Letter to the Editor: What Is the Role of Serum Thyroglobulin Measurement in Patients With Differentiated Thyroid Cancer Treated Without Radioactive Iodine?

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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MANAGEMENT OF ENDOCRINE DISEASE: The role of rhTSH in the management of differentiated thyroid cancer: pros and cons

Acta Endocrinologica ◽

10.1530/eje-19-0149 ◽

2019 ◽

Vol 181 (4) ◽

pp. R133-R145 ◽

Cited By ~ 4

Author(s):

Luca Giovanella ◽

Leonidas H Duntas

Keyword(s):

Thyroid Cancer ◽

Thyroid Hormone ◽

Differentiated Thyroid Cancer ◽

Clinical Role ◽

Serum Thyroglobulin ◽

Thyroid Hormone Withdrawal ◽

Clinical Sensitivity ◽

Pros And Cons ◽

Recombinant Human Thyrotropin

The use of recombinant human thyrotropin (rhTSH) testing in the diagnosis and therapy of differentiated thyroid cancer (DTC) has been adopted over the last two decades as an alternative to the classical thyroid hormone withdrawal avoiding the threat of hypothyroidism. Serum thyroglobulin (Tg) measurement is crucial for monitoring DTC patients over time. Until about a decade ago, optimal sensitivity of Tg assays for the detection of smaller disease foci required Tg measurement after thyrotropin (TSH) stimulation, carried out following thyroid hormone withdrawal or rhTSH administration. In very recent years, significant improvements in assay technology have resulted in highly sensitive Tg (hsTg) assays, sufficiently sensitive to obviate the need for rhTSH stimulation in most DTC patients. The aim of this paper is to review and discuss, via a ‘pros and cons’ approach, the current clinical role of rhTSH to stimulate radioiodine (RAI) uptake for treatment and/or imaging purposes and to increase the clinical sensitivity of Tg measurement for monitoring DTC patients when high-sensitive Tg assays are available.

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Clinician’s awareness and knowledge on the management of differentiated thyroid cancer and the use of radioactive iodine in Tanzania

Tanzania Journal of Health Research ◽

10.4314/thrb.v18i2.1 ◽

2016 ◽

Vol 18 (2) ◽

Author(s):

Lulu L. Sakafu ◽

Teddy Mselle ◽

Julius Mwaiselage ◽

Amina Msengwa ◽

Khamza Maunda ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Radioactive Iodine ◽

Cross Sectional Study ◽

Cross Sectional ◽

Thyroxine Therapy ◽

Post Surgery ◽

Referral Hospitals ◽

Poor Treatment Outcome

Introduction: Thyroid cancer is the most common endocrine malignancy worldwide with better outcome if timely and properly managed. Surgery followed by radioactive iodine (RAI) ablation remains the mainstay in the management of differentiated thyroid cancer (DTC). In Tanzania however, few patients with DTC receive RAI ablation post-surgery, and most of these present late, with advanced disease resulting in poor treatment outcome. The objective of this study was to determine the course for late referral by assessing clinician’s awareness and knowledge on the management of DTC and the use of RAI in Tanzania.Methods: This descriptive cross sectional study was carried out in referral hospitals in Tanzania. Data collection used a standardized self-administered questionnaire. Information sought included awareness, knowledge and practices of clinicians on the management and the use of RAI on patients with DTC was explored.Results: Majority of clinicians managing DTC patients were males (86%), in-training surgeons (54%), and attended less than ten DTC patients per year (62%). About 44% of in-training surgeons never heard of nuclear medicine (p=0.04), and 20% were not aware of the role of RAI in the management of DTC (p=0.031). Only 7.3% of surgeons were aware of the role of thyroxine therapy, or RAI ablation post-surgery. Of all DTC patients managed surgically, only 16% had total thyroidectomy with lymphadenectomy (p=0.05).Conclusion: The findings of this study indicate there is insufficient knowledge on proper management and use of RAI on patients with DTC among clinicians in Tanzania.

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Role of adjuvant therapy with radioactive iodine in patients with elevated serum thyroglobulin after neck reoperation due to recurrent papillary thyroid cancer: a monoinstitutional comparative study

Endocrine ◽

10.1007/s12020-019-02165-8 ◽

2019 ◽

Vol 68 (1) ◽

pp. 144-150 ◽

Cited By ~ 1

Author(s):

Pedro Weslley Rosario ◽

Gabriela Franco Mourão ◽

Maria Regina Calsolari

Keyword(s):

Thyroid Cancer ◽

Adjuvant Therapy ◽

Comparative Study ◽

Papillary Thyroid Cancer ◽

Radioactive Iodine ◽

Elevated Serum ◽

Papillary Thyroid ◽

Serum Thyroglobulin

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Role of Tc-99m pertechnetate for remnant scintigraphy, post-thyroidectomy, and serum thyroglobulin and antithyroglobulin antibody levels in the patients with differentiated thyroid cancer

Annals of Nuclear Medicine ◽

10.1007/s12149-015-1031-1 ◽

2015 ◽

Vol 30 (1) ◽

pp. 60-67 ◽

Cited By ~ 1

Author(s):

Funda Aydin ◽

Murat Sipahi ◽

Evrim Surer Budak ◽

Ali Ozan Oner ◽

Serkan Demirelli ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Serum Thyroglobulin ◽

Antithyroglobulin Antibody ◽

Antibody Levels

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APOPTOSIS ROLE IN FORMING RADIOIODINE RESISTANCE IN DIFFERENTIATED THYROID CANCER

10.25005/2074-0581-2020-22-2-301-310 ◽

2020 ◽

pp. 301-310

Author(s):

K.A. GARIPOV ◽

◽

Z.A. AFANASIEVA ◽

A.D. GAFIULLINA ◽

◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Molecular Mechanisms ◽

Radioactive Iodine ◽

Tumour Regression ◽

Therapeutic Effects ◽

Multikinase Inhibitors ◽

Complete Tumour ◽

Apoptosis Proteins

According to studies, 25-66% of patients with metastatic highly differentiated thyroid cancer (DTC) develop partial or complete resistance of metastases to therapy with radioactive iodine. The review discusses the molecular mechanisms for the involvement of various apoptosis proteins in the formation of radioiodine resistance in patients with DTC, as well as the molecular mechanisms of the action of multikinase inhibitors, with a range of therapeutic effects from complete tumour regression to stabilization, on apoptosis. Considering the literature on the ambiguous role of apoptosis in the formation of radioiodine resistance in DTC, required further examination of its molecular mechanisms, its relationship with such a process as autophagy, the effect of multikinase inhibitors on its molecular basis and on overcoming iodine resistance. Studying the mechanism of apoptosis regulations gives a chance to find new targeted aims exposure in its individual stages in order to regulate or correct them.

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