Treatment and Outcomes in Differentiated Thyroid Cancer: A Retrospective Exploration in Three UK Centres That Provide Different Advice on Low Iodine Diets

Abstract Background International guidelines on the treatment of differentiated thyroid cancers promote low iodine diets (LID) before radioiodine remnant ablation. Evidence that the LID ultimately improves treatment success is inconsistent. This study aimed to determine if there is a difference in ablation success rates according to provision of advice to follow a LID.Methods Retrospective study of patients with differentiated thyroid cancer treated with total thyroidectomy and radioiodine remnant ablation between 01/01/2015 and 31/12/2016 in 3 centres advising: no LID (C1: n=108); LID for 1-week before (C2: n=50); LID for 2-weeks before and 48 hours (C3: n=59) after RRA. Response to treatment was determined by adapted American Thyroid Association Dynamic Risk Stratification Score, stratified as excellent, indeterminate, or incomplete response.Results In total, 217 patients were included in the analysis. We found differences in preparation for radioiodine remnant ablation and in the assessment of outcomes between centres. Furthermore, although there was little difference in staging between centres there was a difference in the percentage of patients receiving 1.1GBq vs higher administered activities (15% in C1, 22% in C2 and 44% in C3, p<0.001). An excellent response was recorded for 49% in C1, 48% in C2 and 36% in C3 (p=0.61). With C1 as reference group, the odds ratios (OR) for an excellent response were C2 OR: 0.96 (95% CI 0.46,2.00) and C3 OR: 0.62 (95% CI 0.29,1.30), p=0.40.Conclusions We found no evidence that advice to follow a low iodine diet for 1 or 2 weeks before radioiodine remnant ablation impacts on ablation success but differences between centres means the results should be regarded as exploratory. There is no immediate need to change practice regarding the LID, but a prospective multi-centre study with a more homogenous approach to patient management or a randomised controlled trial will provide more definitive recommendations.

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A Prospective Study Showing an Excellent Response of Patients with Low-Risk Differentiated Thyroid Cancer Who Did Not Undergo Radioiodine Remnant Ablation after Total Thyroidectomy

European Thyroid Journal ◽

10.1159/000442048 ◽

2015 ◽

Vol 5 (1) ◽

pp. 44-49 ◽

Cited By ~ 6

Author(s):

Carolina C.P.S. Janovsky ◽

Rui M.B. Maciel ◽

Cleber P. Camacho ◽

Rosalia P. Padovani ◽

Claudia C. Nakabashi ◽

...

Keyword(s):

Thyroid Cancer ◽

Prospective Study ◽

Total Thyroidectomy ◽

Differentiated Thyroid Cancer ◽

Low Risk ◽

Remnant Ablation ◽

Excellent Response ◽

A Prospective Study ◽

Radioiodine Remnant Ablation

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Thyroglobulin Levels in Patients who have Undergone Hemithyroidectomy for Differentiated Thyroid Cancer. An Assessment of Levels and Trends at a Tertiary Referral Centre

South Asian Journal of Cancer ◽

10.1055/s-0041-1733315 ◽

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.

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Radioiodine remnant ablation of differentiated thyroid cancer does not further increase oxidative damage to membrane lipids - early effect

Thyroid Research ◽

10.1186/1756-6614-3-7 ◽

2010 ◽

Vol 3 (1) ◽

pp. 7 ◽

Cited By ~ 3

Author(s):

Jacek Makarewicz ◽

Andrzej Lewinski ◽

Malgorzata Karbownik-Lewinska

Keyword(s):

Thyroid Cancer ◽

Oxidative Damage ◽

Differentiated Thyroid Cancer ◽

Membrane Lipids ◽

Early Effect ◽

Remnant Ablation ◽

Radioiodine Remnant Ablation

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TSH Variability of Patients Affected by Differentiated Thyroid Cancer Treated with Levothyroxine Liquid Solution or Tablet Form

International Journal of Endocrinology ◽

10.1155/2017/7053959 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Carlo Cappelli ◽

Ilenia Pirola ◽

Elena Gandossi ◽

Claudio Casella ◽

Davide Lombardi ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Liquid Solution ◽

American Thyroid Association ◽

Liquid Formulation ◽

Remnant Ablation ◽

Tablet Form ◽

Risk Patients ◽

Receive Treatment ◽

To Receive

Background. Recent guidelines from the American Thyroid Association (ATA) indicate that, in many patients affected by differentiated thyroid cancer (DTC), the serum TSH should be maintained between 0.1 and 0.5 mU/L. The purpose of this study was to evaluate the TSH variability of patients affected by DTC treated with liquid L-T4 formulation or in tablet form. Patients and Methods. Patients were eligible if (a) they were submitted to a total thyroidectomy and 131I remnant ablation for DTC in our institution and (b) they were classified low-risk patients according to ATA guidelines 2009. Patients were randomized (1 : 1) to receive treatment of hypothyroidism with liquid L-T4 or tablet form. The first check-up evaluation was made from 8 to 12 months after 131I remnant ablation. TSH values were established again after further 12 months. Results. A significant increase in TSH values (median) was observed in patients taking tablets [TSH (min–max): 0.28 (0.1–0.45) versus 0.34 (0.01–0.78) mIU/L, p=0.041] as compared to those taking liquid formulation [TSH (min–max): 0.28 (0.1–0.47) versus 0.30 (0.1–0.55) mIU/L, p=0.345]. Conclusions. The use of L-T4 liquid formulation, as compared to that of tablets, resulted in a significantly higher number of DTC patients maintaining TSH values in range for the ATA risk score, reducing TSH variability over the time.

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