TITLE:
Differentiated Thyroid Cancer with Thyroglobulin Elevation and Negative Iodine Scintigraphy (TENIS Syndrome)
AUTHORS:
Raja Sfar, Tarek Kamoun, Manel Nouira, Hamza Regaieg, Nouha Ammar, Hela Charfi, Achraf Bahloul, Maha Ben Fredj, Kaouther Chatti, Mohsen Guezguez, Habib Essabbah
KEYWORDS:
Differentiated Thyroid Cancer, Thyroglobulin, Iodine, Scintigraphy, TENIS Syndrome
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.3 No.4,
June
27,
2014
ABSTRACT:
Background and Objectives:
Following the initial management, some patients with differentiated thyroid
cancer (DTC) develop a state of high thyroglobulin (Tg) and Negative Iodine
Scintigraphy. The predisposing factors and outcome of this
condition are unclear. In this study, our objectives were to analyze the
characteristics of patients with high Tg level and negative
Iodine scintigraphy and to determine the predictive factors for development of
high Tg and negative scintigraphy. Patients and Methods: Retrospective study of
34 patients undergoing treatment for DTC, followed in the Nuclear Medicine
department of the University Hospital—Sahloul Sousse between
1990 and 2006 and having a high Tg and negative
Iodine scintigraphy. Fourteen patients had Tg between 2 and 10 ng/ml, 16
had Tg between 11 and 100 ng/ml and 4 patients had Tg more than 100 ng/ml. Results: There
were 25 women and 9 men. The mean age was 51.65 years. In 94.1% of cases, the tumor
was papillary carcinoma. Follicular tumors accounted for only 5.9%. The mean
nodule size was3.26 cm.
Capsular invasion was seen in 47.1% cases. The locoregional invasion was found
in 35.3%. The lymph node extension was found in 84.8% of patients having lymph
node surgery. Lymph node involvement was observed in 92.8% of patients with
papillary cancer but it was found in 7.2% of patients with follicular cancers.
Lymph node invasion was unilateral in 28.6% (N1a) and bilateral, contralateral
or mediastinal in 71.4% (N1b). Initial level of Tg was as follows: 7 patients
had Tg between 2 and 10 ng/ml, 14 patients had Tg between 11 and 100 ng/ml and 12 had Tg more than 100 ng/ml.
The mean number of radioactive Iodine cure was 11.08 for patients with Tg more
than 100 ng/ml with a significant difference (P = 0.001). Conclusion: Among
epidemiological, pathological and clinical characteristics, lymph node invasion is the most frequent parameter
found in patients with a DTC with high Tg level and negative Iodine scintigraphy.