Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diagnostic iodine-131 whole-body scan ((131)I-WBS) and serum thyroglobulin values (Tg) performed 6 to 12 months after thyroid ablation for differentiated thyroid carcinoma were evaluated in 194 consecutive patients at the Hospital de Navarra, (Pamplona, Spain). All patients underwent near-total thyroidectomy and (131)I ablation with 3.7 GBq. Patients with positive anti-Tg antibodies or with (131)I uptake outside the neck were previously excluded. Uptake of (131)I in the thyroid bed was detected in 27 patients (13.9%). Serum Tg levels were below 0.5 ng/mL in 133 patients, ranged from 0.5-10 ng/mL in 39 patients, and was above 10 ng/mL in 22 patients. After a follow-up of 7.7 +/- 3.3 years, persistence of the illness has been observed in 2 patients with undetectable Tg (1.5%), but metastases were not detected in any case. In those with Tg higher than 0.5 ng/mL, 29 of 61 patients had persistence of the disease (47.5%) with evidence of metastases in 15 (24.5%), irrespective of the initial total body scan (131)I uptake. In conclusion, serum Tg levels obtained after thyroid ablation has a good prognostic value and permits the selection of patients for further diagnostic studies, while diagnostic (131)I-WBS performed at that time did not correlate with results of Tg and scarcely provides additional information.
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PMID:Prognostic value of thyroglobulin serum levels and 131I whole-body scan after initial treatment of low-risk differentiated thyroid cancer. 1514 64

In the present study, we examined the clinical value of a differential response of thyroglobulin (Tg) concentration after recombinant human thyrotropin (rhTSH) stimulation (rhTSH Tg testing) and its correlation with (131)I uptake and whole body scanning (rhTSH-WBS) in 104 patients who had previously undergone near total thyroidectomy and (131)I ablation for differentiated thyroid carcinoma (DTC). RhTSH Tg testing was considered negative for rhTSH-Tg < 0.9 ng/mL, low positive for rhTSH-Tg of 1-5 ng/mL and high positive for rhTSHTg > 5 ng/mL. RhTSH Tg testing was negative in 70 patients, one of whom had a lymph-node metastasis, but no (131)I uptake. Seven patients had low positive rhTSH Tg testing and no (131)I uptake, but two of these patients had cervical lymph-node metastases. Twenty-seven patients had high positive rhTSH Tg testing and (131)I uptake was detected in lung, bone, or mediastinum in 11. Imaging techniques (CT, MRI, FDG-PET) documented metastatic disease in 22. In conclusion, our results suggest that any rise in rhTSH-Tg, even at low level, should raise the suspicion of persistent or recurrent DTC. Patients with rhTSH-Tg at high level should be carefully evaluated, since DTC persistence is highly probable. TSH-WBS provides little adjunctive information.
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PMID:Clinical value of different responses of serum thyroglobulin to recombinant human thyrotropin in the follow-up of patients with differentiated thyroid carcinoma. 1675 77

In the present study we examined the clinical value of a differential response of thyroglobulin (Tg) concentration after recombinant human thyrotropin (rhTSH) stimulation (rhTSH Tg testing) and its correlation with (131)I uptake and whole-body scanning (rhTSH-WBS) in 104 patients who had previously undergone near-total thyroidectomy and (131)I ablation for differentiated thyroid carcinoma (DTC). rhTSH Tg testing was considered negative for rhTSH-Tg less than 0.9 ng/mL, low positive for rhTSH-Tg of 1-5 ng/mL and high positive for rhTSHTg greater than 5 ng/mL. rhTSH Tg testing was negative in 70 patients, 1 of whom had a lymph-node metastasis, but no (131)I uptake. Seven patients had low positive rhTSH Tg testing and no (131)I uptake, but 2 of these patients had cervical lymph node metastases. Twenty-seven patients had high positive rhTSH Tg testing and (131)I uptake was detected in lung, bone, or mediastinum in 11. Imaging techniques (computed tomography [CT], magnetic resonance imaging [MRI], fluorine-18 2-fluoro-2-deoxy-D-glucose-positron emission tomography [FDGPET]) documented metastatic disease in 22. In conclusion, our results suggest that any rise in rhTSH-Tg, even at low level, should raise the suspicion of persistent or recurrent DTC. Patients with rhTSH-Tg at high level should be carefully evaluated, because DTC persistence is highly probable. TSH-WBS provides little adjunctive information.
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PMID:Clinical value of different responses of serum thyroglobulin to recombinant human thyrotropin in the follow-up of patients with differentiated thyroid carcinoma. 1578 46

