Relationship between Thyroglobulin and Tumor Detectabilily with Thallium-201 in Differentiated Thyroid Cancer

Summary Aim: Tumor scintigraphy with 201-TICI is an established diagnostic method in the follow-up of differentiated thyroid cancer. We investigated the relationship between thyroglobulin (Tg) level and tumor detectability. Subject and methods: We analyzed the scans of 122 patients (66 patients with proven tumor). The patient population was divided into groups with Tg above (N = 33) and below (N = 33) 5 ng/ml under TSH suppression or above (N = 33) and below (N = 33) 50 ng/ml under TSH stimulation. Tumor detectability was compared by ROC-analysis (True-Positive-Fraction test, specificity 90%). Results: There was no significant difference (sensitivity 75% versus 64%; p = 0.55) for patients above and below 5 ng/ml under TSH suppression and a just significant difference (sensitivity 80% versus 58%; p = 0.04) for patients above and below 50 ng/ml under TSH stimulation. In 18 patients from our sample with tumor, Tg under TSH suppression was negative, but 201-TICI-scan was able to detect tumor in 12 patients. Conclusion: Our results demonstrate only a moderate dependence of tumor detectability on Tg level, probably without significant clinical relevance. Even in patients with slight Tg elevation 201-TICI scintigraphy is justified.

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Potential Impact of BMI on the Aggressiveness of Presentation and Clinical Outcome of Differentiated Thyroid Cancer

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz312 ◽

2019 ◽

Vol 105 (4) ◽

pp. e1124-e1134

Author(s):

Antonio Matrone ◽

Giovanni Ceccarini ◽

Marianna Beghini ◽

Federica Ferrari ◽

Carla Gambale ◽

...

Keyword(s):

Risk Factor ◽

Thyroid Cancer ◽

Clinical Outcome ◽

Differentiated Thyroid Cancer ◽

Normal Weight ◽

American Thyroid Association ◽

131I Treatment ◽

Therapeutic Attitude ◽

The Relationship

Abstract Background Obesity is a risk factor for several cancers, including differentiated thyroid cancer (DTC). Moreover, it has also been investigated as a potential risk factor for aggressiveness of DTC, but the data gathered so far are conflicting. The aim of our study was to evaluate the relationship between body mass index (BMI), aggressiveness of DTC at diagnosis, and clinical outcome. Methods We evaluated 1058 consecutive DTC patients treated with total thyroidectomy and enrolled at the time of first radioactive iodine (131I) treatment. Patients were divided into 4 groups based on their BMI: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Histological aggressiveness of DTC at the time of diagnosis and clinical outcome according to 2015 American Thyroid Association (ATA) guidelines were evaluated. Results No differences in histological features, ATA risk of recurrence, activity of 131I administered and prevalence of 131I avid metastatic disease after first131I treatment, have been demonstrated among the groups. Furthermore, at the end of follow up (median = 5.7 years), no differences were evident in the number of further treatments performed as well as in the clinical response. Conclusions In our study group of Caucasian subjects, we could not demonstrate any association between BMI and aggressiveness of DTC, neither at the time of diagnosis nor during follow-up. These data indicate that postsurgical assessment and therapeutic attitude for treatment and follow-up of DTC should be based on the class of risk applied to the general population, with no concern for BMI.

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Follow-up of thyroid cancer patients using rhTSH -preliminary results

Nuklearmedizin ◽

10.1055/s-0038-1623986 ◽

2001 ◽

Vol 40 (01) ◽

pp. 7-14 ◽

Cited By ~ 10

Author(s):

A. R. Börner ◽

E. Weckesser ◽

B. Soudah ◽

D. Otto ◽

A. Widjaja ◽

...

