scholarly journals Evaluation of the 2015 ATA Guidelines in Patients With Distant Metastatic Differentiated Thyroid Cancer

2019 ◽  
Vol 105 (3) ◽  
pp. e457-e465
Author(s):  
Evert F S van Velsen ◽  
Merel T Stegenga ◽  
Folkert J van Kemenade ◽  
Boen L R Kam ◽  
Tessa M van Ginhoven ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Distant Metastases ◽  
Initial Therapy ◽  
Control Group ◽  
American Thyroid Association ◽  
Excellent Response ◽  
Structural Disease ◽  
Stratification System

Abstract Context Current American Thyroid Association (ATA) Management Guidelines for the treatment of differentiated thyroid cancer (DTC) stratify patients to decide on additional radioiodine (RAI) therapy after surgery, and to predict recurring/persisting disease. However, studies evaluating the detection of distant metastases and how these guidelines perform in patients with distant metastases are scarce. Objective To evaluate the 2015 ATA Guidelines in DTC patients with respect to 1) the detection of distant metastases, and 2) the accuracy of its Risk Stratification System in patients with distant metastases. Patients and Main Outcome Measures We retrospectively included 83 DTC patients who were diagnosed with distant metastases around the time of initial therapy, and a control population of 472 patients (312 low-risk, 160 intermediate-risk) who did not have a routine indication for RAI therapy. We used the control group to assess the percentage of distant metastases that would have been missed if no RAI therapy was given. Results Two hundred forty-six patients had no routine indication for RAI therapy of which 4 (1.6%) had distant metastases. Furthermore, among the 83 patients with distant metastases, 14 patients (17%) had excellent response, while 55 (67%) had structural disease after a median follow-up of 62 months. None of the 14 patients that achieved an excellent response had a recurrence. Conclusions In patients without a routine indication for RAI therapy according to the 2015 ATA Guidelines, distant metastases would initially have been missed in 1.6% of the patients. Furthermore, in patients with distant metastases upon diagnosis, the 2015 ATA Guidelines are an excellent predictor of both persistent disease and recurrence.

scholarly journals Differentiated Thyroid Cancer with Biochemical Incomplete Response: Clinico-Pathological Characteristics and Long Term Disease Outcomes

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5422
Author(s):  
Miriam Steinschneider ◽  
Jacob Pitaro ◽  
Shlomit Koren ◽  
Yuval Mizrakli ◽  
Carlos Benbassat ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Staging System ◽  
Response To Therapy ◽  
American Thyroid Association ◽  
Incomplete Response ◽  
Structural Disease ◽  
Stratification System

Although most patients with differentiated thyroid cancer (DTC) and biochemical incomplete response (BIR) follow a good clinical outcome, progression to structural disease may occur in 8–17% of patients. We aimed to identify factors that could predict the long-term outcomes of BIR patients. To this end, we conducted a retrospective review study of 1049 charts from our Differential Thyroid Cancer registry of patients who were initially treated with total thyroidectomy between 1962 and 2019. BIR was defined as suppressed thyroglobulin (Tg) > 1 ng/mL, stimulated Tg > 10 ng/mL or rising anti-Tg antibodies, who did not have structural evidence of disease, and who were assessed 12–24 months after initial treatment. We found 83 patients (7.9%) matching the definition of BIR. During a mean follow-up of 12 ± 6.6 years, 49 (59%) patients remained in a state of BIR or reverted to no evidence of disease, while 34 (41%) progressed to structural disease. At the last follow-up, three cases (3.6%) were recorded as disease-related death. The American Thyroid Association (ATA) Initial Risk Stratification system and/or AJCC/TNM (8th ed.) staging system at diagnosis predicted the shift from BIR to structural disease, irrespective of their postoperative Tg levels. We conclude that albeit 41% of BIR patients may shift to structural disease, and most have a rather indolent disease. Specific new individual data enable the Response to Therapy reclassification to become a dynamic system to allow for the better management of BIR patients in the long term.

scholarly journals Delayed risk stratification system in pT1aN0/Nx DTC patients treated without radioactive iodine

2017 ◽  
Vol 6 (7) ◽  
pp. 522-527 ◽  
Author(s):  
Danuta Gąsior-Perczak ◽  
Iwona Pałyga ◽  
Monika Szymonek ◽  
Artur Kowalik ◽  
Agnieszka Walczyk ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Clinical Outcomes ◽  
Radioactive Iodine ◽  
Initial Therapy ◽  
American Thyroid Association ◽  
Monitoring Method ◽  
Risk Patients ◽  
Structural Disease ◽  
Stratification System