There is no doubt that the availability of recombinant human thyrotropin (rhTSH) is one of the milestones in the management of patients with differentiated thyroid cancer (DTC). It offers the opportunity to obtain representative serum thyroglobulin (Tg) levels and diagnostic whole-body scanning (Dx WBS) with 131I under adequate TSH elevation, while the patient continues to receive thyroid hormone. But rhTSH is also used with success in the treatment of local recurrences and distant metastases. In this retrospective analysis we were able to show that our excellent clinical experiences with the use of rhTSH (rare side effects and high compliance) could also be demonstrated by sufficiently elevated TSH levels and representative stimulated Tg measurements. Since April 2001 most of the patients with thyroid cancer in our hospital have undergone diagnostic examination (205 patients underwent 319 examinations) and 131I therapy (a total of 68 treatments) with rhTSH stimulation excluding the first radioiodine ablation of remnants after initial thyroidectomy. Our results show that under rhTSH stimulation 83.5% (diagnostic group) and 88% (therapy group) of our patients with DTC obtained a TSH level of greater than 80 mU/L after two injections of rhTSH (Thyrogen, Genzyme Corp., Cambridge, MA) 0.9 mg intramuscularly 24 hours and 48 hours before the administration of 131I. Only 2.3% (diagnostic group) and 0% (therapy group) demonstrated TSH levels less than 50 mU/L. Serum Tg levels under rhTSH-stimulated conditions showed that in 81.2% the serum Tg maximum was obtained on day 5. Because of the costs associated with periodically rhTSH-assisted Tg testing and based on the data of other studies we are now testing mainly on day 5 to identify residual tumor mass and to compare these Tg levels in the follow-up. Our experience demonstrates that the administration of rhTSH is a safe, effective, and-from an economic point of view- valuable tool in the management of patients with DTC.
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PMID:Recombinant human thyrotropin is helpful in the follow-up and 131I therapy of patients with thyroid cancer: a report of the results and benefits using recombinant human thyrotropin in clinical routine. 1587 62

The long-term monitoring of patients with differentiated thyroid carcinoma (DTC) is essential throughout the patient's life after total or near-total thyroidectomy followed by (131)I remnant ablation and thyroid hormone suppression of thyroid-stimulating hormone (TSH). Sensitive surveillance for DTC recurrence and metastases includes radioiodine diagnostic whole-body scanning (DWBS) and measurement of serum thyroglobulin (Tg) after endogenous or exogenous TSH stimulation. Serum Tg levels during thyroid hormone withdrawal (Tg-off) are usually well correlated with the results of DWBS. In general, undetectable Tg levels with negative DWBS (DWBS(-)) suggest complete remission, whereas detectable or elevated Tg concentrations are suggestive of the presence of (131)I uptake in local or distant metastases. However, DTC patients with discordant results of Tg measurement and (131)I WBS have been observed in the follow-up study. Negative (131)I DWBS and a positive Tg test (DWBS(-) Tg(+)) are found in most of these cases. Positive (131)I DWBS and a negative Tg test (DWBS(+) Tg(-)), though of uncommon occurrence, has also been demonstrated in a small but significant number of cases. With this scenario, one should first attempt to uncover a cause for possibly false-negative or false-positive (131)I WBS or serum Tg. Explanations for the discordance are speculative but should be scrutinized when confronted with discrepant data in a given patient.
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PMID:Possible explanations for patients with discordant findings of serum thyroglobulin and 131I whole-body scanning. 1651 26

For early diagnosis of thyroid cancer, ultrasonography (US) and US-guided fine-needle aspiration biopsy are the methods of choice. Thyroid scintigraphy using Tc-99m pertechnetate can underline the necessity of surgery in case of hypofunctioning nodules. Treatment of thyroid cancer includes total thyroidectomy and staging lymphadenectomy, in the case of lymph node metastases, radical neck dissection of the ipsilateral side. Four weeks after surgery, if TSH exceeds a value of 50 mU/l, with the exception of papillary thyroid cancer pT1a (TNM 1997), radioiodine remnant ablation using activities between 2960 and 3700 MBq I-131 is performed in all other cases. As growth of benign and malignant thyroid cells depends on TSH stimulation, thyroid hormone therapy using TSH suppressive doses (TSH, <0.03 mU/l) follows radioiodine remnant ablation. Additional fractionated external radiation therapy (50 Gy) may be administered in advanced cases (e.g., pT4 N1M0; TNM 1997). Standard follow-up of differentiated thyroid cancer includes measurement of serum thyroglobulin, US of the neck and I-131 whole-body scintigraphy (I-131 WBS). With about 98% the sensitivity of thyroglobulin is very high under TSH stimulation. In case of elevated thyroglobulin, US is the method of choice to detect local recurrences and lymph node metastases of the neck. At defined intervals of follow-up or in case of increasing thyroglobulin, I-131 WBS will be performed under TSH stimulation. With the availability of recombinant TSH (exogenous TSH stimulation) the need to withdraw thyroid hormone over a period of 3-4 weeks (endogenous TSH stimulation) is no longer necessary to perform I-131 WBS. However, in about 20-40% of cases or in the course of disease after several radioiodine therapies, recurrences or metastases may be or become iodine negative. In this case, cationic complexes such as Tc-99m Sestamibi or Tc-99m Tetrofosmin are available to detect less differentiated metastases. In the course of dedifferentiation of malignant thyroid cells, the ability of iodine uptake decreases and uptake of glucose increases. This elevated glucose metabolism can be imaged using FDG PET. Today the combination of PET (metabolic imaging) and CT (morphologic imaging) using PET/CT fusion imaging is the method of choice to image iodine-negative metastases.
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PMID:[Diagnosis, treatment and follow-up in the case of differentiated thyroid cancer]. 1642 98

