scholarly journals Pre-operative serum TSH levels: A risk factor for advanced metastatic differentiated thyroid carcinoma

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Sumera Batool ◽  
Muhammad Shakir Afridi ◽  
Adeel Akbar Khoja ◽  
Najmul Islam
Keyword(s):  
Risk Factor ◽  
Thyroid Cancer ◽  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Distant Metastasis ◽  
Differentiated Thyroid Carcinoma ◽  
Thyroid Cancers ◽  
Multifocal Disease ◽  
Serum Tsh ◽  
Tsh Levels

Background and Objective: As the thyroid cancer incidence is increasing, the search for its risk factor is becoming more important. Serum thyroid stimulating hormone (TSH) levels being a growth factor for normal thyroid tissue, is also considered as growth promotor of cancer cells. In our study we aimed for pre-operative serum TSH levels of Differentiated thyroid cancers (DTC) done before their first surgery and determined its association with advanced disease in terms of stage, multifocal disease, lymph node involvement and distant metastasis. Methods: We have conducted a retrospective review of thyroid cancers from 1st January 2008 to 31st December 2017. Out of 281, 142 cases were included according to inclusion criteria. We noted the demographic details of participants, their histopathological diagnosis and serum TSH levels done before first surgery from the medical records. We calculated the stage of tumor through modified American Joint Committee (AJCC) staging system. Results: Out of 147 participants, 89.4% had papillary carcinoma or its variants whereas 10.6% reported follicular carcinoma. The mean pre-op TSH level of the patients included was 2.04 ± 1.79. In addition to the descriptive analysis, the univariate regression analysis revealed that the association of serum TSH levels was found to be statistically insignificant with advanced stage of thyroid cancer, multifocal disease, lymph node metastasis and distant metastasis respectively. Conclusion: The serum TSH levels before surgery was not associated with poor prognosis of differentiated thyroid cancer with respect to higher staging, multifocal disease, lymphatic or distant metastasis. doi: https://doi.org/10.12669/pjms.35.5.704 How to cite this:Batool S, Afridi MS, Khoja A, Islam N. Pre-operative serum TSH levels: A risk factor for advanced metastatic differentiated thyroid carcinoma. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.704 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Genetic profile of advanced thyroid cancers in relation to distant metastasis

2020 ◽  
Vol 27 (5) ◽  
pp. 285-293 ◽  
Author(s):  
Eyun Song ◽  
Dong Eun Song ◽  
Jonghwa Ahn ◽  
Tae Yong Kim ◽  
Won Bae Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Distant Metastasis ◽  
Distant Metastases ◽  
Thyroid Tumors ◽  
Primary Tumors ◽  
Thyroid Cancers ◽  
Histone Methyltransferases ◽  
Thyroid Carcinomas ◽  
Poorly Differentiated

Major clinical challenges exist with differentiated thyroid cancers with distant metastases or rare but aggressive types, such as poorly differentiated thyroid carcinomas and anaplastic thyroid carcinomas. The precise characterization of the mutational profile in these advanced thyroid cancers is crucial. Samples were collected from primary tumors and distant metastases of 64 patients with distant metastases from differentiated thyroid cancer, poorly differentiated thyroid carcinoma, or anaplastic thyroid carcinoma. Targeted next-generation sequencing was performed with 50 known thyroid-cancer-related genes. Of the 82 tissues, 63 were from primary tumors and 19 from distant metastases. The most prevalent mutation observed from the primary tumors was TERT promoter mutation (56%), followed by BRAF (41%) and RAS (24%) mutations. TP3 was altered by 11%. Mutations in histone methyltransferases, SWI/SNF subunit–related genes, and PI3K/AKT/mTOR pathway-related genes were present in 42%, 12%, and 22%, respectively. When the mutational status was analyzed in 15 matched pairs of thyroid tumors and their matched distant metastases and one pair of distant metastases with two distinct sites, the concordance was high. A similar frequency of mutations in TERT promoter (58%) and BRAF (42%) as well as histone methyltransferases (37%), SWI/SNF subunits (10%), and PI3K/AKT/mTOR pathway (26%) were noted. The same main, early and late mutations were practically always present in individual primary tumor–metastasis pairs. Enrichment of TERT promoter, BRAF, and RAS mutations were detected in highly advanced thyroid cancers with distant metastasis. The genetic profiles of primary thyroid tumors and their corresponding distant metastases showed a high concordance.