Keyword(s):

Thyroid Cancer ◽

Fdg Pet ◽

Diagnostic Procedures ◽

Tsh Suppression ◽

Preliminary Results ◽

Serum Hormone ◽

Pet Scans ◽

Radioiodine Scan ◽

Tsh Stimulation

Summary Aim: In the follow-up of patients with advanced stage thyroid cancer radioiodine scintigraphy, F-l 8-FDG PET and tumormarker hTg using stimulation with recombinant human TSH (rhTSH) were compared to the results of same diagnostic procedures during TSH-suppression or endogenous TSH-stimulation. Methods: 30 patients were investigated in hypothyroidism and after application of rhTSH regarding the serum hormone concentrations, hTg, radioiodine scans and FGD-PET scans. Results: Radioiodine avidity and FDG uptake were significantly higher in 7/30 and 3/5 patients, respectively, compared to endogenous stimulation or TSH-suppression. In about one third of patients hTg increased more than 30%. Conclusion: Our preliminary results indicate a sufficient feasibility and sensitivity of rhTSH not only in the follow-up by hTg and radioiodine scan but also in FDG-PET.

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Recombinant human thyrotropin preparation for adjuvant radioiodine treatment in children and adolescents with differentiated thyroid cancer

Acta Endocrinologica ◽

10.1530/eje-15-0562 ◽

2015 ◽

Vol 173 (6) ◽

pp. 873-881 ◽

Cited By ~ 7

Author(s):

Daria Handkiewicz-Junak ◽

Tomasz Gawlik ◽

Jozef Rozkosz ◽

Zbigniew Puch ◽

Barbara Michalik ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Clinical Investigation ◽

Medical Intervention ◽

Radioiodine Treatment ◽

Recombinant Human Thyrotropin ◽

Almost All ◽

Tsh Stimulation

AimAlthough recombinant human thyrotropin (rhTSH) is widely used in treating differentiated thyroid cancer (DTC), almost all clinical investigation has been in adults. The aim of our retrospective study was to evaluate outcomes of adjuvant, rhTSH-aided radioiodine treatment in children/adolescents with DTC and to compare them to131I therapy duringl-thyroxin withdrawal (THW).MethodsPatients with the diagnosis of DTC who were ≤18 years of age and had no signs of persistent disease at the time of131I treatment were included; 48 patients were treated after rhTSH (rhTSH group) and 82 after THW group. The median time of follow-up after therapy was 67 months and was longer in the THW group (99 vs 43 months,P<0.05).ResultsOn the day of131I administration, all but one patient had TSH levels above 25 μIU/ml. Peak TSH concentration was significantly higher in the rhTSH group (152 μIU/ml vs 91 μIU/ml). Similarly, the thyroglobulin concentration was higher in the rhTSH group (9.7 ng/ml vs 1.8 ng/ml). No side effects requiring medical intervention were recorded after rhTSH administration. The evaluation of disease outcomes during TSH stimulation (6–18 months after131I treatment) revealed equal rates of thyroid ablation (71%) in both groups. During subsequent follow-up, five patients showed recurrence (P>0.05).ConclusionsIn children/adolescents, rhTSH-aided adjuvant radioiodine treatment is associated with rates of remnant ablation and short-term recurrence similar to THW. As this preparation has several advantages over THW, rhTSH may become the preferred method of TSH stimulation once studies of long-term outcomes show non-inferiority to THW in this age group.

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The Efficacy of Thyrotropin Suppression Therapy in Treatment of Differentiated Thyroid Cancer after Total Thyroidectomy

Forum of Clinical Oncology ◽

10.1515/fco-2015-0010 ◽

2015 ◽

Vol 6 (2) ◽

pp. 24-33

Author(s):

Niveen A. Abo-Touk ◽

Dalia H. Zayed

Keyword(s):

