Undetectable Sensitive Serum Thyroglobulin (&lt;0.1 ng/ml) in 163 Patients with Follicular Cell-Derived Thyroid Cancer: Results of rhTSH Stimulation and Neck Ultrasonography and Long-Term Biochemical and Clinical Follow-Up

Abstract Context: Surveillance of patients with differentiated thyroid cancer (DTC) is achieved using serum thyroglobulin (Tg), neck ultrasonography (US), and recombinant human TSH (rhTSH)-stimulated Tg (Tg-stim). Objective: Our primary aim was to assess the utility of rhTSH Tg-stim in patients with suppressed Tg (Tg-supp) below 0.1 ng/ml using a sensitive assay. Our secondary aims were to assess the utility of US and to summarize the profile of subsequent Tg-supp measures. Design: This is a retrospective study conducted at two sites of an academic institution. Patients: A total of 163 patients status after thyroidectomy and radioactive iodine treatment who had Tg-supp below 0.1 ng/ml and rhTSH Tg-stim within 60 d of each other were included. Results: After rhTSH stimulation, Tg remained below 0.1 ng/ml in 94 (58%) and increased to 0.1–0.5 in 56 (34%), more than 0.5–2.0 in nine (6%), and above 2.0 ng/ml in four (2%) patients. Serial Tg-supp levels were obtained in 138 patients followed over a median of 3.6 yr. Neck US were performed on 153 patients; suspicious exams had fine-needle aspiration (FNA). All positive FNA were identified around the time of the initial rhTSH test. Six of seven recurrences were detected by US (Tg-stim >2.0 ng/ml in one, 0.8 in one and ≤0.5 in four). One stage IV patient had undetectable Tg-stim. Conclusion: In patients with DTC whose T4-suppressed serum Tg is below 0.1 ng/ml, long-term monitoring with annual Tg-supp and periodic neck US are adequate to detect recurrences. In our experience, rhTSH testing does not change management and is not needed in this group of patients.

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Outcome in surgically treated Rathke's cleft cysts: long-term monitoring needed

Acta Endocrinologica ◽

10.1530/eje-11-0142 ◽

2011 ◽

Vol 165 (1) ◽

pp. 33-37 ◽

Cited By ~ 18

Author(s):

R Trifanescu ◽

V Stavrinides ◽

P Plaha ◽

S Cudlip ◽

J V Byrne ◽

...

Keyword(s):

Visual Field ◽

Visual Field Defects ◽

Rathke's Cleft Cysts ◽

Long Term Monitoring ◽

Rathke's Cleft ◽

Term Monitoring ◽

Field Defects ◽

Tsh Deficiency

ObjectiveTo clarify the outcome of all cases of Rathke's cleft cysts (RCC) treated surgically and followed up in Oxford during a long-term period.Subjects and methodsThe records of all patients with RCC seen in the Department of Endocrinology between January 1978 and June 2009 were reviewed.ResultsA total of 33 patients (20 females, median age 43 years) were identified. At presentation, major visual field defects were detected in 58% of patients and gonadotrophin, ACTH and TSH deficiency in 60, 36 and 36% of patients respectively. Desmopressin treatment was required in 18% of patients. Treatment consisted of cyst evacuation combined with or without biopsy/removal of the wall. Post-operatively, visual fields improved in 83% of patients with impairment, whereas there was no reversal of ACTH or TSH deficiency or of diabetes insipidus. All but one subject had imaging follow-up during a mean period of 48 months (range 2–267). Cyst relapse was detected in 22% of patients at a mean interval of 29 months (range 3–48 months); in 57% of them, the recurrence was symptomatic. Relapse-free rates were 88% at 24-months and 52% at 48-months follow-up. At last assessment, at least quadrantanopia was reported in 19% of patients, gonadotrophin, ACTH and TSH deficiency in 50, 42 and 47% of patients respectively. Desmopressin treatment was required in 39% of patients.ConclusionsIn this study of patients with RCC and long-term follow-up, we showed a considerable relapse rate necessitating long-term monitoring. Surgical intervention is of major importance for the restoration of visual field defects, but it does not improve endocrine morbidity, which in the long-term affects a substantial number of patients.

