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Ann Nucl Med. 2018 Oct 31. doi: 10.1007/s12149-018-1313-5. [Epub ahead of print]

An enhanced treatment effect can be expected from a higher serum thyroglobulin level after radioactive iodine therapy.

Author information

1
Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea.
2
Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea. ilhan@kcch.re.kr.
3
Department of Radiological and Medico-Oncological Sciences, University of Science and Technology, 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea. ilhan@kcch.re.kr.

Abstract

OBJECTIVE:

The aim of this study was to investigate if increased serum thyroglobulin (Tg) levels after radioactive iodine (RAI) showed more therapeutic effects in patients with differentiated thyroid cancer (DTC).

METHODS:

Data of 65 patients with DTC who underwent RAI from June 2014 to September 2016 were reviewed. Serum thyroglobulin was measured immediately before (Tg1) and 48 h (Tg2) after RAI under TSH stimulation. Differences and ratios between serum Tg measurements (DeltaTg = Tg2 - Tg1 and RatioTg = Tg2/Tg1) were calculated. The treatment response of distant metastasis was assessed using the RECIST criteria.

RESULTS:

There was no difference in the median values of Tg1 and Tg2 (2.6 [range, 0.7-1957.5] ng/mL vs. 7.4 [range, 0.7-5276.0] ng/mL, p = 0.240) in all patients (73 scans, 65 patients). In subgroup analysis, Tg levels increased slightly in patients with distant metastasis (8 scans, 7 patients) (Tg1 vs. Tg2; 48.9 [range, 2.4-1957.5] ng/mL vs. 63.2 [range, 4.4-5276.0] ng/mL, p = 0.408). Among patients with distant metastasis, one patient with a partial response to treatment had a more than 4000fold increase in Tg levels and one patient with stable disease showed a 20fold increase in Tg levels. In contrast, five patients with disease progression showed only two to eightfold increase or more than 100fold decrease in Tg levels at 48 h after RAI. However, there was a significant increase in serum Tg levels in patients without distant metastasis (65 scans, 58 patients) after RAI (Tg1 vs. Tg2; 2.0 [range, 0.7-141.9] ng/mL vs. 6.8 [range, 0.7-577.7] ng/mL, p = 0.026).

CONCLUSIONS:

A higher elevation of Tg levels after RAI may be associated with a better treatment outcome in DTC patients with distant metastasis. An increase in Tg levels after RAI may reflect the destruction of cancer and thyroid cells.

KEYWORDS:

DTC; Metastasis; Neck-to-skull ratio; Serum thyroglobulin; Treatment response

PMID:
30382500
DOI:
10.1007/s12149-018-1313-5

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