A 17 years old girl was totaly thyroidectomized for Graves disease and histologic examination revealed a focus of papillary carcinoma of 8 mm. Post thyroidectomy the TRAB is 10,5U/l (normal values < 11), ATPO is >600 UI/ml( normal values <34), and ATGL is 51,43 UI/ml (normal values < 115).
How do I best manage the patient? Shall I send her to radioiodine therapy or shall I just supress her TSH and check her thyroglobulin? Is the increased TRAB titer important in deciding therapy in this case?Any advice will be greately appreciated.
Dr Cristina Dumitrescu, Endocrinologist, Bucharest.
The patient is probably cured. TRAb can stimulate growth of thyroid cancer. Follow up with TG will be difficult in view of the positive antibodies. Although one could simply follow on T4 with occasional US, personally I would prefer to ablate the residual (if any) . A negative scan would then be useful, and in time her TG antibodies should decline. You may still wish to do occasional ultrasounds.
L De Groot,MD