The Role of Total Thyroidectomy in the Initial Treatment of Well-differentiated Follicular-cell-derived Thyroid Carcinomas

2010 ◽  
Vol 06 ◽  
pp. 73
Author(s):  
Alessandro Antonelli ◽  
Pablo Miccoli ◽  
Gabriele Materazzi ◽  
Michele Minuto ◽  
Poupak Fallahi ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Initial Treatment ◽  
Radioactive Iodine ◽  
Primary Tumour ◽  
Low Risk ◽  
Follicular Cell ◽  
Thyroid Carcinomas ◽  
Thyroid Lobectomy ◽  
Risk Patients

The incidence of thyroid cancer has been increasing over the past 30 years. The follicular-cell-derived thyroid carcinomas (DTC) – papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) – are most common (79 and 13%, respectively). Initial treatment of DTC involves resection of the primary tumour. Post-operative therapy consists of radioactive iodine ablation for most patients, followed by thyroid-stimulating hormone (TSH) suppression with thyroxine. An ongoing controversy in the surgical treatment of DTC is the extent of thyroid gland resection. Consensus guidelines recommend total or near-total thyroidectomy in high-risk DTC (PTC tumour >1–2cm, any tumour, node, metastasis [TNM] stage III and IV [extrathyroidal spread], any N1 [regional metastasis] or M1 [distant metastasis], any patient 㹅 years and <16 years of age, aggressive histological subtypes) rather than thyroid lobectomy as the initial procedure of choice, given its advantages of treating potential multicentric disease, facilitating maximal uptake of adjuvant radioactive iodine and facilitating post-treatment follow-up by monitoring serum thyroglobulin levels and neck ultrasonography. Low-risk patients are currently treated by thyroid lobectomy or total (or near-total) thyroidectomy; in fact, conflicting views persist for low-risk patients who have differentiated thyroid cancer. The main arguments for lobectomy in low-risk PTC patients are that there is no clear evidence that total thyroidectomy may affect the survival of patients with low-risk PTC, and that total thyroidectomy increases the risk of recurrent laryngeal nerve injury and hypoparathyroidism even in the hands of an experienced endocrine surgeon.

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

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 &lt;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 &lt;0.1 ng/ml in 122 (62%) patients and 0.1–2.0 ng/ml in 74 (38%). Of 122 patients with nsTg &lt;0.1 ng/ml, 120 (98%) had sTg levels &lt;1 ng/ml, with no structural or functional disease. sTg levels &gt;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 &lt;1 ng/ml developed structural or functional disease over the follow-up period.ConclusionSuppressed thyroglobulin (nsTg &lt; 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.

scholarly journals Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients

2011 ◽  
Vol 165 (3) ◽  
pp. 441-446 ◽  
Author(s):  
Maria Grazia Castagna ◽  
Fabio Maino ◽  
Claudia Cipri ◽  
Valentina Belardini ◽  
Alexandra Theodoropoulou ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
Low Risk ◽  
Risk Category ◽  
Radioiodine Ablation ◽  
Risk Patients

IntroductionAfter initial treatment, differentiated thyroid cancer (DTC) patients are stratified as low and high risk based on clinical/pathological features. Recently, a risk stratification based on additional clinical data accumulated during follow-up has been proposed.ObjectiveTo evaluate the predictive value of delayed risk stratification (DRS) obtained at the time of the first diagnostic control (8–12 months after initial treatment).MethodsWe reviewed 512 patients with DTC whose risk assessment was initially defined according to the American (ATA) and European Thyroid Association (ETA) guidelines. At the time of the first control, 8–12 months after initial treatment, patients were re-stratified according to their clinical status: DRS.ResultsUsing DRS, about 50% of ATA/ETA intermediate/high-risk patients moved to DRS low-risk category, while about 10% of ATA/ETA low-risk patients moved to DRS high-risk category. The ability of the DRS to predict the final outcome was superior to that of ATA and ETA. Positive and negative predictive values for both ATA (39.2 and 90.6% respectively) and ETA (38.4 and 91.3% respectively) were significantly lower than that observed with the DRS (72.8 and 96.3% respectively,P<0.05). The observed variance in predicting final outcome was 25.4% for ATA, 19.1% for ETA, and 62.1% for DRS.ConclusionsDelaying the risk stratification of DTC patients at a time when the response to surgery and radioiodine ablation is evident allows to better define individual risk and to better modulate the subsequent follow-up.

Postoperative Stimulated Thyroglobulin of Less Than 1 ng/mL as a Criterion to Spare Low-Risk Patients with Papillary Thyroid Cancer from Radioactive Iodine Ablation

Thyroid ◽  
2012 ◽  
Vol 22 (11) ◽  
pp. 1140-1143 ◽  
Author(s):  
Pedro Weslley Rosario ◽  
Augusto Flávio Campos Mineiro Filho ◽  
Brenda Sá Senna Prates ◽  
Lívia Cristina Oliveira Silva ◽  
Maria Regina Calsolari
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Radioactive Iodine ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Risk Patients ◽  
Radioactive Iodine Ablation

scholarly journals Change in Practice of Radioactive Iodine Administration in Differentiated Thyroid Cancer: A Single-Centre Experience

2021 ◽  
pp. 1-8
Author(s):  
Ayanthi Wijewardene ◽  
Matti Gild ◽  
Carolina Nylén ◽  
Geoffrey Schembri ◽  
Paul Roach ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Adjuvant Therapy ◽  
Radioactive Iodine ◽  
Temporal Trends ◽  
Low Risk ◽  
American Thyroid Association ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Risk Patients

<b><i>Objective:</i></b> Our study aimed to analyse temporal trends in radioactive iodine (RAI) treatment for thyroid cancer over the past decade; to analyse key factors associated with clinical decisions in RAI dosing; and to confirm lower activities of RAI for low-risk patients were not associated with an increased risk of recurrence. <b><i>Methods:</i></b> Retrospective analysis of 1,323 patients who received RAI at a quaternary centre in Australia between 2008 and 2018 was performed. Prospectively collected data included age, gender, histology, and American Joint Committee on Cancer stage (7th ed). American Thyroid Association risk was calculated retrospectively. <b><i>Results:</i></b> The median activities of RAI administered to low-risk patients decreased from 3.85 GBq (104 mCi) in 2008–2016 to 2.0 GBq (54 mCi) in 2017–2018. The principal driver of this change was an increased use of 1 GBq (27 mCi) from 1.3% of prescriptions in 2008–2011 to 18.5% in 2017–2018. In patients assigned as low risk per ATA stratification, lower activities of 1 GBq or 2 GBq (27 mCi or 54 mCi) were not associated with an increased risk of recurrence. In patients assigned to intermediate- or high-risk categories who received RAI as adjuvant therapy, there was no difference in risk of recurrence between 4 GBq (108 mCi) and 6 GBq (162 mCi). <b><i>Conclusions:</i></b> Our data demonstrate an evolution of RAI activities consistent with translation of ATA guidelines into clinical practice. Use of lower RAI activities was not associated with an increase in recurrence in low-risk thyroid cancer patients. Our data also suggest lower RAI activities may be as efficacious for adjuvant therapy in intermediate- and high-risk patients.

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