Abstract
The extend, intensity and timing of the follow-up of differentiated thyroid cancer (DTC) patients remains unclear. Recent studies identified an undetectable TSH stimulated Tg measurement after one year as a prognostic factor for the risk of recurrence during further follow-up, thereby further dividing patients based on risk for recurrence. Because patients experience their disease on an emotional basis rather than related to actual disease severity, follow-up should be targeted to detect recurrence without ‘over-investigating’ patients. The aim of our study was to investigate the recurrence rate in high and low risk patients with DTC and the need for repeated (TSH stimulated) Tg measurement. Methods: We retrospectively reviewed the medical records of 264 DTC patients with absent Tg-Ab and identified the patients with persistent/ recurrent disease. We compared recurrence rates between patients with and without detectable TSH-stimulated Thyroglobulin levels. Results: Recurrence rate was significantly higher in patients with positive stimulated Tg measurement within one year after treatment (p<0.001) While the negative predictive value (NPV) of an undectectable Tg was 0.97 for both high and low risk patients. The percentage of high risk patients with undetectable Tg after one year however is significantly lower compared to low risk patients. Conclusion: Recurrence rates for patients with undectable TSH stimulated Tg one year after initial diagnosis is very low and identical for low and high risk patients. Therefore it seems sensible to discharge patients from a strict specialist follow-up regime.
Highlights
The main focus in the post surgical follow-up of patients with differentiated thyroid cancer (DTC) is the detection of persistent or recurrent disease
Recurrence rate was significantly higher in patients with positive stimulated Tg measurement within one year after treatment (p
Because traditional treatment of DTC larger than 1 cm in our center consists of total thyroidectomy followed by I-131 ablation of the remaining thyroid tissue, this follow-up can be performed using TSH stimulated thyroglobulin (Tg) measurements
Summary
The main focus in the post surgical follow-up of patients with differentiated thyroid cancer (DTC) is the detection of persistent or recurrent disease. The majority of patients with DTC are initially classified as low risk patients This could be explained by the increased use and sensitivity of ultrasound. Low risk patients with excellent response to therapy could be classified as real low risk patients with minimal chance of recurrent disease during further follow-up. Baudin et al [2] for example showed that the recurrence rate in low risk patients with undetectable Tg levels at the time of performing the control WBS was only 0.6%.Several other recent studies show very high negative predictive value of TSH stimulated Tg measurement one year after initial therapy for the risk of recurrence [3,4,5]
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