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Abstract
Papillary and follicular (differentiated) thyroid carcinomas are among the most curable cancers. However, some patients are at high risk for recurrent disease or even death. Most of these patients can be identified at the time of diagnosis by using well-established prognostic indicators.
The extent of the initial treatment and follow-up care should therefore be tailored to the level of risk.
This study included thirty patients suffering from differentiated thyroid carcinoma. They were classified in to two groups one group was 12 patients diagnosed as follicular carcinoma and second group was 18 diagnosed as papillary carcinoma and the mean age of the study groups was from 25-71 years. All patients were treated by total thyroidectomy, appropriate type of neck dissection was done and radioactive iodine ablation was carried out after one month.
All the patients were followed up post operatively by the following :
• Radio active iodine scanning (RAIS) within two weeks.
• Multi-slice computerized tomography scan and ultrasonography within two weeks.
• RAI scan after RAI ablation within two months.
• Multi-slice computerized tomography scan and ultrasonography after RI ablation within two months.
• Serum thyroglobulin after RI ablation.
In our study we found that RAI scan post operatively is highly sensitive and less specific.
As we found after two weeks RAI scan detected about 9 patients with residual thyroid tissues at the surgical bed and about 21 patients without residual. While US neck at the same time showed 2 patients with residual thyroid tissue , 28 patients without residual and 7 patients out of this 28 patients showed post operative edema and hematoma .
CT scan neck was done at the same time and revealed 4 patients with residual, 26 patients without residual tissues and about 6 out of these present with postoperative edema and hematoma.
In our study neck ultrasound is highly specific for detection of thyroid tumor remnants post operatively at either after two weeks or two month post operative compared to RAI scan in which some patients show positive scan after two weeks but they are negative by neck US.
In our study serum thyroglobulin (Tg) was done for all patients and was detectable in 5 of them with remnant tissues and about 25 patients showed normal or not detected in patients without residual tissues. And this coincides with the imaging techniques which were done while RAI scan gave false positive results by showing patients with normal serum TG ,positive for residual thyroid tissues unlike neck US & CT scan that was done for the same patients and showed negative results for tumor recurrence and normal serum Tg either after two weeks or two months post operatively.