Roelants V, Nayer P D, Bouckaert A, Beckers C
Center of Nuclear Medicine, University of Louvain Medical School, Brussels, Belgium.
Eur J Nucl Med. 1997 Jul;24(7):722-7. doi: 10.1007/BF00879658.
A strict and careful strategy has to be adopted to cure thyroid cancer. Diagnostic iodine-131 whole-body scan (WBS) and serum thyroglobulin (Tg) are important tools to detect thyroid remnants after thyroidectomy and radioiodine therapy. The aim of this retrospective study was to compare the relative sensitivity of WBS and Tg in the detection of thyroid remnants or metastases and to evaluate the predictive value of Tg in the clinical and scintigraphic course of the disease. Ninety-three patients were followed up after total thyroidectomy and the administration 4-6 weeks later of an ablative dose of 100 or 150 mCi 131I. Eighty-five percent of the patients were free of regional or distant metastases. The follow-up scheme included clinical examination of the patient followed by WBS, Tg, thyroid-stimulating hormone and free thyroxine measurements performed 4 weeks after thyroxine withdrawal and the observance of a low-iodine diet for at least 1 week. WBS (+) patients received a 100- or 150-mCi therapeutic dose of 131I. All patients were further followed up in the same way every 6 months until both WBS and Tg became negative, and thereafter at 1-, 2- and 4-year intervals. Six months after the postoperative radioiodine treatment (first visit), the sensitivity of WBS and Tg was 87% and 26% respectively. Among patients who were WBS(+) at the first visit, 95% of those who were Tg(-) and 47% of those who were Tg(+) had become disease-free at a median of 4 years after surgery (chi2=13.6; P<0.05). Patients whose tests were both positive required more radioiodine to be cured (335+/-90 vs 250+/-95 mCi; P<0.05). Our data indicate that in early diagnosed thyroid cancer, serum Tg measured 6 months after the postoperative 131I ablative dose is less sensitive than WBS for the demonstration of persistence of residual thyroid tissue but provides predictive information on the disease course. WBS(+) and Tg(-) patients are cured earlier and with less radioiodine than those who remain Tg(+).
必须采用严格且谨慎的策略来治疗甲状腺癌。诊断性碘 - 131全身扫描（WBS）和血清甲状腺球蛋白（Tg）是检测甲状腺切除术后及放射性碘治疗后甲状腺残余组织的重要工具。这项回顾性研究的目的是比较WBS和Tg在检测甲状腺残余组织或转移灶方面的相对敏感性，并评估Tg在该疾病临床及闪烁扫描病程中的预测价值。93例患者在接受全甲状腺切除术后，于4 - 6周后给予100或150毫居里131I的消融剂量，并进行随访。85%的患者无区域或远处转移。随访方案包括对患者进行临床检查，随后进行WBS、Tg、促甲状腺激素和游离甲状腺素测量，这些测量在甲状腺素停药4周后进行，且患者需遵循至少1周的低碘饮食。WBS（阳性）患者接受100或150毫居里的131I治疗剂量。所有患者每6个月以相同方式进一步随访，直至WBS和Tg均变为阴性，此后分别在1年、2年和4年的间隔时间进行随访。术后放射性碘治疗6个月后（首次就诊），WBS和Tg的敏感性分别为87%和26%。在首次就诊时WBS（阳性）的患者中，Tg（阴性）患者中有95%以及Tg（阳性）患者中有47%在术后中位4年时疾病已治愈（χ2 = 13.6；P < 0.05）。两项检查均为阳性的患者需要更多的放射性碘才能治愈（335±90与250±95毫居里；P < 0.05）。我们的数据表明，在早期诊断的甲状腺癌中，术后131I消融剂量6个月后测量的血清Tg对于显示残余甲状腺组织的持续性不如WBS敏感，但能提供有关疾病病程的预测信息。WBS（阳性）且Tg（阴性）的患者比Tg仍为（阳性）的患者治愈得更早，且所需放射性碘更少。