scholarly journals Pattern of metastasis in differentiated thyroid carcinoma

1970 ◽  
Vol 15 (2) ◽  
pp. 60-68
Author(s):  
Nanda Kishore Sinha ◽  
Md Monjurul Alam ◽  
Dewan Golam Md Akaiduzzaman ◽  
M Alauddin
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Thyroid Carcinoma ◽  
Papillary Carcinoma ◽  
Distant Metastasis ◽  
Follicular Carcinoma ◽  
Cervical Lymph Node Metastasis ◽  
Differentiated Thyroid Carcinoma ◽  
Age Group ◽  
Node Metastasis

Total 60 patients were selected as per described criteria from the department of Otolaryngology and head neck surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2005 to October 2006. In this study of 60 patients of differentiated thyroid carcinoma (DTC), majority of the patients are within 31-50 yrs age group with female predominance. Papillary carcinoma was more common in 31-40 yrs age group and follicular carcinoma was more common in 41-50 years. Thyroid swelling was the most common presenting symptom of DTC (91.66%), followed by cervical lymphadenopathy (33.33%). Among the 60 DTC patients, papillary carcinoma was commoner (73.33%) than follicular carcinoma (26.67%). Overall female-male ratio for these 60 patients of DTC was 1.72: 1, but in papillary type the ratio was 1.44:1. and for follicular carcinoma was 3:1. Out of 44 papillary carcinoma patients 18 patients had cervical lymph node metastasis (40.90%), and out of 16 follicular carcinoma patients 2 had cervical lymph node metastasis (12.50%); P < 0.05. Among the 44 papillary carcinoma patients only 1 had distant metastasis (2.27%), and among the 16 follicular carcinoma patients 4 had distant metastasis (25%); P <0.05. 85% of the patients were presented with unilateral and 15% were presented with bilateral lymph node metastasis. In this series, distant metastasis was found in bone and lung, Maximum lymph node metastasis was found in level II (42.10%), level III (57.89%) and level IV (42.10%). Finally the Chi-square (x2) significance test was performed according to above described findings and it was found that there is significant difference in the pattern of lymph node metastasis and of distant metastasis between papillary and follicular type of DTC (P<0.05). Key words: Thyroid carcinoma; Metastasis. DOI: 10.3329/bjo.v15i2.5059 Bangladesh J Otorhinolaryngol 2009; 15(2): 60-68

scholarly journals The Differences in Distant Metastatic Patterns and Their Corresponding Survival Between Thyroid Cancer Subtypes

2021 ◽  
Author(s):  
Huy Gia Vuong ◽  
Minh-Khang Le ◽  
Lewis Hassell ◽  
Tetsuo Kondo ◽  
Kennichi Kakudo
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Significant Risk ◽  
Differentiated Thyroid Carcinoma ◽  
Anaplastic Thyroid Carcinoma ◽  
Tumor Diameter ◽  
Large Tumor ◽  
Thyroid Cancers ◽  
Cancer Subtypes ◽  
Metastatic Patterns

Abstract Introduction: Distant metastasis (DM) at presentation is one of the important prognostic factors in thyroid cancers. Dissemination patterns of different thyroid cancer subtypes are still controversial. This study aimed to systematically elucidate the metastatic patterns and their corresponding survival of each thyroid cancer subtype at time of diagnosis. Methods: We accessed the Surveillance, Epidemiology, and End Results (SEER) database from 2010-2018 to search for primary thyroid cancers with DM at presentation (M1). Results: We included 2,787 M1 thyroid cancers for statistical analyses and the incidence of DM at presentation was 2.4%. Lung was the most common metastatic site for anaplastic thyroid carcinoma (ATC), poorly-differentiated thyroid carcinoma (PDTC), papillary thyroid carcinoma (PTC), and oncocytic (Hurthle) cell carcinoma (HCC) whereas bone is the favorable disseminated site of follicular thyroid carcinoma (FTC) and medullary thyroid carcinoma (MTC). The risk of liver metastasis was highest in MTC while metastases to the brain were uncommon among thyroid cancer subtypes. Among M1 thyroid cancers, ATC showed the worst outcome while PTC and FTC exhibited a superior survival. Patients with multi-organ metastases had the worst survival whereas bone metastases were associated with a favorable outcome (p < 0.001). We identified significant risk factors associated with multi-organ metastases including non-Caucasian race, large tumor diameter, ATC/FTC/MTC histology, and unifocality. Conclusion: There are significant differences in DM patterns of thyroid cancer subtypes and their corresponding survival. These clinical data could be useful for clinicians to better evaluate risk stratification and predict patient outcomes.

scholarly journals Pattern analysis for prognosis of differentiated thyroid cancer according to preoperative serum thyrotropin levels

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hosu Kim ◽  
Jaehoon Jung ◽  
Young-Seok Cho ◽  
Joon Young Choi ◽  
Hyunju Park ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Distant Metastasis ◽  
Tumor Size ◽  
Primary Tumor ◽  
Differentiated Thyroid Cancer ◽  
Pattern Analysis ◽  
Primary Tumor Size ◽  
Preoperative Serum ◽  
Serum Tsh ◽  
Tsh Levels

