Información del artículo
Se presenta un caso clínico de cáncer diferenciado de tiroides de bajo riesgo, sólo desde el punto de vista del seguimiento a largo plazo, evaluando fundamentalmente el papel que desempeña la determinación de tiroglobulina en este seguimiento, en situación tanto de eutiroidismo como de hipotiroidismo o tras la administración de tirotropina recombinante. Se consideran las características para la determinación de tiroglobulina y también el papel que ejercen en este seguimiento otras exploraciones, tales como el rastreo con radioyodo y la ecografía cervical.
Palabras clave:
Cáncer diferenciado de tiroides de bajo riesgo
Tiroglobulina
Tirotropina recombinante
Seguimiento a largo plazo
We report a case of low-risk differentiated thyroid carcinoma from the point of view of long-term follow-up. The role played by thyroglobulin in follow-up, both in cases of euthyroidism and hypothyroidism or after administration of recombinant thyrotropin is evaluated. The characteristics for determination of thyroglobulin and the role of other investigations in follow-up, such as radioiodine scanning and cervical ultrasonography, are discussed.
Key words:
Low-risk differentiated thyroid cancer
Thyroglobulin
Recombinant thyrotropin
Long-term follow-up
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Bibliografía
[1.]
E.L. Mazzaferri, N. Massoll.
Long term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer.
Am J Med, 97 (1994), pp. 418-428
[2.]
C.A. Spencer, M. Takeuchi, M. Kazarosyan, C.C. Wang, R.B. Günter, P.A. Singer, et al.
Serum thyroglobulin antibodies: prevalence, influence on serum thyroglobulin measurament and prognosis significance in patients with differentiated thyroid carcinoma.
J Clin Endocrinol Metab, 83 (1998), pp. 1121-1127
[3.]
M.J. Schlumberger, E. Baudin.
Serum thyroglobulin determination in the follow-up of patients with differentiated thyroid carcinoma.
Eur J Endocrinol, 138 (1998), pp. 249-252
[4.]
A.F. Cailleux, E. Baudin, J.P. Travagli, M. Richard, M. Schlumberger.
Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer?.
J Clin Endocrinol Metab, 85 (2000), pp. 175-178
[5.]
R. Robbins, J.T. Chon, M. Fleisher, S.M. Larson, R.M. Tuttle.
Is the serum thyroglobulin response to recombinant human thyrotropin sufficient by itself to monitor for residual thyroid carcinoma?.
J Clin Endocrinol Metab, 87 (2002), pp. 3242-3247
[6.]
F. Pacini, R. Capezzone, C. Elisei.
Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum Tg levels after initial treatment.
J Clin Endocrinol Metab, 87 (2002), pp. 1499-1501
[7.]
E.L. Mazzaferri, R.T. Kloos.
Is diagnostic iodine-131 scanning with recombinant human TSH useful in the follow-up of differentiated thyroid cancer after thyroid ablation?.
J Clin Endocrinol Metab, 87 (2002), pp. 1490-1498
[8.]
M. Torlontano, U. Crocetti, L. D’Alosio, N. Bonfitto, A. Di Giorgio, S. Modoni, et al.
Serum thyroglobulin and 131 whole body scan after recombinant human TSH stimulation in the followup of low risk patients with differentiated thyroid cancer. The role of ultrasonography.
Eur J Endocrinology, 148 (2003), pp. 18-24
[9.]
P.W. Ladenson.
Comparison of administration of recombinant human thyrotropin with withdrawal of thyroid hormone for radioactive iodine scanning in patients with thyroid carcinoma.
N Eng J Med, 337 (1997), pp. 888-896
[10.]
B. Haugen.
A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer.
J Clin Endocrinol Metab, 84 (1999), pp. 3877-3885
[11.]
F. Pacini.
Prediction of disease status by recombinant human TSH-stimulated serum Tg in the post surgical follow-up of differentiated thyroid carcinoma.
J Clin Endocrinol Metab, 86 (2001), pp. 5686-5690
[12.]
B. Haugen.
Clinical comparison of whole-body scan and serum thyroglobulin after stimulation with recombinant human thyrotropin.
Thyroid, 12 (2002), pp. 37-43
[13.]
R. Robbins.
Preparation by recombinant human thyrotropin or thyroid hormone withdrawal are comparable for the detection of residual differentiated thyroid carcinoma.
J Clin Endocrinol Metab, 8 (2001), pp. 619-624
[14.]
E.L. Mazzaferri, R.J. Robbins, C.A. Spencer, E. Braverman, F. Pacini, L. Wartofsky, et al.
Consensus report of the role of serum thyroglobulin as a monitoring method for low risk patients with papillary thyroid carcinoma.
J Clin Endocrinol Metab, 88 (2003), pp. 1433-1441
[15.]
M. Schumberger, G. Berg, O. Cohen, L. Duntas, L. Jamar, B. Jarzab, et al.
Follow-up of low risk patients with differentiated thyroid carcinoma: a European perspective.
Eur J Endocrinology, 150 (2004), pp. 105-111
[16.]
F. Pacini, E. Molinaro, M.G. Castagna, L. Agate, R. Elisei, C. Ceccarelli, et al.
RhTSH stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma.
J Clin Endocrinol Metab, 88 (2003), pp. 3668-3673
[17.]
A. Frasoldati, M. Presenti, M. Gallo, A. Caroggio, D. Salvo, R. Valcavi.
Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma.
Cancer, 97 (2003), pp. 90-96
[18.]
M. Torlontano, M. Attard, U. Crocetti, S. Tumino, R. Bruno, G. Constante, et al.
Follow-up of low risk patients with papillary thyroid cancer: role of neck ultrasonography in detecting lymph node metastases.
J Clin Endocrinol Metab, 89 (2004), pp. 3402-3407
[19.]
E. Baudin, C. Do Cao, A.F. Cailleux, S. Leboulleux, J.P. Travagli, M. Schlumberger.
Positive predictive value of serum thyroglobulin levels, measured during the first year of follow-up after thyroid hormone withdrawal in thyroid cancer patients.
J Clin Endocrinol Metab, 88 (2003), pp. 1107-1111
[20.]
F. Pacini, L. Agate, R. Elisei, C. Ceccarelli, F. Lippi, E. Molinaro, et al.
Outcome of differentiated thyroid cancer with detectable serum Tg and negative diagnostic 131 whole scan: comparison of patients treated with high activities versus untreated patients.
J Clin Endocrinol Metab, 86 (2001), pp. 4092-4097
[21.]
Demers LM, Spencer CA. Laboratory support for the diagnosis and monitoring of thyroid disease. Disponible en: http://www.nacb.org
[22.]
J. Rodríguez-Espinosa.
Problemas en la determinación de tiroglobulina.
Endocrinol Nutr, 51 (2004), pp. 316-324
[23.]
J.L. Torrens, H.B. Burch.
Serum thyroglobulin measurement: utility in clinical practice.
Endocrinol Metab Clin North Am, 30 (2001), pp. 1-34
[24.]
AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. Endocr Pract. 2001;7:202-20.
[25.]
British Thyroid Association 2002 Guidelines for the management of differentiated thyroid cancer in adults. Disponible en: http://www.bristish-thyroid-association.org/guidelines.htm
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