Purpose Delayed risk stratification (DRS) system by Momesso and coworkers was accepted by the American Thyroid Association as a diagnostic tool for the risk stratification of unfavorable clinical outcomes and to monitor the clinical outcomes of differentiated thyroid cancer (DTC) patients treated without radioactive iodine (RAI). The aim of this study was to evaluate the DRS system in patients with pT1aN0/Nx stage. Methods The study included 304 low-risk patients after thyroidectomy (n = 202) or lobectomy (n = 102) without RAI and were treated at a single center. The median age was 50.5 years, 91.1% were women and the median follow-up was 4 years. DRS of the treatment response was performed based on medical records and according to the criteria of Momesso and coworkers. Disease course (recurrence, death) and status (remission, persistent disease) on December 31, 2016 were evaluated. The relationship between unfavorable outcomes and the DRS system was evaluated. Results Response to initial therapy was excellent in 272 patients (89.5%), indeterminate in 31 (10.2%) and biochemical incomplete (increased TgAb levels) in one (0.3%). Two patients in the excellent response group experienced recurrence at 6 and 7 years of follow-up (after lobectomy). None of the patients with indeterminate and biochemical incomplete response developed structural disease, and none of the patients died during the follow-up. Conclusions The DRS system was not useful for predicting the risk of unfavorable clinical outcomes and cannot be used to personalize the monitoring method of the disease in patients at pT1aN0/Nx stage who are not treated with RAI.

scholarly journals Differentiated Thyroid Cancer in Children and Adolescents: Long Term Outcome and Risk Factors for Persistent Disease

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3732
Author(s):  
Giulia Sapuppo ◽  
Dana Hartl ◽  
Brice Fresneau ◽  
Julien Hadoux ◽  
Ingrid Breuskin ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Distant Metastases ◽  
American Thyroid Association ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Incomplete Response ◽  
Imaging Results

Background: Pediatric differentiated thyroid cancer (P-DTC) frequently presents with advanced disease. The study aim was to evaluate the outcome of P-DTC and a modified 2015 American Thyroid Association risk classification (ATA-R). Methods: A retrospective study of consecutive P-DTC patients was performed. The ATA-R for P-DTC was used with a cut-off of ≤ 5 N1a for low-risk. The outcome could be excellent response (ER) (thyroglobulin < 1 ng/mL and no evidence of disease (EoD) at imaging), biochemical incomplete response (BIR) (thyroglobulin ≥ 1 ng/mL and no EoD at imaging) or structural incomplete response (SIR) (EoD at imaging). Results: We studied 260 P-DTC (70% females; median age at diagnosis 14 years; 93% total thyroidectomy and 82% lymph node dissection). The ATA-R was low in 30% cases, intermediate in 15% and high in 55%, including 31.5% with distant metastases. Radioiodine treatment was administered in 218 (83.8%), and further radioiodine and surgery was performed in 113 (52%) and 76 (29%) patients, respectively. After a median follow-up of 8.2 years, the outcome was ER in 193 (74.3%), BIR in 17 (6.5%) and SIR in 50 (19.2%). Independent predictors of SIR or BIR at first and last visits were ATA-R intermediate or high. Conclusion: P-DTC has an excellent prognosis. Modified ATA-R is a useful prognostic tool in P-DTC to guide management.

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 Prognostic Role of Postablative Non-Stimulated Thyroglobulin in Differentiated Thyroid Cancer

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 310
Author(s):  
Szabina Szujo ◽  
Laszlo Bajnok ◽  
Beata Bodis ◽  
Zsuzsanna Nagy ◽  
Orsolya Nemes ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Diagnostic Accuracy ◽  
Differentiated Thyroid Cancer ◽  
Residual Disease ◽  
Fold Increase ◽  
American Thyroid Association ◽  
Thyroglobulin Antibody ◽  
Structural Disease ◽  
One Year

