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.
Cite this paper
Sfar, R. , Kamoun, T. , Nouira, M. , Regaieg, H. , Ammar, N. , Charfi, H. , Bahloul, A. , Fredj, M. , Chatti, K. , Guezguez, M. and Essabbah, H. (2014) Differentiated Thyroid Cancer with Thyroglobulin Elevation and Negative Iodine Scintigraphy (TENIS Syndrome). International Journal of Otolaryngology and Head & Neck Surgery
, 149-153. doi: 10.4236/ijohns.2014.34028
 Chen Chan, A., Hin Lang, B.H. and Pun Wong, K. (2003) The Pros and Cons of Routine Central Compartment Neck Dissection for Clinically Nodal Negative (cN0) Papillary Thyroid Cancer. Gland Surgery, 2, 186-195.
 Pagano, L., Klain, M., Pulcrano, M., et al. (2004) Follow-Up of Differentiated Thyroid Carcinoma. Minerva Endocrinologica, 29, 161-174.
 Cooper, D., Doherty, G.M., Haugen, B.R., et al. (2009) Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 19, 1-44. http://dx.doi.org/10.1089/thy.2009.0110
 Luster, M., Clarke, S.E., Dietlein, M., et al. (2008) Guidelines for Radioiodine Therapy of Differentiated Thyroid Cancer. European Journal of Nuclear Medicine and Molecular Imaging, 35, 1941-1959. http://dx.doi.org/10.1007/s00259-008-0883-1
 Edward, B. (2011) The Problem of the Patient with Thyroglobulin Elevation but Negative Iodine Scintigraphy: The TENIS Syndrome. Seminars in Nuclear Medicine, 41, 113-120. http://dx.doi.org/10.1053/j.semnuclmed.2010.10.002
 Mazzaferri, E.L. (2005) Empirically Treating High Serum Thyroglobulin Levels. Journal of Nuclear Medicine, 46, 1079-1086.
 Preissner, C.M., O’Kane, D.J., Singh, R.J., et al. (2003) Phantoms in the Assay Tube: Heterophile Antibody Interference in Serum Thyroglobulin Assays. The Journal of Clinical Endocrinology and Metabolism, 88, 3069-3074. http://dx.doi.org/10.1210/jc.2003-030122
 Mazzaferri, E.L., Robbins, R.J., Spencer, C.A., et al. (2003) A Consensus Report of the Role of Serum Thyroglobulin as a Monitoring Method for Low-Risk Patients with Papillary Thyroid Carcinoma. The Journal of Clinical Endocrinology and Metabolism, 88, 1433-1441. http://dx.doi.org/10.1210/jc.2002-021702
 Clark, O.H. and Hoelting, T. (1994) Management of Patients with Differentiated Thyroid Cancer Who Have Positive Serum Thyroglobulin Levels and Negative Radioiodine Scans. Thyroidology, 4, 501-505. http://dx.doi.org/10.1089/thy.1994.4.501
 Dottorini, M.E., Vignati, A., Mazzuccheli, L., et al. (1997) Differentiated Thyroid Cancer in Children and Adolescents: A 37 Year Experience in 85 Patients. Journal of Nuclear Medicine, 38, 669-675.
 Pacini, F., Agate, L., Elisei, R., et al. (2001) Outcome of Differentiated Thyroid Cancer with Detectable Serum Thyroglobulin and Negative Diagnostic Iodine Whole Body Scan: Comparison of Patients Treated with High I-131 Activities versus Untreated Patients. The Journal of Clinical Endocrinology and Metabolism, 86, 4092-4097. http://dx.doi.org/10.1210/jcem.86.9.7831
 Rosário, P.W., Maia, F.C., Barroso, A.L. and Purisch, S. (2005) Investigating Patients with Differentiated Thyroid Carcinoma and Elevated Serum Thyroglobulin but Negative Whole-Body Scan. Arquivos Brasileiros de Endocrinologia & Metabologia, 49, 246-252.