This study evaluated the follow-up of high-risk patients with thyroid cancer after initial therapy. A total of 125 high-risk patients (tumor >4 cm and/or extrathyroid invasion and/or lymph node metastases, and age >45 years), with complete resection of the tumor, were selected. All patients underwent total thyroidectomy and ablation with (131)I[3.7-5.5 GBq (100-150 mCi)]. Eighteen patients (14.8%) presenting metastases on post-dose whole-body scan (RxWBS) were excluded. The negative predictive value of stimulated Tg < or =1 ng/ml in combination with neck US during first assessment (612 mo. after ablative therapy) was 96.2% for the absence of recurrence up to 5 years. This value increased to 98.7% when adding WBS performed with 185 MBq (5 mCi) (131)I (DxWBS). The positive predictive value (PPV) of stimulated Tg >1 ng/ml was 52% for the detection of the presence of metastases up to 5 years; however, considering only patients with initially negative DxWBS and US, the PPV was 19% (9% if Tg of 110 ng/ml vs. 40% if Tg >10 ng/ml). Tg levels decreased spontaneously in patients with stimulated Tg >1 ng/ml during first assessment, negative US and DxWBS, and no recurrence during follow-up, with Tg being undetectable in half these patients at the end of 5 years. Twenty patients presented uptake in the thyroid bed upon DxWBS during the first year after ablative therapy, with stimulated Tg and US being negative, and were not treated with 131I; these patients did not relapse and no uptake on DxWBS was observed in 60% after 5 years. Recurrence after 5 years was only 1.3% in patients without apparent disease (negative US and DxWBS) and stimulated Tg <1 ng/ml. An algorithm for the follow-up of high-risk patients after initial therapy is presented in this study.
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PMID:[Follow-up of high-risk patients with differentiated thyroid cancer without persistent disease after initial therapy]. 1716 Feb 15

An elevated thyroglobulin (Tg) level after total thyroidectomy for differentiated thyroid cancer is often associated with disease recurrence. 131I-whole body scans (131I-WBS) and cross-sectional imaging are commonly used to localize occult metastases in these patients. Localizing disease when 131I-WBS are negative and cross-section imaging is equivocal remains a challenge. The medical records of 12 patients with thyroid cancer undergoing positive positron emission tomography (PET) scans for 131I-WBS-negativeTg elevations or the presence of anti-Tg antibodies were identified and charts were reviewed in a retrospective fashion. All had been treated with total thyroidectomy and 131I ablation in the past. Computed tomography, magnetic resonance imaging, or ultrasound studies revealed suspicious lesions in eight patients. All 12 patients underwent resection of the PET-positive lesions. All resections were positive for thyroid cancer in the regions predicted by the positive PET scan. All nine (100%) patients with elevated preoperative Tg levels experienced a reduction in Tg level after resection. PET scans accurately predict the presence of recurrent thyroid cancer when 131I-WBS are negative. PET scans should be considered in the follow up of 131I-WBS-negative patients with thyroid cancer who are suspected of having recurrent disease.
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PMID:The role of positron emission tomography scanning in patients with radioactive iodine scan-negative, recurrent differentiated thyroid cancer. 1798 80

We present three papillary thyroid carcinoma PTC patients with brain metastases who are unusual in many aspects. The first case is a unique 3mm papillary thyroid microcarcinoma (PTMC) patient with metastases to the cerebrum and lung. The solitary cerebral lesion was identified by iodine-131 whole- body scan ((131)I-WBS) and (131)I single photon emission tomography/computed tomography (SPET/CT). Almost complete response achieved after radiosurgery. The second case is a unique PTC patient with coexistent (131)I-negative cerebrum, adrenal gland and ilium metastases, which were identified by (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI). Partial response achieved after radiosurgery. The third case is a patient with an incident solitary cystic cerebellar mass as a primary presentation of follicular variant of PTC and absent other distant metastases. In conclusion, widespread metastases from small PTMC may occur. Concomitant brain and adrenal metastases may occur in a same PTC patient. Brain metastasis may present as a cystic lesion.
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PMID:Brain metastases with exceptional features from papillary thyroid carcinoma: report of three cases. 2151 67

Differentiated thyroid cancer (DTC) is usually indolent with good prognosis and long-term survival. However, DTC distant metastasis is often a grave event and accounts for most of its disease-specific mortality. The major sites of distant metastases are the lung and bone. Metastases to the brain, breast, liver, kidney, muscle, and skin are rare or relatively rare. Nevertheless, recognizing rare metastases from DTC has a significant impact on the clinical decision making and prognosis of patients. (131)I single photon emission computed tomography/computed tomography ((131)I-SPECT/CT) can provide both metabolic and anatomic information about a lesion; therefore, it can better localize and define the (131)I-WBS findings in DTC patients. In this pictorial review, the imaging features of a range of rare metastases from DTC are demonstrated, with a particular emphasis on the (131)I-SPECT/CT diagnostic aspect.
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PMID:Rare metastases of differentiated thyroid carcinoma: pictorial review. 2163 5


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