scholarly journals The Prognostic Role of Postablative Non-Stimulated Thyroglobulin in Differentiated Thyroid Cancer

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 310
Author(s):  
Szabina Szujo ◽  
Laszlo Bajnok ◽  
Beata Bodis ◽  
Zsuzsanna Nagy ◽  
Orsolya Nemes ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Diagnostic Accuracy ◽  
Differentiated Thyroid Cancer ◽  
Residual Disease ◽  
Fold Increase ◽  
American Thyroid Association ◽  
Thyroglobulin Antibody ◽  
Structural Disease ◽  
One Year

Thyroglobulin (Tg) is the most important tumor marker in differentiated thyroid cancer (DTC). The aim of this study was to assess the diagnostic and prognostic roles of postoperative stimulated and postablative lowest, highest, and one-year non-stimulated Tg values obtained during the follow-up of patients with DTC. In this retrospective study, 222 radioiodine-treated, anti-thyroglobulin antibody (TgAb)-negative DTC patients having at least 9 months’ follow-up time were included (172 papillary and 50 follicular cancers; median age: 48 (from 15 to 91) years; female–male ratio: 158/64; median (quartiles) follow-up time: 54 (22–97) months). The 2015 American Thyroid Association guidelines were applied as criteria of the therapeutic response. Postoperative stimulated Tg values had significantly lower diagnostic accuracy than any of the non-stimulated postablative Tg values. One-year non-stimulated Tg had excellent prognostic value for structural disease: a cut-off value of 0.85 ng/mL had an 88.1% diagnostic accuracy. If the Tg value did not decrease below 0.75 ng/mL at any time during follow-up, the risk of residual disease was 25 times higher. The highest non-stimulated Tg during follow-up was the best predictor of residual disease (e.g., a Tg value exceeding 7.7 ng/mL indicated a 30-fold increase in risk). Non-stimulated Tg values measured during follow-up have excellent diagnostic accuracy to predict structural disease in DTC patients. The risk classification of a patient can safely be modified based on even a single Tg measurement.

scholarly journals Differentiated Thyroid Cancer with Biochemical Incomplete Response: Clinico-Pathological Characteristics and Long Term Disease Outcomes

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5422
Author(s):  
Miriam Steinschneider ◽  
Jacob Pitaro ◽  
Shlomit Koren ◽  
Yuval Mizrakli ◽  
Carlos Benbassat ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Staging System ◽  
Response To Therapy ◽  
American Thyroid Association ◽  
Incomplete Response ◽  
Structural Disease ◽  
Stratification System

Although most patients with differentiated thyroid cancer (DTC) and biochemical incomplete response (BIR) follow a good clinical outcome, progression to structural disease may occur in 8–17% of patients. We aimed to identify factors that could predict the long-term outcomes of BIR patients. To this end, we conducted a retrospective review study of 1049 charts from our Differential Thyroid Cancer registry of patients who were initially treated with total thyroidectomy between 1962 and 2019. BIR was defined as suppressed thyroglobulin (Tg) > 1 ng/mL, stimulated Tg > 10 ng/mL or rising anti-Tg antibodies, who did not have structural evidence of disease, and who were assessed 12–24 months after initial treatment. We found 83 patients (7.9%) matching the definition of BIR. During a mean follow-up of 12 ± 6.6 years, 49 (59%) patients remained in a state of BIR or reverted to no evidence of disease, while 34 (41%) progressed to structural disease. At the last follow-up, three cases (3.6%) were recorded as disease-related death. The American Thyroid Association (ATA) Initial Risk Stratification system and/or AJCC/TNM (8th ed.) staging system at diagnosis predicted the shift from BIR to structural disease, irrespective of their postoperative Tg levels. We conclude that albeit 41% of BIR patients may shift to structural disease, and most have a rather indolent disease. Specific new individual data enable the Response to Therapy reclassification to become a dynamic system to allow for the better management of BIR patients in the long term.

scholarly journals Evaluation of the 2015 ATA Guidelines in Patients With Distant Metastatic Differentiated Thyroid Cancer

2019 ◽  
Vol 105 (3) ◽  
pp. e457-e465
Author(s):  
Evert F S van Velsen ◽  
Merel T Stegenga ◽  
Folkert J van Kemenade ◽  
Boen L R Kam ◽  
Tessa M van Ginhoven ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Distant Metastases ◽  
Initial Therapy ◽  
Control Group ◽  
American Thyroid Association ◽  
Excellent Response ◽  
Structural Disease ◽  
Stratification System

