scholarly journals Evaluation of the response levels of non-metastatic thyroid cancer patients in the postoperative twelfth month

2020 ◽  
Vol 7 (8) ◽  
pp. 584-588
Author(s):  
Hasan İkbal Atılgan ◽  
Hülya Yalçın
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Radioactive Iodine ◽  
Thyroid Tissue ◽  
Thyroid Stimulating Hormone ◽  
Response To Therapy ◽  
Response Level ◽  
Excellent Response ◽  
Incomplete Response

Objective: Radioactive iodine (RAI) is used to ablate residual thyroid tissue after total thyroidectomy. The aim of this study was to evaluate the response according to the12th-month results of thyroid cancer patients and to investigate the changes in response level during follow-up. Materials and Methods: The study included 97 patients, comprising 88 (90.7%) females and 9 (9.3%) males, with a mean age of 41.68±13.25 years. None of the patients had lymph node or distant metastasis and all received RAI therapy. Thyroid-stimulating hormone (TSH), thyroglobulin (TG), and anti-TG levels and neck USG were examined in the 12th-month. Response to therapy was evaluated as an excellent response, biochemical incomplete response, structural incomplete response, or indeterminate response. Results: In the 12th month, 80 patients (82.47%) had excellent response, 13 patients (13.40%) had an indeterminate response, 3 patients (3.09%) had structural incomplete response and 1 patient (1.03 %) had biochemical incomplete response. Of the 80 patients with excellent response, 15 had no follow-up after the 12th month. The remaining 65 patients were followed up for 31.11±9.58 months. The response changed to indeterminate in the 18th month in 1 (1.54%) patient and to structural incomplete response in the 35th month in 1 (1.54%) patient. The 13 patients with indeterminate responses were followed up for 20.61±6.28 months. Conclusion: The TG level at 12th months provides accurate data about the course of the disease especially in patients with excellent responses. Patients with excellent response in the 12th month may be followed up less often and those with the indeterminate or incomplete responses should be followed up more often.

scholarly journals A New Dynamic Response to Therapy Assessment in Postoperative Patients With Low-Risk Differentiated Thyroid Cancer Treated Without Radioactive Iodine

2021 ◽  
Vol 11 ◽  
Author(s):  
Ping Dong ◽  
Li Wang ◽  
Liu Xiao ◽  
Liu Yang ◽  
Rui Huang ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Dynamic Response ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Response To Therapy ◽  
Low Risk ◽  
Therapy Assessment ◽  
Incomplete Response ◽  
Increasing Trend

BackgroundTotal thyroidectomy (TT) or lobectomy without radioactive iodine (RAI) is becoming a common management for patients with low-risk differentiated thyroid cancer (DTC). However, the assessment of response to therapy for these patients remains controversial. The aim of this study was to propose and validate a new dynamic evaluation strategy to assess the response to therapy in patients with low-risk DTC treated with TT or lobectomy but without RAI.MethodsWe performed a retrospective analysis of 543 adult patients with low-risk DTC who underwent TT or lobectomy without RAI therapy. Follow-up consisted of trends of serum thyroglobulin (Tg), anti-thyroglobulin antibody (TgAb) levels and neck ultrasonography (US) were conducted every 6–24 months. Response to therapy assessments were defined as excellent response, biochemical incomplete response, structural incomplete response, and indeterminate response according to the follow-up findings.ResultsAt a median follow-up of 51 months (range 33–66 months), 517 (95%) had excellent response, while the other 26 had either biochemical incomplete response (an increasing trend of suppressed serum Tg levels, n=9; an increasing trend of TgAb levels, n=3) or indeterminate response (a stable or decreasing trend of suppressed serum Tg levels, but a stable positive trend of TgAb levels, n=14). No patients had structural incomplete response or no deaths related to thyroid cancer. The risk of incomplete response was significantly higher in lobectomy than in TT (p<0.001).ConclusionOur study proposed and validated a new dynamic response to therapy assessment depending on trends of suppressed serum Tg, TgAb levels, and neck US findings which could be an appropriate tool for postoperative follow-up in low-risk DTC patients without RAI therapy. Our findings provided further evidence to support no routine recommendation of RAI after surgery in low-risk DTC.

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.

Scintigraphic Visualization of Glossal Thyroid Tissue During the Follow-up of Thyroid Cancer Patients

2007 ◽  
Vol 32 (12) ◽  
pp. 911-914 ◽  
Author(s):  
Paolo Zanotti-Fregonara ◽  
Elif Hindié ◽  
Isabelle Keller ◽  
Marie Calzada-Nocaudie ◽  
Jean-Yves Devaux
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Thyroid Tissue

scholarly journals An Unusual Case of Metastatic Follicular Thyroid Cancer 40 Years after Initial Diagnosis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Lakshmi Pakath Menon ◽  
Spyridoula Maraka
Keyword(s):  
Thyroid Cancer ◽  
Cancer Recurrence ◽  
Initial Diagnosis ◽  
Response To Therapy ◽  
Follicular Thyroid Cancer ◽  
X Ray ◽  
Excellent Response ◽  
Chest X Ray ◽  
Thyroid Cancer Recurrence