AbstractSerum thyrotropin (TSH) level after thyroid surgery affects the prognosis of differentiated thyroid cancer (DTC). However, the effects of preoperative serum TSH levels on the prognosis of DTC remain contradictory. In this study, to better understand the relationship between preoperative TSH levels and the prognosis of DTC, we performed pattern analysis of prognostic factors of DTC according to preoperative serum TSH levels. We retrospectively reviewed the clinical records of patients who were diagnosed and treated for DTC at the Samsung Medical Center, between 1994 and 2016. We reviewed preoperative serum TSH levels and performed a pattern analysis with prognostic risk factors for DTC. For pattern analysis, TSH was divided into 10 groups of equal fractions (TSH decile). We found a linear association between preoperative TSH levels and extra-thyroidal extension and lymph node metastasis. However, primary tumor size and initial distant metastasis showed a bimodal peak, which was similar to the pattern of overall and disease-specific death. We found that preoperative TSH range which showed the lowest mortality rate was about 0.8 to 1.59 mIU/L, which are slightly lower normal TSH levels. Although there was no linear trend, the primary tumor size, initial distant metastasis, and mortality of DTC were closely related with preoperative TSH decile and they showed a bimodal pattern. The results obtained in this study provide additional information for understanding the association between preoperative TSH levels and DTC prognosis.

scholarly journals Monitoring Thyroglobulin in a Sensitive Immunoassay Has Comparable Sensitivity to Recombinant Human TSH-Stimulated Thyroglobulin in Follow-Up of Thyroid Cancer Patients

2007 ◽  
Vol 92 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Robert C. Smallridge ◽  
Shon E. Meek ◽  
Melissa A. Morgan ◽  
Geoffrey S. Gates ◽  
Thomas P. Fox ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Local Recurrence ◽  
Distant Metastasis ◽  
Residual Disease ◽  
Differentiated Thyroid Carcinoma ◽  
Detectable Level ◽  
Malignant Lymph Node ◽  
Recombinant Human Tsh

Abstract Context: Most thyroglobulin (Tg) assays have a sensitivity of 0.5–1 ng/ml. A minority of patients with undetectable T4-suppressed Tg levels have a recombinant human TSH (rhTSH)-stimulated Tg above 2 ng/ml and identifiable residual disease. Objective: The objective was to determine whether a Tg assay with improved sensitivity could eliminate the need for rhTSH stimulation when baseline Tg is below 0.1 ng/ml. Design: A retrospective study of two academic endocrine practices was conducted. Population: A total of 194 patients undergoing rhTSH stimulation participated in the study. Results: Of the 80 patients with Tg below 0.1 ng/ml, two (2.5%) had rhTSH-stimulated Tg above 2 ng/ml. One other patient with stimulation to 0.3 ng/ml and negative 123I scan had an ultrasound-detected malignant lymph node resected. None had 131I/123I imaging after rhTSH stimulation suggestive of local recurrence or distant metastasis. If T4-suppressed Tg was 0.1–0.5 or 0.6–2.0 ng/ml, rhTSH Tg was above 2 ng/ml in 24.2 and 82.4%, respectively. Conclusions: Patients with differentiated thyroid carcinoma and a T4-suppressed serum Tg below 0.1 ng/ml rarely have a rhTSH-stimulated Tg above 2 ng/ml, and none of these patients had 131I or 123I imaging after rhTSH stimulation suggestive of local recurrence or distant metastasis. We recommend monitoring such patients with a T4-suppressed Tg level and periodic neck ultrasonography. An increase in T4-suppressed serum Tg to a detectable level or the appearance of abnormal lymph nodes by physical or ultrasound exam should prompt further investigation.

Mendelian randomization to investigate the link between TSH and thyroid cancer

2021 ◽  
Author(s):  
Jonathan M Fussey ◽  
Robin N Beaumont ◽  
Andrew R Wood ◽  
Bijay Vaidya ◽  
Joel Smith ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Thyroid Disease ◽  
Mendelian Randomization ◽  
Positive Association ◽  
Differentiated Thyroid Carcinoma ◽  
Thyroid Stimulating Hormone ◽  
Causal Role ◽  
Inverse Association ◽  
Tsh Levels

