Abstract
Preablative stimulated thyroglobulin (ps‑Tg) is an important investigation in the follow‑up of patients with Differentiated thyroid cancer(DTC) after surgery. Levels of ps‑Tg >2–10 ng/ml have been suggested to predict metastasis to cervical and extracervical sites. There is still debate on the need for routine iodine whole‑body scan (131I WBS) in the management of low‑to‑intermediate‑risk DTC patients. Objective: We analyzed our data of patients with DTC who underwent total thyroidectomy to discuss the predictability of ps‑Tg on metastatic disease on the 131I WBS. Materials and Methods: Retrospective analysis of patient records. Results: One hundred and seventeen patients with DTC (95 papillary thyroid cancer [71 had classic histology, 8 had tall cell variant, 16 had follicular variant] and 22 follicular thyroid cancer [18 minimally invasive, 2 hurtle cell, and 2 widely invasive cancers]) had undergone total thyroidectomy. All these patients underwent ps‑Tg assessment and an 131I WBS. About 65% of them went on to have radioiodine ablation along with a posttherapy 131I WBS. We divided the cohort into four groups based on their ps‑Tg levels: Group 1 (ps‑Tg <1), Group 2 (ps‑Tg 1–1.9), Group 3 (ps‑Tg 2–5), and Group 4 (ps‑Tg >5). None of the patients in Group 1, 7% of those combined in Groups 2 and 3 (2 out of 28 patients), and 26% (12 out of 47) of those in Group 4 had either cervical or extracervical metastasis. Those with extracervical metastatic disease to lungs and bones had a mean (standard deviation) ps‑Tg value of 436 (130) and median of 500 ng/ml and those with cervical metastatic disease had a mean Tg value of 31 (64) and median 6.6 ng/ml. Conclusions: A ps‑Tg value in the absence of anti‑Tgantibodies <1 ng/ml reliably excludes metastatic disease in DTC, while a value >5 ng/ml has a 26% risk of having either cervical or extracervical metastasis.