Defining a rational step-care algorithm for managing thyroid carcinoma patients with elevated thyroglobulin and negative on radioiodine scintigraphy (TENIS): considerations and challenges towards developing an appropriate roadmap

Excerpt

One of the most challenging clinical situations in patients with differentiated thyroid cancer (DTC) is an elevated serum thyroglobulin (Tg) level with negative radioiodine scintigraphy (commonly termed “TENIS”). The diagnostic and therapeutic approaches adopted by attending physicians in day-to-day routine vary quite widely. The main reason for this variation is the rarity of the condition (2 – 13 % from various series reported in literature), and its management, especially therapeutic strategies, continues to be imperfect in the absence of a clear-cut understanding and lack of evidence of its aetiology, as observed by various authorities [1]. In this editorial, we discuss the different therapeutic strategies that have been explored and the associated pitfalls in interpretation of clinical findings, and propose a logical step-wise algorithmic approach to care to follow in routine clinics in this particular group of patients. Our views are supported by an overview of the evidence in the literature (with respect to both efficacy and adverse effects) and by practical experience. In addition, we critically review and analyse the steps needed in the immediate future to enhance and rationalize patient care. We believe that such endeavours to identify and prioritize the challenges will further the roadmap to the development of a systematic and scientific approach to the management of patients with TENIS. …