Thyroglobulin (Tg) is the most important tumor marker in differentiated thyroid cancer (DTC). The aim of this study was to assess the diagnostic and prognostic roles of postoperative stimulated and postablative lowest, highest, and one-year non-stimulated Tg values obtained during the follow-up of patients with DTC. In this retrospective study, 222 radioiodine-treated, anti-thyroglobulin antibody (TgAb)-negative DTC patients having at least 9 months’ follow-up time were included (172 papillary and 50 follicular cancers; median age: 48 (from 15 to 91) years; female–male ratio: 158/64; median (quartiles) follow-up time: 54 (22–97) months). The 2015 American Thyroid Association guidelines were applied as criteria of the therapeutic response. Postoperative stimulated Tg values had significantly lower diagnostic accuracy than any of the non-stimulated postablative Tg values. One-year non-stimulated Tg had excellent prognostic value for structural disease: a cut-off value of 0.85 ng/mL had an 88.1% diagnostic accuracy. If the Tg value did not decrease below 0.75 ng/mL at any time during follow-up, the risk of residual disease was 25 times higher. The highest non-stimulated Tg during follow-up was the best predictor of residual disease (e.g., a Tg value exceeding 7.7 ng/mL indicated a 30-fold increase in risk). Non-stimulated Tg values measured during follow-up have excellent diagnostic accuracy to predict structural disease in DTC patients. The risk classification of a patient can safely be modified based on even a single Tg measurement.

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

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 (&lt; 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.

scholarly journals Significance of “de novo” appearance of thyroglobulin antibodies in patients with differentiated thyroid cancer

2020 ◽  
Vol 35 (3) ◽  
pp. 41-49
Author(s):  
Lorenzo Scappaticcio ◽  
Pierpaolo Trimboli ◽  
Frederik A. Verburg ◽  
Luca Giovanella
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
De Novo ◽  
Disease Free Survival ◽  
Thyroglobulin Antibodies ◽  
Free Survival ◽  
Similar Disease ◽  
Structural Disease ◽  
Disease Free

Objective Clinical and laboratory guidelines recommend thyroglobulin antibodies (TgAbs) measurement with every thyroglobulin (Tg) measurement for the follow-up of differentiated thyroid cancer (DTC) patients. However, no evidence exists on the need for perpetual TgAbs testing in patients who are TgAb-negative at baseline. Our study was carried out to evaluate the prevalence, the dynamic changes, and the clinical significance of TgAbs that appeared de novo during the follow-up of DTC patients who were TgAb-negative at baseline. Methods The data of DTC patients with negative pre-ablation TgAbs were reviewed retrospectively. The main characteristics of patients with both transient and sustained de novo TgAbs appearance were analyzed. DTC patients with persistently negative TgAbs served as controls. Results Among 119 patients with pre-ablation negative TgAbs, 14 cases (11.7%) with de novo TgAbs appearance (10 and 4 patients with a transient and sustained de novo TgAbs appearance, respectively) were detected. No differences in disease-free survival were observed in patients with de novo TgAbs appearance compared to controls. The TgAbs peak value was higher in patients with sustained de novo appearance compared to patients with transient de novo. Two of 14 patients with de novo TgAbs developed structural disease with concurrently detectable Tg in both cases. Conclusions Transient de novo TgAbs appearance is not infrequent during DTC patients’ follow-up, and it has no apparent clinical impact. Sustained de novo TgAbs appearance is rare and may predict structural recurrences; however, similar disease-free survival was observed in patients with sustained de novo TgAbs and TgAb-negative DTC patients.

scholarly journals Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines

2016 ◽  
Vol 130 (S2) ◽  
pp. S150-S160 ◽  
Author(s):  
A L Mitchell ◽  
A Gandhi ◽  
D Scott-Coombes ◽  
P Perros
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Differentiated Thyroid Cancer ◽  
Distant Metastases ◽  
Central Compartment ◽  
Extrathyroidal Extension ◽  
Papillary Thyroid ◽  
Ultrasound Scanning

