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Postoperative Stimulated Thyroglobulin of Less Than 1 ng/mL as a Criterion to Spare Low-Risk Patients with Papillary Thyroid Cancer from Radioactive Iodine Ablation

2012; Mary Ann Liebert, Inc.; Volume: 22; Issue: 11 Linguagem: Inglês

10.1089/thy.2012.0190

1557-9077

Pedro Weslley Rosário, Augusto Flávio Campos Mineiro Filho, Brenda Sá Senna Prates, Lívia Cristina Oliveira Silva, Maria Regina Calsolari,

Thyroid and Parathyroid Surgery

Background: Stimulated thyroglobulin (Tg) ≤1 ng/mL after thyroidectomy (after L-thyroxine [L-T4] withdrawal or administration of recombinant human thyrotropin [rhTSH]) has been proposed as a criterion to spare patients with papillary thyroid cancer (PTC), who are at low risk of recurrence, from ablation with iodine-131 (131I). The objective of this prospective study was to evaluate the recurrence rate using this approach. Methods: This prospective study included 136 patients with PTC who underwent total thyroidectomy with apparently complete tumor resection and who presented no signs of persistent disease after surgery. The patients were classified as low risk of recurrence (nonaggressive histology, T1b—3 N0 M0). All patients had stimulated Tg ≤1 ng/mL, negative anti-Tg antibodies (TgAb), and neck ultrasound (US) showing no anomalies ∼16 weeks after thyroidectomy, and none of them were submitted to ablation with 131I. The time of follow-up ranged from 12 to 72 months (median: 44 months). Results: Among the patients studied, 134 (98.5%) continued to have serum Tg concentrations of 4 cm or minimal extrathyroid invasion (T3 N0 M0). Conclusions: Low-risk patients with PTC who have stimulated Tg ≤1 ng/mL after thyroidectomy do not require ablation with 131I.