Brendel A J, Lambert B, Guyot M, Jeandot R, Dubourg H, Roger P, Wynchauk S, Manciet G, Lefort G
Hopital Univ. Pellegrin, Bordeaux, France.
Eur J Nucl Med. 1990;16(1):35-8. doi: 10.1007/BF01566010.
We evaluated the reliability of very low serum thyroglobulin (Tg) levels (less than 3 ng/ml) obtained after withdrawal of thyroid suppression therapy in 224 patients without anti-Tg antibodies, who had undergone total thyroidectomy (125 patients) or thyroidectomy followed by 1 or more courses of 131I therapy (99 patients), by performing whole body scans after a therapeutic course of 131I given at the same time of Tg measurement. In 79 patients (35%) a positive scan, associated with a very low level of Tg, was noted. The 131I uptake was limited to the thyroid bed in 60 patients, but metastases were demonstrated in 19 patients (8.5%). These results are mainly explained by the much improved performance of scintigraphy after administration of therapeutic doses of 131I. In the majority of patients, especially those whose 131I uptake was limited to the thyroid bed, further scans were negative. Therefore, in these cases, negative Tg values can generally be considered an early indication of satisfactory evolution. However, in 8.5% of all cases, very low Tg levels were associated with metastases. Thus the follow up of thyroid cancer should not rely only upon Tg determination, even after suppression therapy withdrawal.
我们评估了224例无抗甲状腺球蛋白（Tg）抗体、接受了甲状腺全切术（125例）或甲状腺切除术后接受1个或更多疗程131I治疗（99例）的患者，在停用甲状腺抑制治疗后所测得的极低血清Tg水平（低于3 ng/ml）的可靠性。在测量Tg的同时给予一个疗程的131I治疗后，进行全身扫描。在79例患者（35%）中，发现扫描阳性且Tg水平极低。60例患者的131I摄取局限于甲状腺床，但19例患者（8.5%）显示有转移。这些结果主要是由于给予治疗剂量的131I后，闪烁扫描的性能有了很大改善。在大多数患者中，尤其是那些131I摄取局限于甲状腺床的患者，进一步扫描为阴性。因此，在这些病例中，Tg值阴性通常可被视为病情进展良好的早期指标。然而，在所有病例的8.5%中，极低的Tg水平与转移有关。因此，即使在停用抑制治疗后，甲状腺癌的随访也不应仅依赖于Tg测定。