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Long-Term Monitoring of Tricyclic Antidepressant Plasma Concentrations

The British Journal of Psychiatry ◽

10.1192/bjp.137.5.444 ◽

1980 ◽

Vol 137 (5) ◽

pp. 444-451 ◽

Cited By ~ 14

Author(s):

Agrégé Henry Loo ◽

Kader Benyacoub ◽

Vincenzo Rovei ◽

Carlo A. Altamura ◽

Marthe Vadrot ◽

...

Keyword(s):

Drug Interaction ◽

Side Effects ◽

Plasma Concentrations ◽

Antidepressant Drugs ◽

Tricyclic Antidepressant ◽

Self Medication ◽

Long Term Monitoring ◽

Term Monitoring

SummaryPlasma levels of antidepressant drugs were measured in 17 depressed patients at roughly monthly intervals over follow-up periods of three to 26 months. Good results in seven were associated with small fluctuations in level from visit to visit, while big fluctuations were associated with poor outcome. Such fluctuations were probably from poor compliance or drug interaction from self-medication. Severe side effects and cardiotoxicity were associated with high levels.

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Controversies in the follow-up and management of well-differentiated thyroid cancer.

Endocrine Related Cancer ◽

10.1677/erc.0.0110097 ◽

2004 ◽

Vol 11 (1) ◽

pp. 97-116 ◽

Cited By ~ 46

Author(s):

M D Ringel ◽

P W Ladenson

Keyword(s):

Thyroid Cancer ◽

Residual Disease ◽

Wide Spectrum ◽

Preoperative Assessment ◽

Staging System ◽

Primary Treatment ◽

Long Term Monitoring ◽

Well Differentiated ◽

Term Monitoring

Thyroid cancer is a common malignancy with an apparent increasing incidence and a wide spectrum of clinical behavior and therapeutic responsiveness. Recent advances in diagnosis, primary treatment, and long-term monitoring have led to enhanced detection of primary and recurrent disease and improvements in therapy. Controversy still surrounds several issues: the most accurate predictive staging system and histological subclassification scheme, optimal preoperative assessment and surgical extent, appropriate use of radioiodine for remnant ablation, goal for thyrotropin-suppressive thyroid hormone therapy, best practices in immediate postoperative and long-term monitoring, and approach to the patient with thyroglobulin evidence of residual disease. In this paper, recent data related to these controversial issues are critically reviewed.

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Decision aid on radioactive iodine treatment for early stage papillary thyroid cancer: update to study protocol with follow-up extension

Trials ◽

10.1186/s13063-015-0819-6 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 3

Author(s):

Anna M. Sawka ◽

Sharon Straus ◽

Gary Rodin ◽

Kevin E. Thorpe ◽

Shereen Ezzat ◽

...

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Cancer ◽

Study Protocol ◽

Decision Aid ◽

Radioactive Iodine ◽

Early Stage ◽

Papillary Thyroid ◽

Iodine Treatment

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Complications of Radioactive Iodine Treatment of Thyroid Carcinoma

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2010.0094 ◽

2010 ◽

Vol 8 (11) ◽

pp. 1277-1287 ◽

Cited By ~ 59

Author(s):

Stephanie L. Lee

Keyword(s):

Thyroid Cancer ◽

Radioactive Iodine ◽

Second Primary ◽

Cancer Metastases ◽

Risk Patients ◽

Iodine Treatment ◽

The Common ◽

Second Primary Malignancies ◽

Thyroid Cancer Metastases

Radioactive iodine (RAI) in the form of 131I has been used to treat thyroid cancer since 1946. RAI is used after thyroidectomy to ablate the residual normal thyroid remnant, as adjuvant therapy, and to treat thyroid cancer metastases. Although the benefits of using RAI in low-risk patients with thyroid cancer are debated, it is frequently used in most patients with thyroid cancer and is clearly associated with acute and long-term risks and side effects. Acute risks associated with RAI therapy include nausea and vomiting, ageusia (loss of taste), salivary gland swelling, and pain. Longer-term complications include recurrent sialoadenitis associated with xerostomia, mouth pain, dental caries, pulmonary fibrosis, nasolacrimal outflow obstruction, and second primary malignancies. This article summarizes the common complications of RAI and methods to prevent and manage these complications.

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Patients with chronic autoimmune thyroiditis are not at higher risk for developing clinically overt thyroid cancer: a 10-year follow-up study

Acta Endocrinologica ◽

10.1530/eje-20-0350 ◽

2020 ◽

Vol 183 (3) ◽

pp. 317-323

Author(s):

Mario Rotondi ◽

Gloria Groppelli ◽

Laura Croce ◽

Francesco Latrofa ◽

Giuseppe Ancona ◽

...

