Outcomes of 756 patients with differentiated thyroid cancer and excellent response to treatment: an evidence‐based paradigm for long‐term surveillance strategies.

2021 ◽  
Author(s):  
Khyatisha Seejore ◽  
Omar Mulla ◽  
Georgina E Gerrard ◽  
Vanessa M Gill ◽  
Ahmed Al‐Qaissi ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Response To Treatment ◽  
Evidence Based ◽  
Excellent Response

scholarly journals Treatment and Outcomes in Differentiated Thyroid Cancer: A Retrospective Exploration in Three UK Centres That Provide Different Advice on Low Iodine Diets

2021 ◽  
Author(s):  
Clare England ◽  
Kate Ingarfield-Herbert ◽  
Matthew Beasley ◽  
Laura Moss ◽  
Sobhan Vinjamuri ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Treatment Success ◽  
Response To Treatment ◽  
American Thyroid Association ◽  
Multi Centre Study ◽  
Remnant Ablation ◽  
Excellent Response ◽  
Ablation Success ◽  
Radioiodine Remnant Ablation

Abstract Background International guidelines on the treatment of differentiated thyroid cancers promote low iodine diets (LID) before radioiodine remnant ablation. Evidence that the LID ultimately improves treatment success is inconsistent. This study aimed to determine if there is a difference in ablation success rates according to provision of advice to follow a LID.Methods Retrospective study of patients with differentiated thyroid cancer treated with total thyroidectomy and radioiodine remnant ablation between 01/01/2015 and 31/12/2016 in 3 centres advising: no LID (C1: n=108); LID for 1-week before (C2: n=50); LID for 2-weeks before and 48 hours (C3: n=59) after RRA. Response to treatment was determined by adapted American Thyroid Association Dynamic Risk Stratification Score, stratified as excellent, indeterminate, or incomplete response.Results In total, 217 patients were included in the analysis. We found differences in preparation for radioiodine remnant ablation and in the assessment of outcomes between centres. Furthermore, although there was little difference in staging between centres there was a difference in the percentage of patients receiving 1.1GBq vs higher administered activities (15% in C1, 22% in C2 and 44% in C3, p<0.001). An excellent response was recorded for 49% in C1, 48% in C2 and 36% in C3 (p=0.61). With C1 as reference group, the odds ratios (OR) for an excellent response were C2 OR: 0.96 (95% CI 0.46,2.00) and C3 OR: 0.62 (95% CI 0.29,1.30), p=0.40.Conclusions We found no evidence that advice to follow a low iodine diet for 1 or 2 weeks before radioiodine remnant ablation impacts on ablation success but differences between centres means the results should be regarded as exploratory. There is no immediate need to change practice regarding the LID, but a prospective multi-centre study with a more homogenous approach to patient management or a randomised controlled trial will provide more definitive recommendations.

scholarly journals Thyroglobulin Levels in Patients who have Undergone Hemithyroidectomy for Differentiated Thyroid Cancer. An Assessment of Levels and Trends at a Tertiary Referral Centre

2021 ◽  
Author(s):  
Ashwini Munnagi ◽  
Vijay Pillai ◽  
R. Vidhya Bushan ◽  
Vivek Shetty ◽  
Narayana Subramaniam ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Thyroid Stimulating Hormone ◽  
Response To Treatment ◽  
American Thyroid Association ◽  
Tertiary Referral Centre ◽  
Serum Thyroglobulin ◽  
Excellent Response ◽  
Thyroid Lobectomy

AbstractSerum thyroglobulin (Tg) and thyroglobulin antibody (TgAb) levels are used to monitor patients with differentiated thyroid cancer (DTC) after total thyroidectomy with or without radioiodine (RAI) ablation. However, they are also measured in patients who are treated with thyroid lobectomy (TL)/hemithyroidectomy (HT). Data on the levels of Tg and its trend in those undergoing TL/HT is sparse in India. We reviewed retrospective data of DTC patients who underwent TL/HT and were followed-up with postoperative Tg levels between 2015 and 2020. Out of 247 patients, 17 had undergone either TL or HT, which included papillary thyroid cancer (n = 12), follicular thyroid cancer (n = 4), and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 1 patient. All patients with DTC had tumor size < 4 cm (T1/2, clinical N0, Mx). The median follow-up was 15 months (range, 1–125) and the median Tg level was 7.5 ng/mL (interquartile range [IQR]; 3.6, 7.5) and ranged from 0.9 to 36.7 ng/mL. The median thyroid-stimulating hormone (TSH) level was 2.03 IU/L (IQR; 1.21, 3.59) and it ranged from 0.05 to 8.54 IU/L. As of last follow-up, none of them underwent completion thyroidectomy; however, eight patients had a decline in Tg ranging from 8 to 64%, four patients had increase in Tg ranging from 14 to 145%, three patients had stable Tg, and one of them had an increase in TgAb titers. As per American Thyroid Association (ATA) response-to-treatment category, six patients had indeterminate response, five patients had biochemical incomplete response, four patients had excellent response, and two did not have follow-up Tg and TgAb levels. While absolute values of Tg were well below 30 ng/mL in almost all patients with HT/TL, the Tg trends were difficult to predict, and only 23% of patients were able to satisfy the criteria for “excellent response” on follow-up. We suggest keeping this factor in mind in follow-up and while counselling for HT in patients with low-risk DTC.

scholarly journals The role of Hashimoto thyroiditis in predicting radioiodine ablation efficacy and prognosis of low to intermediate risk differentiated thyroid cancer

