Resumé
Introduction: Thyroid cancer follow up protocol has recently been reviewed globally, in this study; we present a 20 years descriptive retrospective study froma tertiary hospital.
Method: A total of 106 patients who met the inclusion criteria out of 287 patients treated with radioactive iodine post thyroidectomy for differentiated thyroid carcinoma were reviewed.
Result: There were 91 female and 15 male; M: F of 6:1. The mean age of the patients was 45 years (range: 16-81 years). Papillary thyroid cancer was the most common 58 (55%) then follicular 30 (28%), Hurthle cell 10(9%) and the mixed papillary- follicular 8 (8%) types. The mean ages of occurrence of papillary, follicular, Hurthle and Mixed papillary and follicular cancers were 40, 49, 53
and 49 years respectively More than half of the patients 58 (53.7%) had total thyroidectomy, while 36(34%), and 12(11.3%) patients had near total thyroidectomy and lobectomy respectively. The proportion of patients with negative whole body iodine scan after radioactive iodine ablation (RIA) increased progressively from 57 to 98%, 6-24 months of follow up. The mean iodine dose
administered by the 1st 6 month of follow-up was 80mCi (range 30-200mCi) compared to total dose of 429mCi in patients that received multiple treatment (range 220-1160 mCi) At the end of first iodine treatment, 58 patients out 100 were Iodine scan negative. The remaining 42 patients became negative by the 4th treatment. Most patients had undetectable Tg level at 24 months, with a small proportion17 out of 51 (33.3%) with significantly elevated Tg among the Tg >2ng/ml group. Negative iodine scan and Tg level were concordant in 89 (72.1%) of the patients studied at 24 month and discordant in 12 (11.9%) patients. There was no tumour recurrence or rebound serum Tg up till the 24 month follow up period.
Conclusion: Repeated iodine scan is unnecessary in patients who are iodine negative with concordant serum Tg.
Keywords: Differentiated thyroid cancer, follow up, radioiodine therapy, Iodine scan, review
Résumé
Récemment, le cancer de la thyroïde suivant le protocole a été revu globalement dans cette étude, nous présentons 20 ans d’étude descriptive et rétrospective d’un hôpital tertiaire. Au total 106 patients qui obéissaient aux critères d’inclusion des 287 patients traits avec de l’idoine radioactive post thyroïdectomie pour des carcinomes de thyroïdes différenciés étaient revues. Ils y avaient 91 femelles et 15 males; M: F 6:1. La moyenne d’âge des patients était de 45 ans (variation: 16-81 ans). Le cancer de la thyroïde papillaire était le plus commun 58 des cas (55%) , suivi de cancer folliculaires 30 cas (28%), les cellules d’Hurtle 10(9%) et les types de follicules papillaires mixes 8 (8%). Les moyennes d’âge de la présentation des cancers papillaire, folliculaires, de Hurtle et de papillaire mixe étaient de 40, 49, 53 et 49 ans respectivement. Plus de la moitie des patients 58 (53.7%) avaient une thyroïdectomie, alors que 36(34%), et 12(11.3%) des patients avaient une thyroidectomie totale et lobectomie respectivement. La proportion des patients avec des résultats négatifs à l’iodine après ablation radioactive a l’iodine (ARI) qui augmentait progressivement de 57 à 98%, 6-24 mois de suivi. La dose moyenne d’iodine administrée dans les premiers 6 mois de sui était de 80mCi (Intervalle 30-200mCi) compare a la dose totale de 429mCi chez les patients qui recevaient multiple traitement (Intervalle 220-1160 mCi).A la fin du traitement à l’iodine, 58 patients sur 100 étaient des résultats négatifs. Le reste des 42 patients ne devenaient negative qu’au 4ieme traitement. Plusieurs patients avaient un taux non détectable de tg à 24 mois, avec une petite proportion de 17 des 51 cas (33.3%) avec un taux significatif élevé de tg >2ng/ml. Les taux d’iodine et de tg étaient concordants chez 89 (72.1%) des patients étudiés en 24 mois et étaient discordant chez 12 (11.9%) patients. Il n’y avait pas de tumeur récurrence ou le sérum Tg pendant les 24 mois de suivi. En conclusion, le scanner de reprise d’iodine n’est pas nécessaire chez les patients qui sont négative à l’iodine avec un taux de sérum Tg concordant.
Correspondence: Dr K.S. Adedapo, Department of Chemical Pathology, University College Hospital, PMB 5116, Ibadan. E-mail: ksadedapo@yahoo.com
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