Keyword(s):

Thyroid Cancer ◽

Autoimmune Thyroiditis ◽

Thyroid Nodules ◽

Thyroid Volume ◽

Needle Aspiration ◽

Chronic Autoimmune Thyroiditis ◽

Needle Aspiration Cytology ◽

Design And Methods

Objective: The association between chronic autoimmune thyroiditis (CAT) and differentiated thyroid cancer (DTC) remains controversial. The incidence of DTC increases when screening procedures are implemented, as typically occurs in CAT patients being routinely submitted to thyroid ultrasound (US). The aim of this study was to longitudinally evaluate the long-term development of DTC in patients with CAT. Design and methods: A retrospective longitudinal cohort study was designed. For the study, 510 patients with chronic autoimmune thyroiditis (CAT) with a 10-year follow-up were enrolled. Patients were divided in two groups according to the presence (CAT+ NOD+; n = 115) or absence (CAT+ NOD−; n = 395) of co-existent nodules at diagnosis. The main outcome measures were appearance of new thyroid-nodules and development of DTC during follow-up. Results: During a 10-year median follow-up period, new thyroid-nodules were detected in 34/115 (29.5%) patients in the CAT+ NOD+ group and in 41/395 (10.3%) in the CAT+ NOD− group (P < 0.001). Logistic regression analysis showed that thyroid-volume at diagnosis and belonging to the CAT+ NOD+ group significantly predicted the appearance of a new thyroid nodule during follow-up, independently of baseline age and sex. Among the 75 patients experiencing the appearance of a new nodule, 27 (39%) met the criteria for fine-needle-aspiration-cytology (FNAC). A benign cytological diagnosis was rendered in all cases. Conclusions: In our series of CAT patients, the appearance of new thyroid-nodules was frequent, but none of them were found to be malignant. The presence of CAT appears to be associated with a negligible risk of developing clinically overt DTC.

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Utility of Stimulated Thyroglobulin in Reclassifying Low Risk Thyroid Cancer Patients’ Following Thyroidectomy and Radioactive Iodine Ablation: A 7-Year Prospective Trial

Frontiers in Endocrinology ◽

10.3389/fendo.2020.603432 ◽

2021 ◽

Vol 11 ◽

Author(s):

Anwar A. Jammah ◽

Afshan Masood ◽

Layan A. Akkielah ◽

Shaimaa Alhaddad ◽

Maath A. Alhaddad ◽

...

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Differentiated Thyroid Cancer ◽

Radioactive Iodine ◽

Prospective Trial ◽

Low Risk ◽

University Hospital ◽

Serum Thyroglobulin ◽

Risk Of Recurrence

ContextFollowing total thyroidectomy and radioactive iodine (RAI) ablation, serum thyroglobulin levels should be undetectable to assure that patients are excellent responders and at very low risk of recurrence.ObjectiveTo assess the utility of stimulated (sTg) and non-stimulated (nsTg) thyroglobulin levels in prediction of patients outcomes with differentiated thyroid cancer (DTC) following total thyroidectomy and RAI ablation.MethodA prospective observational study conducted at a University Hospital in Saudi Arabia. Patients diagnosed with differentiated thyroid cancer and were post total thyroidectomy and RAI ablation. Thyroglobulin levels (nsTg and sTg) were estimated 3–6 months post-RAI. Patients with nsTg <2 ng/ml were stratified based on their levels and were followed-up for 5 years and clinical responses were measured.ResultsOf 196 patients, nsTg levels were <0.1 ng/ml in 122 (62%) patients and 0.1–2.0 ng/ml in 74 (38%). Of 122 patients with nsTg <0.1 ng/ml, 120 (98%) had sTg levels <1 ng/ml, with no structural or functional disease. sTg levels >1 occurred in 26 (35%) of patients with nsTg 0.1–2.0 ng/ml, 11 (15%) had structural incomplete response. None of the patients with sTg levels <1 ng/ml developed structural or functional disease over the follow-up period.ConclusionSuppressed thyroglobulin (nsTg < 0.1 ng/ml) indicates a very low risk of recurrence that does not require stimulation. Stimulated thyroglobulin is beneficial with nsTg 0.1–2 ng/ml for re-classifying patients and estimating their risk for incomplete responses over a 7 years follow-up period.

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