Follow-up of differentiated thyroid carcinoma.

Area of Science:

• Endocrinology and Oncology
• Thyroid Cancer Management

Background:

• Differentiated thyroid carcinoma (CTD) follow-up aims to assess remission and detect recurrence early.
• Thyroglobulin (Tg) and imaging are crucial for monitoring persistent or recurrent disease.
• Thyroglobulin antibodies can interfere with accurate Tg level assessment.

Purpose of the Study:

• To review current tools and strategies for differentiated thyroid carcinoma (CTD) follow-up.
• To highlight the evolution of imaging techniques and the role of sensitive assays.
• To discuss risk stratification based on treatment response for adapted follow-up.

Main Methods:

• Assessment of thyroglobulin (Tg) levels, with consideration for TSH stimulation and antibody interference.
• Neck ultrasonography (US) as the primary imaging modality, supplanting (131)iodine whole body scans.
• Cytological analysis of fine needle biopsies for suspicious lymph nodes and (18)FDG PET for metastatic disease.

Main Results:

• Neck ultrasonography (US) is superior to (131)iodine whole body scans for CTD follow-up.
• Standardized criteria for lymph node metastasis and fine needle aspiration biopsy improve diagnostic accuracy.
• (18)FDG PET is valuable for metastatic patients, particularly those with negative (131)I WBS.

Conclusions:

• Initial response assessment via Tg and neck US allows for risk reassessment.
• Adapted follow-up rhythms and modalities are proposed based on reassessed risk.
• Sensitive Tg assays may reduce the need for TSH stimulation in certain cases.