Evidence from observational studies suggests a positive association between serum thyroid stimulating hormone (TSH) levels and differentiated thyroid carcinoma. However, the cause-effect relationship is poorly understood and these studies are susceptible to bias and confounding. Using Mendelian randomization (MR) methodology, this study aimed to investigate the causal role of TSH in both benign thyroid nodules and thyroid cancer in up to 451,025 UK Biobank. Hospital Episode Statistics and Cancer Registry databases were used to identify 462 patients with differentiated thyroid carcinoma and 2031 patients with benign nodular thyroid disease. MR methods using genetic variants associated with serum TSH were used to test causal relationships between TSH and the two disease outcomes. We observed evidence of an inverse association between TSH levels and both thyroid cancer and benign nodular thyroid disease. Two-sample MR suggested that a one standard deviation higher genetically instrumented TSH (approximately 0.8 mlU/L) resulted in an 80% reduction of risk of benign nodular disease (OR 0.2; 95% CI 0.10 – 0.41) and a 50% reduction of risk of thyroid cancer (OR 0.50; 95% CI 0.27 – 0.92). In keeping with other recently published studies, our results refute a causal role for TSH in both benign nodular thyroid disease and thyroid cancer, with increasing genetically instrumented TSH resulting in a lower risk of both diseases.

scholarly journals MON-452 Poorly Differentiated Thyroid Carcinoma Metastatic to the Adrenal Gland

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Priyanka Mathias ◽  
Anjali Manavalan ◽  
Sandra Aleksic ◽  
Noah Bloomgarden ◽  
Ulrich Schubart
Keyword(s):  
Thyroid Cancer ◽  
Adrenal Gland ◽  
Thyroid Carcinoma ◽  
Distant Metastasis ◽  
Differentiated Thyroid Carcinoma ◽  
Whole Body ◽  
Poorly Differentiated Thyroid Carcinoma ◽  
Poorly Differentiated ◽  
The Right ◽  
Post Therapy

Abstract Background: Poorly differentiated thyroid carcinoma (PDTC) constitutes 1-15% of all thyroid cancers.1 Invasive adrenal metastases secondary to PTDC are exceedingly rare. Clinical Case: A 64-year-old woman with a non-toxic multinodular goiter presented with right upper quadrant abdominal pain and distension for three months. CT imaging revealed a 13.5 cm right suprarenal retroperitoneal mass invading the liver and inferior vena cava (IVC), concerning for adrenocortical carcinoma. She underwent resection of the mass with en block right adrenalectomy, partial hepatectomy, and IVC resection. Pathology demonstrated metastatic thyroid cancer with necrosis of the adrenal gland and IVC. Immunohistochemical staining was positive for PAX8, TTF1, and thyroglobulin (Tg). Completion thyroidectomy revealed an encapsulated 2 cm focus of PDTC with Hurthle cell phenotype in the right thyroid lobe. The mitotic activity was 5/10 per HPF. There were focal areas of tumor necrosis, 3 foci of capsular invasion, and extensive angioinvasion. Surgical margins were free of tumor invasion. Eight resected lymph nodes were negative for malignancy (Stage T1bN0M1; AJCC 8, Stage IVb). Genetic testing was positive for somatic mutations of NRAS, TERT, PTEN, and GNAS with broad copy number loss on chromosome 22q conferring aggressive tumor behavior.3 MRI of the brain and spine ruled out additional metastases. A radioactive iodine (RAI) whole-body scan (WBS) showed residual uptake of 7.6% in the right thyroid bed and a focus of increased uptake at the right sternoclavicular joint. A therapeutic dose of 206 mCi of I-131 was administered. A post-therapy WBS demonstrated focal activity in the right thyroid bed, distal right clavicle, and lower lung lobes. Chest CT and MRI of the right shoulder revealed no structural evidence of metastases corresponding to radiotracer uptake. The stimulated Tg level prior to RAI was 323 ng/mL with a TSH of 66 uU/mL (0.4-4.6 uU/mL). Tg antibodies were undetectable. She was maintained on 150 mcg of levothyroxine with the goal of TSH suppression. Tg levels declined to 4.8 ng/mL at three months, and to 0.3 ng/mL eight months post-RAI. Discussion: PDTC is an aggressive thyroid cancer subtype with distant metastasis reported in 36-85% of cases.2 Distant metastasis is predictive of poorer outcomes, with patients three times more likely to die from the disease than those without metastatic disease.1 Adrenal metastasis of thyroid cancer is rare, and unlike in our patient, usually asymptomatic and frequently detected on a post-therapy scan. Despite a dramatic response to therapy, given the poorly differentiated features of the primary tumor, a whole-body PET-CT is warranted to evaluate for RAI refractory disease. References: 1. Ibrahimpasic T et al. J Clin Endocrinol Metab. 2014;99(4):1245-52. 2. Sanders EM Jr et al. World J Surg. 2007;31(5):934-45. 3. Cheng DT et al. J Mol Diagn. 2015;17(3):251-64.

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