Thyroid cancer recurrence can occur decades after initial diagnosis despite excellent response to therapy. Thyroid cancer recurrence is evaluated using serum thyroglobulin (Tg) and imaging studies including I-131 WBS and neck ultrasound. Limitations in Tg measurement and WBS may result in failure to detect recurrence. We report the case of a 63-year-old man who was noted to have rhonchi during a routine visit. He had a past history of follicular thyroid cancer that was diagnosed 40 years ago and treated with total thyroidectomy and radioactive iodine. He had excellent response to therapy with undetectable Tg levels, normal neck ultrasounds, and multiple negative whole body scans (WBS) due to which he was discharged from endocrinology clinic after 37 years of follow-up. Chest X-ray revealed a left lung mass with biopsy positive for thyroid cancer. Tg remained undetectable with negative anti-Tg antibody. Left pneumonectomy was done which revealed a mix of 70% differentiated thyroid cancer and 30% poorly differentiated/anaplastic thyroid cancer. He received two cycles of Doxorubicin and Paclitaxel. At 4 months follow-up after surgery, he had 3 subcentimeter nodules in his right lung. This case highlights that physical exam remains an essential tool to evaluate for recurrence. Since the lungs are the most common site of metastasis in follicular thyroid cancer, a chest X-ray may help detect metastasis that is missed on other modalities.

scholarly journals Natural Course of the American Thyroid Association Response to Therapy Statuses (Dynamic Risk Stratification) in Differentiated Thyroid Cancer

2020 ◽  
pp. 1-10
Author(s):  
Noha Mukhtar ◽  
Hadeel Aljamei ◽  
Abeer Aljomaiah ◽  
Yosra Moria ◽  
Ali S. Alzahrani
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Differentiated Thyroid Cancer ◽  
Response To Therapy ◽  
Natural Course ◽  
Initial Management ◽  
Excellent Response ◽  
Dynamic Risk ◽  
The Status

The concept of response to therapy in differentiated thyroid cancer (DTC) was introduced as a dynamic risk stratification used to assess the status of the disease at the time of the evaluation during the follow-up and the risk of recurrence in the future. Our aim in this study was to evaluate the natural course over time of different response to therapy statuses. <b><i>Methods:</i></b> We studied 501 nonselected DTC patients (102 males and 399 females) with a median age of 37 years (interquartile range [IQR] 29–48). All patients underwent near-total or total thyroidectomy followed by I-131 ablation (initial management). <b><i>Results:</i></b> Of the 501 patients, 387 patients (77.2%) did not have any additional therapuetic interventions after the initial management. In this group, the response to therapy status at the time of the first evaluation after I-131 (median 17 months, IQR 14–22) was an excellent response in 258 (66.7%), an indeterminate response in 101 (26.1%), biochemically incomplete in 17 (4.4%), and structurally incomplete in 11 patients (2.8%). The status changed spontaneously without any intervention in many of them. At the last follow-up visit (median duration 101 months, IQR 71–126), 357 patients (92.2%) achieved an excellent response, 4 (1%) an indeterminate response, 8 (2.1%) a biochemically incomplete status, 16 (4.1%) a structurally incomplete status, and 2 (0.5%) died secondary to DTC with a structurally incomplete status. The response to therapy in the other 114 patients who underwent additional interventions changed from before intervention to the last evaluation as follows: excellent response, 0 to 60 patients (52.6%), indeterminate response, 20 (17.5%) to 1 patient (0.9%), biochemically incomplete 25 (21.9%) to 10 patients (9%), and structurally incomplete 69 (60.5%) to 43 patients (37.7%). Overall, at the last evaluation, 417 (83.2%) were in an excellent response, 5 (1%) in an indeterminate response, 18 (3.6%) in a biochemically incomplete status, 50 (10.2%) in a structurally incomplete status, and 11 (2.2%) died secondary to DTC with a structurally incomplete status. <b><i>Conclusions:</i></b> The response to therapy at the initial evaluation is predictive of the long-term outcome. Most patients with the indeterminate response and some in the biochemically incomplete statuses spontaneously regress to an excellent status. Mortality and progression of DTC occur mostly in the structurally incomplete status.

scholarly journals Post-surgical thyroid ablation with low or high radioiodine activities results in similar outcomes in intermediate risk differentiated thyroid cancer patients

2013 ◽  
Vol 169 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Maria Grazia Castagna ◽  
Gabriele Cevenini ◽  
Alexandra Theodoropoulou ◽  
Fabio Maino ◽  
Silvia Memmo ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Recurrent Disease ◽  
Intermediate Risk ◽  
Persistent Disease ◽  
Thyroid Ablation ◽  
The Impact

BackgroundIn differentiated thyroid cancer (DTC) patients at intermediate risk of recurrences, no evidences are provided regarding the optimal radioactive iodine (RAI) activity to be administered for post-surgical thyroid ablation.MethodsThis study aimed to evaluate the impact of RAI activities on the outcome of 225 DTC patients classified as intermediate risk, treated with low (1110–1850 MBq) or high RAI activities (≥3700 MBq).ResultsSix to 18 months after ablation, remission was observed in 60.0% of patients treated with low and in 60.0% of those treated with high RAI activities, biochemical disease was found in 18.8% of patients treated with low and in 14.3% of patients treated with high RAI activities, metastatic disease was found in 21.2% of patients treated with low and in 25.7% of patients treated with high RAI activities (P=0.56). At the last follow-up (low activities, median 4.2 years; high activities, median 6.9 years), remission was observed in 76.5% of patients treated with low and in 72.1% of patients treated with high RAI activities, persistent disease was observed in 18.8% of patients treated with low and in 23.5% of patients treated with high RAI activities, recurrent disease was 2.4% in patients treated with low and 2.1% in patients treated with high RAI activities, deaths occurred in 2.4% of patients treated with low and in 2.1% of patients treated with high RAI activities (P=0.87).ConclusionOur study provides the first evidence that in DTC patients at intermediate risk, high RAI activities at ablation have no major advantage over low activities.

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