2021 ◽  
Author(s):  
Domenico Albano ◽  
Francesco Dondi ◽  
Valentina Zilioli ◽  
Maria Beatrice Panarotto ◽  
Alessandro Galani ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Treatment Response ◽  
Differentiated Thyroid Cancer ◽  
Hashimoto Thyroiditis ◽  
Prognostic Impact ◽  
Intermediate Risk ◽  
Excellent Response ◽  
Radioiodine Ablation ◽  
One Year

Abstract Objective The baseline treatment of differentiated thyroid cancer (DTC) consists of thyroidectomy followed by postoperative risk-adapted radioiodine therapy (RAIT) when indicated. The choice of most appropriate RAI activities to administer with the aim to reach an efficient remnant ablation and reduce the risk of recurrence is yet an open issue and the detection of basal factors that may predict treatment response seems fundamental. The aim of this study was to investigate the potential role of Hashimoto thyroiditis (HT) in predicting 1-year and 5-year treatment response after RAIT and prognosis. Methods We retrospectively included 314 consecutive patients (174 low-risk and 140 intermediate-risk) who received thyroidectomy plus RAIT. One-year and 5-year disease status was evaluated according to 2015 ATA categories response based upon biochemical and structural findings. Results HT was reported histopathologically in 120 patients (38%). DTC patients with concomitant HT received a higher number of RAITs and cumulative RAI activities. Initial RAIT reached an excellent response in 63% after one year and 84% after 5 years. The rate of excellent response one year and 5-year after first RAIT was significantly lower in HT groups, compared to not HT (p < 0.001). Instead, HT did not have a prognostic role considering PFS and OS; while stimulate thyroglobulin (sTg) at ablation was significantly related to survival. Conclusions HT may affect the efficacy of RAIT in low to intermediate risk DTC, particularly reducing the successful rate of excellent response after RAIT. Instead, HT did not have a prognostic impact such as stimulated sTg.

scholarly journals Efficacy of Dosimetric Versus Empiric Prescribed Activity of 131I for Therapy of Differentiated Thyroid Cancer

2011 ◽  
Vol 96 (10) ◽  
pp. 3217-3225 ◽  
Author(s):  
Joanna Klubo-Gwiezdzinska ◽  
Douglas Van Nostrand ◽  
Frank Atkins ◽  
Kenneth Burman ◽  
Jacqueline Jonklaas ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Side Effects ◽  
High Risk ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Differentiated Thyroid Cancer ◽  
Progression Free Survival ◽  
Response To Treatment ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background: The optimal management of high-risk patients with differentiated thyroid cancer (DTC) consists of thyroidectomy followed by radioiodine (131I) therapy. The prescribed activity of 131I can be determined using two approaches: 1) empiric prescribed activity of 131I (E-Rx); and 2) dosimetry-based prescribed activity of 131I (D-Rx). Aim: The aim of the study was to compare the relative treatment efficacy and side effects of D-Rx vs. E-Rx. Methods: A retrospective analysis was performed of patients with distant metastases and/or locoregionally advanced radioiodine-avid DTC who were treated with either D-Rx or E-Rx. Response to treatment was based on RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria. Results: The study group consisted of 87 patients followed for 51 ± 35 months, of whom 43 were treated with D-Rx and 44 with E-Rx. Multivariate analysis, controlling for age, gender, and status of metastases revealed that the D-Rx group tended to be 70% less likely to progress (odds ratio, 0.29; 95% confidence interval, 0.087–1.02; P = 0.052) and more likely to obtain complete response (CR) compared to the E-Rx group (odds ratio, 8.2; 95% confidence interval, 1.2–53.5; P = 0.029). There was an association in the D-Rx group between the observed CR and percentage of maximum tolerable activity given as a first treatment of 131I (P = 0.030). The advantage of D-Rx was specifically apparent in the locoregionally advanced group because CR was significantly higher in D-Rx vs. E-Rx in this group of patients (35.7 vs. 3.3%; P = 0.009). The rates of partial response, stable disease, and progression-free survival, as well as the frequency of side effects, were not significantly different between the two groups. Conclusion: Higher efficacy of D-Rx with a similar safety profile compared to E-Rx supports the rationale for employing individually prescribed activity in high-risk patients with DTC.

scholarly journals Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer

2009 ◽  
Vol 53 (7) ◽  
pp. 884-887 ◽  
Author(s):  
Fabián Pitoia ◽  
Laura Ward ◽  
Nelson Wohllk ◽  
Celso Friguglietti ◽  
Eduardo Tomimori ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Latin American ◽  
Differentiated Thyroid Cancer ◽  
State Of The Art ◽  
Evidence Based ◽  
Group Meeting ◽  
Expert Opinions ◽  
Medical Centers ◽  
Based Medicine ◽  
Latin American Countries

The aims of these recommendations were to develop clinical guidelines for evaluation and management of patients with differentiated thyroid cancer applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society (LATS) involved with research and management of thyroid cancer from different medical centers in Latin America. The recommendations were produced on the basis of the expert opinion of the panel with use of principles of Evidence-Based Medicine. Following a group meeting, a first draft based on evidences and the expert opinions of the panel was elaborated and, later, circulated among panel members, for further revision. After, this document was submitted to the LATS members, for commentaries and considerations, and, finally, revised and refined by the authors. The final recommendations presented in this paper represent the state of the art on management of differentiated thyroid cancer applied to all Latin American countries.

Sign in / Sign up

Export Citation Format

Share Document