Thyroid Cancer ◽

High Risk ◽

Thyroid Carcinoma ◽

Differentiated Thyroid Cancer ◽

Tumour Size ◽

Differentiated Thyroid Carcinoma ◽

Tsh Suppression ◽

Significant Difference ◽

Tsh Suppression Therapy ◽

Disease Free

AbstractBackground: The aim of this prospective study was to assess the effect of the TSH suppression on both disease-free and overall survivals in patients with nonmetastatic differentiated thyroid cancer (DTC) after total thyroidectomy.Patients & Methods: One hundred and forty eight patients with pathologically proved operable differentiated thyroid carcinoma were enrolled in this prospective study. Levothyroxin (L-T4) therapy was started in doses according to treatment groups. Patients were randomly assigned to receive either postoperative TSH suppression therapy in group I (76 patients) or nonsuppression therapy in group II (72 patients).Results: During the period of follow up with a median 54 months, the disease-free survival for patients without TSH suppression therapy did not reach statistically significant difference comparing with those for patients with the suppression therapy (p=0.09). However, the difference was statistically significant for high-risk patients (p=0.04). On comparing both groups there was no statistically significant difference with regard to overall survival (p=0.17). The age of the patients more than 45 years, tumour size more than 4 cm and high-risk group were significant independent predictors for thyroid carcinoma-related relapse in univariate analysis. However, tumour size was the only significant factor in multivariate analysis.Conclusion: Suppressive treatment with L-T4 therapy in patients with differentiated thyroid carcinoma should be individualised and balanced against the adverse effects. TSH suppression is indicated in patients with high-risk disease or recurrent tumour. Normalisation of serum TSH is preferred for long-term treatment of disease-free elderly patients with DTC and comorbidities.

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Effects of TSH Suppressive Therapy On Bone Mineral Density (BMD) and Bone Turnover Markers (BTMs) in Patients with Differentiated Thyroid Cancer in Northeast China: A Prospective Controlled Cohort Study

10.21203/rs.3.rs-1056076/v1 ◽

2021 ◽

Author(s):

Shiwei Wang ◽

Yu Wang ◽

Li Zhu ◽

Liang He ◽

Mutian Lv ◽

...

Keyword(s):

Bone Mineral Density ◽

Thyroid Cancer ◽

Bone Turnover ◽

Northeast China ◽

Differentiated Thyroid Cancer ◽

Suppressive Therapy ◽

Mineral Density ◽

Significant Difference ◽

Turnover Markers

Abstract Purpose This study aimed to evaluate the effects of thyroid-stimulating hormone (TSH) suppressive therapy on bone mineral density (BMD) and bone turnover markers (BTMs) in differentiated thyroid cancer (DTC) patients after postoperative 1-2 years in Northeast China. Methods Five male, sixteen premenopausal, and eight postmenopausal female DTC patients receiving TSH suppressive therapy after thyroidectomy were enrolled. Patients were matched with healthy controls in a ratio of 1:2. All participants completed postoperative 1-year follow-up, and postmenopausal women completed 2-year follow-up. We measured BMD of the lumbar spine (LS), femoral neck (FN), and total hip (TH) using dual-energy X-ray absorptiometry (DXA). Bone formation marker P1NP and bone resorption marker β-CTX were also evaluated. Fracture risks were assessed by FRAX. Results There was no difference in BMD and BTMs between DTC patients and controls in the male group at 1-year follow-up. In the premenopausal women, the LS-BMD, FN-BMD, and TH-BMD in DTC patients were all higher than those in controls, but only FN-BMD showed a significant difference. The change rate of P1NP showed a significant difference between DTC patients and controls, while no difference was found in the β-CTX level. In the postmenopausal women, no difference in BMD and BTMs were observed between DTC patients and controls at the 1-year and 2-year follow-up. Conclusion Our study indicated that postoperative 1-year TSH suppressive therapy did not show detrimental effects on BMD and BTMs in men, premenopausal, and postmenopausal DTC patients. The 2-year postoperative TSH suppressive therapy did not lead to additional loss of bone mass in postmenopausal DTC patients.

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The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

Acta Endocrinologica ◽

10.1530/eje-16-0360 ◽

2016 ◽

Vol 175 (5) ◽

pp. 379-385 ◽

Cited By ~ 4

Author(s):

A Kukulska ◽

J Krajewska ◽

Z Kołosza ◽

E Paliczka-Cies´lik ◽

Z Puch ◽

...

