Faculty Opinions recommendation of Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system.

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

Cancers ◽

10.3390/cancers13215422 ◽

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.

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Long-Term Prognostic Value of the Response to Therapy Assessed by Laboratory and Imaging Findings in Patients with Differentiated Thyroid Cancer

Cancers ◽

10.3390/cancers13174338 ◽

2021 ◽

Vol 13 (17) ◽

pp. 4338

Author(s):

Michele Klain ◽

Emilia Zampella ◽

Leandra Piscopo ◽

Fabio Volpe ◽

Mariarosaria Manganelli ◽

...

Keyword(s):

Thyroid Cancer ◽

High Risk ◽

Differentiated Thyroid Cancer ◽

Response To Therapy ◽

Whole Body ◽

American Thyroid Association ◽

Neck Ultrasound ◽

Risk Of Recurrence

This study assessed the long-term predictive value of the response to therapy, evaluated by serum thyroglobulin (Tg) determination and neck ultrasound, and estimated the potential additional impact of diagnostic whole-body scan (WBS) in patients with differentiated thyroid cancer (DTC) treated with surgery and radioactive iodine (RAI) therapy. We retrospectively evaluated 606 DTC patients treated with surgery and RAI. Response to 131I therapy at 12 months was assessed by serum Tg measurement, neck ultrasound, and diagnostic WBS. According to American Thyroid Association (ATA) guidelines, patients were classified as having a low, intermediate or high risk of recurrence and at 12 months as having an excellent response (ER) or no-ER. Follow-up was then performed every 6–12 months with serum Tg determination and imaging procedures. With a median follow-up of 105 months (range 10–384), 42 (7%) events requiring further treatments occurred. Twenty-five patients had additional RAI therapy, 11 with structural disease in the thyroid bed, eight in both thyroid bed and neck lymph nodes, four had lung metastases and two had bone metastases. The other 17 patients had additional surgery for nodal disease followed by RAI therapy. The ATA intermediate and high risk of recurrence, post-operative and pre-RAI therapy Tg ≥ 10 ng/mL, and the absence of ER at 12 months were independent predictors of events. Diagnostic WBS at 12 months permitted the identification of only five recurrences among the 219 ER patients according to serum Tg levels and ultrasound. In DTC patients, the response to therapy at 12 months after RAI therapy could rely on serum Tg measurement and neck ultrasound, while diagnostic WBS was not routinely indicated in patients considered in ER.

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Initial Therapy with Either Thyroid Lobectomy or Total Thyroidectomy without Radioactive Iodine Remnant Ablation Is Associated with Very Low Rates of Structural Disease Recurrence in Properly Selected Patients with Differentiated Thyroid Cancer

10.1210/endo-meetings.2011.part4.p11.p3-679 ◽

2011 ◽

pp. P3-679-P3-679 ◽

Cited By ~ 2

Author(s):

Fernanda Vaisman ◽

Ashok Shaha ◽

Stephanie Fish ◽

RMichael Tuttle

Keyword(s):

Thyroid Cancer ◽

Total Thyroidectomy ◽

Differentiated Thyroid Cancer ◽

Radioactive Iodine ◽

Disease Recurrence ◽

Initial Therapy ◽

Remnant Ablation ◽

Thyroid Lobectomy ◽

Structural Disease

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Dynamic Risk Stratification in Patients with Differentiated Thyroid Cancer Treated Without Radioactive Iodine

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2015-4290 ◽

2016 ◽

Vol 101 (7) ◽

pp. 2692-2700 ◽

Cited By ~ 103

Author(s):

Denise P. Momesso ◽

Fernanda Vaisman ◽

Samantha P. Yang ◽

Daniel A. Bulzico ◽

Rossana Corbo ◽

...

Keyword(s):

Thyroid Cancer ◽

Risk Stratification ◽

Differentiated Thyroid Cancer ◽

Radioactive Iodine ◽

Response To Therapy ◽

Therapy Assessment ◽

Dynamic Risk ◽

Incomplete Response ◽

Risk Estimates ◽

Negative Imaging

Context: Although response to therapy assessment is a validated tool for dynamic risk stratification in patients with differentiated thyroid cancer (DTC) treated with total thyroidectomy (TT) and radioactive iodine therapy (RAI), it has not been well studied in patients treated with lobectomy or TT without RAI. Because these responses to therapy definitions are heavily dependent on serum thyroglobulin (Tg) levels, modifications of the original definitions were needed to appropriately classify patients treated without RAI. Objective: This study aimed to validate the response to therapy assessment in patients with DTC treated with lobectomy or TT without RAI. Design and Setting: This was a retrospective study, which took place at a referral center. Patients: A total of 507 adults with DTC were treated with lobectomy (n = 187) or TT (n = 320) without RAI. They had a median age of 43.7 y, 88% were female, 85.4% had low risk, and 14.6% intermediate risk. Main Outcome Measure: Main outcome measured was recurrent/persistent structural evidence of disease (SED) during a median followup period of 100.5 months (24–510). Results: Recurrent/persistent SED was observed in 0% of the patients with excellent response to therapy (nonstimulated Tg for TT < 0.2 ng/mL and for lobectomy < 30 ng/mL, undetectable Tg antibodies [TgAb] and negative imaging; n = 326); 1.3% with indeterminate response (nonstimulated Tg for TT 0.2–5 ng/mL, stable or declining TgAb and/or nonspecific imaging findings; n = 2/152); 31.6% of the patients with biochemical incomplete response (nonstimulated Tg for TT > 5 ng/mL and for lobectomy > 30 ng/mL and/or increasing Tg with similar TSH levels and/or increasing TgAb and negative imaging; n = 6/19) and all (100%) patients with structural incomplete response (n = 10/10) (P < .0001). Initial American Thyroid Association risk estimates were significantly modified based on response to therapy assessment. Conclusions: Our data validate the newly proposed response to therapy assessment in patients with DTC treated with lobectomy or TT without RAI as an effective tool to modify initial risk estimates of recurrent/persistent SED and better tailor followup and future therapeutic approaches. This study provides further evidence to support a selective use of RAI in DTC.

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