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the management of thyroid cancer in adults and is based on the 2014 British Thyroid Association guidelines.Recommendations• Ultrasound scanning (USS) of the nodule or goitre is a crucial investigation in guiding the need for fine needle aspiration cytology (FNAC). (R)• FNAC should be considered for all nodules with suspicious ultrasound features (U3–U5). If a nodule is smaller than 10 mm in diameter, USS guided FNAC is not recommended unless clinically suspicious lymph nodes on USS are also present. (R)• Cytological analysis and categorisation should be reported according to the current British Thyroid Association Guidance. (R)• Ultrasound scanning assessment of cervical nodes should be done in FNAC-proven cancer. (R)• Magnetic resonance imaging (MRI) or computed tomography (CT) should be done in suspected cases of retrosternal extension, fixed tumours (local invasion with or without vocal cord paralysis) or when haemoptysis is reported. When CT with contrast is used pre-operatively, there should be a two-month delay between the use of iodinated contrast media and subsequent radioactive iodine (I131) therapy. (R)• Fluoro-deoxy-glucose positron emission tomography imaging is not recommended for routine evaluation. (G)• In patients with thyroid cancer, assessment of extrathyroidal extension and lymph node disease in the central and lateral neck compartments should be undertaken pre-operatively by USS and cross-sectional imaging (CT or MRI) if indicated. (R)• For patients with Thy 3f or Thy 4 FNAC a diagnostic hemithyroidectomy is recommended. (R)• Total thyroidectomy is recommended for patients with tumours greater than 4 cm in diameter or tumours of any size in association with any of the following characteristics: multifocal disease, bilateral disease, extrathyroidal spread (pT3 and pT4a), familial disease and those with clinically or radiologically involved nodes and/or distant metastases. (R)• Subtotal thyroidectomy should not be used in the management of thyroid cancer. (G)• Central compartment neck dissection is not routinely recommended for patients with papillary thyroid cancer without clinical or radiological evidence of lymph node involvement, provided they meet all of the following criteria: classical type papillary thyroid cancer, patient less than 45 years old, unifocal tumour, less than 4 cm, no extrathyroidal extension on ultrasound. (R)• Patients with metastases in the lateral compartment should undergo therapeutic lateral and central compartment neck dissection. (R)• Patients with follicular cancer with greater than 4 cm tumours should be treated with total thyroidectomy. (R)• I131 ablation should be carried out only in centres with appropriate facilities. (R)• Serum thyroglobulin (Tg) should be checked in all post-operative patients with differentiated thyroid cancer (DTC), but not sooner than six weeks after surgery. (R)• Patients who have undergone total or near total thyroidectomy should be started on levothyroxine 2 µg per kg or liothyronine 20 mcg tds after surgery. (R)• The majority of patients with a tumour more than 1 cm in diameter, who have undergone total or near-total thyroidectomy, should have I131 ablation. (R)• A post-ablation scan should be performed 3–10 days after I131 ablation. (R)• Post-therapy dynamic risk stratification at 9–12 months is used to guide further management. (G)• Potentially resectable recurrent or persistent disease should be managed with surgery whenever possible. (R)• Distant metastases and sites not amenable to surgery which are iodine avid should be treated with I131 therapy. (R)• Long-term follow-up for patients with differentiated thyroid cancer (DTC) is recommended. (G)• Follow-up should be based on clinical examination, serum Tg and thyroid-stimulating hormone assessments. (R)• Patients with suspected medullary thyroid cancer (MTC) should be investigated with calcitonin and carcino-embryonic antigen levels (CEA), 24 hour catecholamine and nor metanephrine urine estimation (or plasma free nor metanephrine estimation), serum calcium and parathyroid hormone. (R)• Relevant imaging studies are advisable to guide the extent of surgery. (R)• RET (Proto-oncogene tyrosine-protein kinase receptor) proto-oncogene analysis should be performed after surgery. (R)• All patients with known or suspected MTC should have serum calcitonin and biochemical screening for phaeochromocytoma pre-operatively. (R)• All patients with proven MTC greater than 5 mm should undergo total thyroidectomy and central compartment neck dissection. (R)• Patients with MTC with lateral nodal involvement should undergo selective neck dissection (IIa–Vb). (R)• Patients with MTC with central node metastases should undergo ipsilateral prophylactic lateral node dissection. (R)• Prophylactic thyroidectomy should be offered to RET-positive family members. (R)• All patients with proven MTC should have genetic screening. (R)• Radiotherapy may be useful in controlling local symptoms in patients with inoperable disease. (R)• Chemotherapy with tyrosine kinase inhibitors may help in controlling local symptoms. (R)• For individuals with anaplastic thyroid carcinoma, initial assessment should focus on identifying the small proportion of patients with localised disease and good performance status, which may benefit from surgical resection and other adjuvant therapies. (G)• The surgical intent should be gross tumour resection and not merely an attempt at debulking. (G)

Sign in / Sign up

Export Citation Format

Share Document