Keyword(s):

Thyroid Cancer ◽

Fdg Pet ◽

Differentiated Thyroid Cancer ◽

Prognostic Significance ◽

Whole Body ◽

Asymptomatic Patients ◽

Pet Ct ◽

Fdg Pet Ct ◽

Tsh Stimulation

IntroductionAvailable methods, including serum thyroglobulin (Tg) measurement and whole-body scan (WBS) performed after radioiodine administration, allow for a precise diagnostics in differentiated thyroid cancer (DTC). However, some asymptomatic patients demonstrate negative WBS despite a high Tg serum concentration. In these subjects, fluorodeoxyglucose-positron emission tomography (FDG-PET) should be considered. The primary aim of our study was to evaluate a diagnostic value of FDG-PET in asymptomatic hyperthyroglobulinemia. The secondary one was to determine a prognostic value of a negative FDG-PET result in DTC patients with elevated Tg level.MaterialOne hundred and ten FDG-PET/CT scans were retrospectively analyzed, 85 scans were done under TSH stimulation and 25 on LT4suppressive therapy. Follow-up ranged between 4 and 9 years.ResultsThe first FDG-PET/CT detected cancer foci in 49 subjects with a global sensitivity of 45%. When the sensitivity was evaluated with reference to TSH stimulation and suppression, its values were 50 and 28% respectively. In 42 patients, FDG-PET failed to diagnose the reason for elevated Tg level. During further follow-up, in 17 of them, DTC recurrence was detected by other methods (CT, MRI, US). Fourteen subjects with asymptomatic hyperthyroglobulinemia were free of DTC progression for at least 4 years.ConclusionsFDG-PET in DTC patients with asymptomatic hyperthyroglobulinemia constitutes a valuable diagnostic tool. Negative FDG-PET demonstrated a limited prognostic significance, as only every third patient did not show DTC progression. Moreover, negative FDG-PET does not justify less strict DTC monitoring, because it is related to 40% risk of relapse during the 5-year follow-up.

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No Reason for Hypothyroidism. Five year follow-up results after combined thyroidectomy and Radio Ablation Therapy for differentiated thyroid cancer

Zeitschrift für Gastroenterologie ◽

10.1055/s-0031-1285752 ◽

2011 ◽

Vol 49 (08) ◽

Author(s):

N Emmanouilidis ◽

WH Knapp ◽

J Klempnauer ◽

GFW Scheumann

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Ablation Therapy

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Confronting the practice of surgery on differentiated thyroid cancer with current guidelines in Germany

Nuklearmedizin ◽

10.1055/s-0038-1625203 ◽

2005 ◽

Vol 44 (05) ◽

pp. 185-191 ◽

Cited By ~ 4

Author(s):

H. Wieler ◽

S. Birtel ◽

E. Ostwald-Lenz ◽

K. P. Kaiser ◽

H. P. Becker ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Survival Rates ◽

Perioperative Morbidity ◽

Referral Hospitals ◽

Principles Of Treatment ◽

Current Guidelines ◽

Papillary Microcarcinomas ◽

Retrospective Multicenter Study

Summary:Aim: For the surgical therapy of differentiated thyroid cancer precise guidelines are applied by the German medical societies. In a retrospective multicenter study, we investigated the following issues: Are the current guidelines respected?. Is there a difference concerning the surgical radicalism and the outcome?. Does the perioperative morbidity increase with the higher radicalism of the procedure?. Patients, methods: Data gained from 102 patients from 17 regional referral hospitals who underwent surgery for thyroid cancer and a following radioiodine treatment (mean follow up: 42.7 [24-79] months) were analyzed. At least 71 criterias were analyzed in a SPSS file. Results: 46.1% of carcinomas were incidentally detected during goiter surgery. The thyroid cancer (papillary n = 78; follicular n = 24) occurred in 87% unilateral and in 13% bilateral. Papillary carcinomas <1 cm were detected in 25 cases; in five of these cases (20%) contralateral carcinomas <1 cm were found. There were significant differences concerning the surgical radicalism: a range from hemithyroidectomy to radical thyroidectomy with lateral neck dissection. Analysis of the histopathologic reports revealed that lymph node dissection was not performed according to guidelines in 55% of all patients. The perioperative morbidity was lower in departments with a high case load. The postoperative dysfunction of the recurrent laryngeal nerve (mean: 7.9% total / 4.9% nerves at risk) variated highly, depending on differences in radicalism and hospitals. Up to now these variations in surgical treatment have shown no differences in their outcome and survival rates, when followed by radioiodine therapy. Conclusion: Current surgical regimes did not follow the guidelines in more than 50% of all cases. This low acceptance has to be discussed. The actual discussion about principles of treatment regarding, the socalled papillary microcarcinomas (old term) has to be respected within the current guidelines.

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