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Is the I-131 whole-body scanning proper for follow-up management of the patients with malignant struma ovarii without performing the thyroidectomy?

2005; Elsevier BV; Volume: 99; Issue: 2 Linguagem: Inglês

10.1016/j.ygyno.2005.04.017

1095-6859

Tansel Ansal Balcı, Levent Kabasakal,

Thyroid and Parathyroid Surgery

We read the article of the Makani et al. [ [1] Makani S. Kim W. Gaba A.R. Struma ovarii with a focus of papillary thyroid cancer: a case report and review of the literature. Gynecol. Oncol. 2004; 94: 835-839 Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar ] with great interest. Because we are nuclear medicine specialists, the part of the article about the management and the follow-up of the patients with Malignant Struma Ovarii especially caught our attention. The authors recommended postoperative total-body scanning with I-131 for residual disease and monitorization of the serum thyroglobulin levels for recurrence. We could not see any information within the article about if total thyroidectomy was performed after the gynecologic surgery or not. If not, how can they/we actually recognize the metastasis, recurrence, or residual tissue? It is very well known that even after total ablation of normal thyroid tissue, the sensitivity of I-131 whole-body scans is very low for detection of residual or recurrent malignant tissue [ [2] Cailleux A.F. Baudin E. Travagli J.P. Ricard M. Schlumberger M. Is diagnostic iodine 131 scanning useful after total thyroid ablation for differentiated thyroid cancer?. J. Clin. Endocrinol. Metab. 2000; 85: 175-178 Crossref PubMed Scopus (288) Google Scholar ]. If the thyroid gland is not removed, all of the I-131, which we give to the patient for whole-body scanning, will be taken up by the normal thyroid gland and nothing will remain for the pathologic tissue on the other sites of the body. We cannot easily interpret the abdominal Tc-99m uptake as the thyroid tissue, because of the various tissues that accumulate Tc-99m pertechnetate in the abdomen. In addition, we cannot monitor the serum thyroglobulin for assessment of recurrence or metastasis if the thyroid gland is not removed. Since thyroid gland normally secretes thyroglobulin, thyroglobulin can be considered as a tumor marker only in patients who have been totally ablated [ [3] Schlumberger M. Baudin F. Serum thyroglobulin determination in the follow-up of patients with differentiated thyroid carcinoma. Eur. J. Endocrinol. 1998; 138: 249-252 Crossref PubMed Scopus (163) Google Scholar ]. When we look up the literature, we can see that the removal of the thyroid gland is recommended after the diagnosis of thyroid carcinoma in struma ovarii tissue has become definite by pathological examination [ 4 Konez O. Hanelin L.G. Jenison E.L. Goyal M. Randolph W. Functioning liver metastases on an I-131 whole-body scan: a case of malignant struma ovarii. Clin. Nucl. Med. 2000; 25: 465-496 Crossref PubMed Scopus (19) Google Scholar , 5 Barrande G. Munz C. de Rochambeau B. Dazza F. Lemarois E. Aurengo A. et al. Struma ovarii or malignant ovarian goiter. A case. Presse Med. 1997; 26: 900-902 PubMed Google Scholar , 6 DeSimone C.P. Lele S.M. Modesitt S.C. Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I-131 therapy. Gynecol. Oncol. 2003; 89: 543-548 Abstract Full Text Full Text PDF PubMed Scopus (138) Google Scholar , 7 Checrallah A. Medlej R. Saade C. Khayat G. Halaby G. Malignant struma ovarii: an unusual presentation. Thyroid. 2001; 11: 889-892 Crossref PubMed Scopus (42) Google Scholar ]. So, thyroidectomy must be performed if the conditions are appropriate for these women. We just want to emphasize the importance of the removal of the thyroid gland for the follow-up of these patients from the nuclear medicine point of view.