（USG）外，两项诊断测试在这些患者的随访中发挥着核心作用：放射性碘全身扫描和血清甲状腺球蛋白（Tg）测定。在促甲状腺激素（TSH）刺激期间，这两项测试的诊断价值最为准确。既往，甲状腺激素治疗的暂时中断是TSH刺激试验的唯一有效方法。然而，激素撤药与严重甲状腺功能减退的发病率相关。重组人TSH（rhTSH）刺激试验的引入提供了另一种方法。最近的临床试验表明，单独测量rhTSH刺激的血清Tg浓度（rhTSH-Tg）是检测残留或复发性甲状腺癌最敏感的方法。
本研究的目的是调查1至3年前已完成放射性碘治疗（常规随访）且被认为已治愈的患者以及放射性碘治疗多年后对DTC复发有新的不确定（轻微）怀疑患者的rhTSH-Tg，并报告斯洛伐克首次使用这种诊断程序的经验。
对84例临床无疾病的患者（72例女性和12例男性）进行了rhTSH-Tg检测，这些患者在完成放射性碘治疗后1至3年。第二组由4例患者（2例女性和2例男性）组成，在131I治疗后5、9、12和38年，轻度怀疑DTC复发。
rhTSH检测耐受性良好。未检测到不良事件。在第一组临床无疾病的患者中，77例（91.7%）的rhTSH-Tg检测不到（<0.2 ng/ml），4例（4.8%）的Tg高于诊断临界值（>2 ng/ml），3例（3.6%）的Tg在0.6至2 ng/ml范围内。在第二组的所有患者中，rhTSH-Tg升高（2.9至7.3 ng/ml）证实了先前对DTC复发的不确定怀疑。
与文献一致，rhTSH-Tg浓度与颈部USG相结合在检测残留或复发性DTC方面具有最高的敏感性和阴性预测价值（表1，图1，参考文献1）。全文（免费，PDF）www.bmj.sk 。
