High Serum Tg Levels and Negative Whole Body 131I Imaging

The main consequence of applying sensitive diagnostic tests during follow-up is identifying patients with elevated serum Tg levels and negative 131I imaging studies. This is a complex problem that requires careful evaluation but sometimes identifies patients with early metastatic tumor that is often highly amenable to 131I therapy. This problem is reviewed in depth in Chapter 20. The new management and

Phase l First FoIIowup after Surgery

Phase l First FoIIowup after Surgery

Whole Body Medical Indication
Figure 1.10 The first phase of follow-up of DTC occurs about 1-2 months after surgery.* This indication for rhTSH is not approved by the US FDA, but the drug can be used in selected patients (see text).

Phase 2 Followup after 131I Remnant Ablation

Phase 2 Followup after 131I Remnant Ablation

Further Imaging (FDG-PET, CT)

Figure 1.11 The second phase of follow-up of DTC occurs about 6-12 months after surgery.

Further Imaging (FDG-PET, CT)

Figure 1.11 The second phase of follow-up of DTC occurs about 6-12 months after surgery.

Phase 3 Long-term Followup

Tg Value

No Rise 60-70%

Recommendation

Prompt Evaluation TSH 0.1uU/mL

Periodic rhTSH Tg Until no rise TSH 0.3 MU/mL

Annual THST -Tg TSH 0.5 mUML

Baseline Tg rhTSH Tg Figure 1.12 The third phase of follow-up of DTC occurs after the patient has no evidence of tumor.

follow-up paradigms described in this book offer substantial improvement over those used in the past.

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