Correlation of diffuse hepatic uptake with stimulated thyroglobulin levels and remnant thyroid uptake in post-radioiodine ablation scintigraphy among patients with differentiated thyroid cancer

Document Type : Original Article

Authors

Department of Nuclear Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

10.22034/irjnm.2024.129829.1651

Abstract

Introduction: Diffuse hepatic uptake in post-radioiodine treatment whole-body scans is commonly observed. This study explored the correlation between hepatic absorption intensity, stimulated serum thyroglobulin levels, and remnant thyroid uptake in post-treatment whole-body scans.
Methods: This cross-sectional study analyzed 120 post-treatment whole-body scans from 60 patients. Fixed regions of interest (ROIs) in the liver, thyroid, and thigh areas were considered, and absorption values were systematically calculated. Patient information including corrected hepatic uptake, corrected remnant thyroid uptake, and thyroglobulin levels-was collected and subjected to statistical analysis.
Results: Statistical analysis revealed that stimulated pre-treatment Tg level (p=0.882), hepatic uptake (p=0.114), and remnant thyroid uptake (p=0.836) in post-treatment whole-body scans, had no statistical difference between the responded and non-responded groups. There was a significant positive association between stimulated pre-treatment Tg level and remnant thyroid uptake only in the responded group (p=0.001, r=0.586). Stimulated pre-treatment Tg level had no significant association with hepatic uptake in total patients (p=0.927), responded (p=0.831), and non-responded group (p=0.906). Assessing the relation of administered iodine amount with thyroid remnant uptake, revealed that there was a significant and reverse association between administered iodine amount and remnant thyroid uptake (p=0.000, r=-0.499).
Conclusion: Hepatic uptake, stimulated thyroglobulin levels, and the remaining thyroid tissue did not correlate with treatment response rates. A positive relationship exists between hepatic uptake and remaining thyroid uptake. A positive relationship only exists between stimulated pre-treatment Tg level and remnant thyroid uptake in the responded group. Additionally, a significant negative correlation with iodine intake suggests that the thyroid may be saturated.

Keywords

Main Subjects


  1. Hiller-Sturmhöfel S, Bartke A. The endocrine system: an overview. Alcohol Health Res World. 1998;22(3):153-64.
  2. Porterfield SP, Hendrich CE. The role of thyroid hormones in prenatal and neonatal neurological development--current perspectives. Endocr Rev. 1993 Feb;14(1):94-106. 
  3. Welker MJ, Orlov D. Thyroid nodules. Am Fam Physician. 2003 Feb 1;67(3):559-66.
  4. Cohen JI, Salter KD; American Thyroid Association; American Association of Clinical Endocrinologists; Associazione Medici Endocrinologi. Thyroid disorders: evaluation and management of thyroid nodules. Oral Maxillofac Surg Clin North Am. 2008 Aug;20(3):431-43.
  5. Cabanillas ME, McFadden DG, Durante C. Thyroid cancer. Lancet. 2016 Dec 3;388(10061):2783-95.
  6. Beynon ME, Pinneri K. An overview of the thyroid gland and thyroid-related deaths for the forensic pathologist. Acad Forensic Pathol. 2016 Jun;6(2):217-36.
  7. Cabanillas ME, Dadu R, Hu MI, Lu C, Gunn GB, Grubbs EG, Lai SY, Williams MD. Thyroid gland malignancies. Hematol Oncol Clin North Am. 2015 Dec;29(6):1123-43. 
  8. Sampson E, Brierley JD, Le LW, Rotstein L, Tsang RW. Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis. Cancer. 2007 Oct 1;110(7):1451-6.
  9. Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013;2013:965212.
  10. Schmidbauer B, Menhart K, Hellwig D, Grosse J. Differentiated thyroid cancer-treatment: state of the art. Int J Mol Sci. 2017 Jun 17;18(6):1292.
  11. Wei WJ, Zhang GQ, Luo QY. Postsurgical management of differentiated thyroid cancer in China. Trends Endocrinol Metab. 2018 Feb;29(2):71-3.
  12. Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001 Apr;86(4):1447-63. 
  13. Tatar FA, Morita E, Ituarte PH, Cavalieri RR, Duh QY, Price DC, Siperstein AE, Clark OH. Association between residual thyroid carcinoma and diffuse hepatic uptake of 131I following radioiodine ablation in postoperative total thyroidectomy patients. World J Surg. 2001 Jun;25(6):718-22. 
  14. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 Jan;26(1):1-133. 
  15. Polachek A, Hirsch D, Tzvetov G, Grozinsky-Glasberg S, Slutski I, Singer J, Weinstein R, Shimon I, Benbassat CA. Prognostic value of post-thyroidectomy thyroglobulin levels in patients with differentiated thyroid cancer. J Endocrinol Invest. 2011 Dec;34(11):855-60. 
  16. Jun S, Lee JJ, Park SH, Kim TY, Kim WB, Shong YK, Ryu JS. Prediction of treatment response to ¹³¹I therapy by diffuse hepatic uptake intensity on post-therapy whole-body scan in patients with distant metastases of differentiated thyroid cancer. Ann Nucl Med. 2015 Aug;29(7):603-12. 
  17. Kim K, Kim SJ, Kim IJ, Kim YK, Kim BS, Pak K. Clinical significance of diffuse hepatic visualization and thyroid bed uptake on post-ablative iodine-131 whole body scan in differentiated thyroid cancer. Onkologie. 2012;35(3):82-6. 
  18. Omür O, Akgün A, Ozcan Z, Sen C, OzkiIiç H. Clinical implications of diffuse hepatic uptake observed in postablative and post-therapeutic I-131 scans. Clin Nucl Med. 2009 Jan;34(1):11-4. 
  19. Ferris HA, Williams G, Parker JA, Garber JR. Therapeutic implications of diffuse hepatic uptake following I-131 therapy for differentiated thyroid cancer. Endocr Pract. 2013 Mar-Apr;19(2):263-7.
  20. Lee JW, Lee SM, Choi J. Clinical significance of diffuse hepatic uptake on post-therapeutic early and delayed (131)I scan in differentiated thyroid cancer: a preliminary report. Ann Nucl Med. 2015 Feb;29(2):190-7.