Abstract Context Current American Thyroid Association (ATA) Management Guidelines for the treatment of differentiated thyroid cancer (DTC) stratify patients to decide on additional radioiodine (RAI) therapy after surgery, and to predict recurring/persisting disease. However, studies evaluating the detection of distant metastases and how these guidelines perform in patients with distant metastases are scarce. Objective To evaluate the 2015 ATA Guidelines in DTC patients with respect to 1) the detection of distant metastases, and 2) the accuracy of its Risk Stratification System in patients with distant metastases. Patients and Main Outcome Measures We retrospectively included 83 DTC patients who were diagnosed with distant metastases around the time of initial therapy, and a control population of 472 patients (312 low-risk, 160 intermediate-risk) who did not have a routine indication for RAI therapy. We used the control group to assess the percentage of distant metastases that would have been missed if no RAI therapy was given. Results Two hundred forty-six patients had no routine indication for RAI therapy of which 4 (1.6%) had distant metastases. Furthermore, among the 83 patients with distant metastases, 14 patients (17%) had excellent response, while 55 (67%) had structural disease after a median follow-up of 62 months. None of the 14 patients that achieved an excellent response had a recurrence. Conclusions In patients without a routine indication for RAI therapy according to the 2015 ATA Guidelines, distant metastases would initially have been missed in 1.6% of the patients. Furthermore, in patients with distant metastases upon diagnosis, the 2015 ATA Guidelines are an excellent predictor of both persistent disease and recurrence.

Potential Impact of BMI on the Aggressiveness of Presentation and Clinical Outcome of Differentiated Thyroid Cancer

2019 ◽  
Vol 105 (4) ◽  
pp. e1124-e1134
Author(s):  
Antonio Matrone ◽  
Giovanni Ceccarini ◽  
Marianna Beghini ◽  
Federica Ferrari ◽  
Carla Gambale ◽  
...  
Keyword(s):  
Risk Factor ◽  
Thyroid Cancer ◽  
Clinical Outcome ◽  
Differentiated Thyroid Cancer ◽  
Normal Weight ◽  
American Thyroid Association ◽  
131I Treatment ◽  
Therapeutic Attitude ◽  
The Relationship

Abstract Background Obesity is a risk factor for several cancers, including differentiated thyroid cancer (DTC). Moreover, it has also been investigated as a potential risk factor for aggressiveness of DTC, but the data gathered so far are conflicting. The aim of our study was to evaluate the relationship between body mass index (BMI), aggressiveness of DTC at diagnosis, and clinical outcome. Methods We evaluated 1058 consecutive DTC patients treated with total thyroidectomy and enrolled at the time of first radioactive iodine (131I) treatment. Patients were divided into 4 groups based on their BMI: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Histological aggressiveness of DTC at the time of diagnosis and clinical outcome according to 2015 American Thyroid Association (ATA) guidelines were evaluated. Results No differences in histological features, ATA risk of recurrence, activity of 131I administered and prevalence of 131I avid metastatic disease after first131I treatment, have been demonstrated among the groups. Furthermore, at the end of follow up (median = 5.7 years), no differences were evident in the number of further treatments performed as well as in the clinical response. Conclusions In our study group of Caucasian subjects, we could not demonstrate any association between BMI and aggressiveness of DTC, neither at the time of diagnosis nor during follow-up. These data indicate that postsurgical assessment and therapeutic attitude for treatment and follow-up of DTC should be based on the class of risk applied to the general population, with no concern for BMI.

scholarly journals Significance of “de novo” appearance of thyroglobulin antibodies in patients with differentiated thyroid cancer

2020 ◽  
Vol 35 (3) ◽  
pp. 41-49
Author(s):  
Lorenzo Scappaticcio ◽  
Pierpaolo Trimboli ◽  
Frederik A. Verburg ◽  
Luca Giovanella
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
De Novo ◽  
Disease Free Survival ◽  
Thyroglobulin Antibodies ◽  
Free Survival ◽  
Similar Disease ◽  
Structural Disease ◽  
Disease Free

Objective Clinical and laboratory guidelines recommend thyroglobulin antibodies (TgAbs) measurement with every thyroglobulin (Tg) measurement for the follow-up of differentiated thyroid cancer (DTC) patients. However, no evidence exists on the need for perpetual TgAbs testing in patients who are TgAb-negative at baseline. Our study was carried out to evaluate the prevalence, the dynamic changes, and the clinical significance of TgAbs that appeared de novo during the follow-up of DTC patients who were TgAb-negative at baseline. Methods The data of DTC patients with negative pre-ablation TgAbs were reviewed retrospectively. The main characteristics of patients with both transient and sustained de novo TgAbs appearance were analyzed. DTC patients with persistently negative TgAbs served as controls. Results Among 119 patients with pre-ablation negative TgAbs, 14 cases (11.7%) with de novo TgAbs appearance (10 and 4 patients with a transient and sustained de novo TgAbs appearance, respectively) were detected. No differences in disease-free survival were observed in patients with de novo TgAbs appearance compared to controls. The TgAbs peak value was higher in patients with sustained de novo appearance compared to patients with transient de novo. Two of 14 patients with de novo TgAbs developed structural disease with concurrently detectable Tg in both cases. Conclusions Transient de novo TgAbs appearance is not infrequent during DTC patients’ follow-up, and it has no apparent clinical impact. Sustained de novo TgAbs appearance is rare and may predict structural recurrences; however, similar disease-free survival was observed in patients with sustained de novo TgAbs and TgAb-negative DTC patients.

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