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High Negative Predictive Value (NPV) Of Undetectable TSH Stimulated Tg For Disease Recurrence In Both Low And High Risk Differentiated Thyroid Cancer

 SGA de Meer, MR Vriens1, GD Valk, IHM Borel Rinkes and B de Keizer

The extend, intensity and timing of the follow-up of differentiated thyroid cancer (DTC) patients remains unclear. Recent studies identified an undetectable TSH stimulated Tg measurement after one year as a prognostic factor for the risk of recurrence during further follow-up, thereby further dividing patients based on risk for recurrence. Because patients experience their disease on an emotional basis rather than related to actual disease severity, follow-up should be targeted to detect recurrence without ‘over-investigating’ patients. The aim of our study was to investigate the recurrence rate in high and low risk patients with DTC and the need for repeated (TSH stimulated) Tg measurement. Methods: We retrospectively reviewed the medical records of 264 DTC patients with absent Tg-Ab and identified the patients with persistent/ recurrent disease. We compared recurrence rates between patients with and without detectable TSH-stimulated Thyroglobulin levels. Results: Recurrence rate was significantly higher in patients with positive stimulated Tg measurement within one year after treatment (p<0.001) While the negative predictive value (NPV) of an undectectable Tg was 0.97 for both high and low risk patients. The percentage of high risk patients with undetectable Tg after one year however is significantly lower compared to low risk patients. Conclusion: Recurrence rates for patients with undectable TSH stimulated Tg one year after initial diagnosis is very low and identical for low and high risk patients. Therefore it seems sensible to discharge patients from a strict specialist follow-up regime.