A Patient with Papillary Thyroid Cancer and Biochemical Evidence of Disease at the One-Year Follow-Up Visit

Fig. 13.1

Trend of serial basal Tg determination during the first 5 years after thyroidectomy. The graph line displays the Tg levels obtained with a highly sensitive immunometric assay (functional sensitivity, 0.2 ng/mL) at each annual visit. The corresponding TSH values are reported in the graph

Clinical Pearls

Neck ultrasound is the mainstay of follow-up for PTC patients who have not undergone post-thyroidectomy RRA, especially during the first 5 years when serum Tg levels may be relatively uninformative.
In over half of all PTC patients who have not undergone RRA, benign Tg production is already undetectable (i.e., <0.2 ng/mL) at the 1-year follow-up visit, and the percentage approaches 80 % by year 5. For this subset of patients, the specificity of a positive serum Tg assay for predicting persistent/recurrent disease is the same as it is in ablated patients.
Roughly one out of five nonablated patients will have persistent, stable low-level production (≥0.2 ng/mL). In the absence of clinical or imaging evidence of disease, watchful waiting may be the most appropriate course in these cases.

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