The Management of Anti-thyroglobulin Antibody Elevation in the Follow-up of Patients with Differentiated Thyroid Cancer

Incidence of differentiated thyroid cancer has increased in the last two decades. This type of cancer is now being diagnosed at an earlier stage. Treatment strategy has been modified. Aims: The goals of this study were to analyze the outcome of differentiated thyroid cancer after initial treatment (surgery and radioiodine ablation) in patients evaluated and followed up in a single centre between l999 and 2009, to compare these results with others as well as to monitor the adoption of international recommendation. 107 patients having T1-T2 differentiated thyroid cancer were studied. Mean follow-up time was 63 months. Results: After surgery patients were prepared using thyroid hormone withdrawal or recombinant human thyrotropin, then 1.1-3.7 GBq 131-iodine was administered. First year evaluation consisted of ultrasound as well as serum thyrotropin and thyroglobulin (plus thyroglobulin antibody) determinations. Ablation success rate was 83% and the five year survival was 100%. There was not any cancer specific death. Conclusion: In the future somewhat more radical surgery and less remnant ablation is needed with unified follow-up protocol. Orv. Hetil., 2011, 152, 1731–1738.

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

Cancers ◽

10.3390/cancers13020310 ◽

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.

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No Reason for Hypothyroidism. Five year follow-up results after combined thyroidectomy and Radio Ablation Therapy for differentiated thyroid cancer

Zeitschrift für Gastroenterologie ◽

10.1055/s-0031-1285752 ◽

2011 ◽

Vol 49 (08) ◽

Author(s):

N Emmanouilidis ◽

WH Knapp ◽

J Klempnauer ◽

GFW Scheumann

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Ablation Therapy

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Confronting the practice of surgery on differentiated thyroid cancer with current guidelines in Germany

Nuklearmedizin ◽

10.1055/s-0038-1625203 ◽

2005 ◽

Vol 44 (05) ◽

pp. 185-191 ◽

Cited By ~ 4

Author(s):

H. Wieler ◽

S. Birtel ◽

E. Ostwald-Lenz ◽

K. P. Kaiser ◽

H. P. Becker ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Survival Rates ◽

Perioperative Morbidity ◽

Referral Hospitals ◽

Principles Of Treatment ◽

Current Guidelines ◽

Papillary Microcarcinomas ◽

Retrospective Multicenter Study

Summary:Aim: For the surgical therapy of differentiated thyroid cancer precise guidelines are applied by the German medical societies. In a retrospective multicenter study, we investigated the following issues: Are the current guidelines respected?. Is there a difference concerning the surgical radicalism and the outcome?. Does the perioperative morbidity increase with the higher radicalism of the procedure?. Patients, methods: Data gained from 102 patients from 17 regional referral hospitals who underwent surgery for thyroid cancer and a following radioiodine treatment (mean follow up: 42.7 [24-79] months) were analyzed. At least 71 criterias were analyzed in a SPSS file. Results: 46.1% of carcinomas were incidentally detected during goiter surgery. The thyroid cancer (papillary n = 78; follicular n = 24) occurred in 87% unilateral and in 13% bilateral. Papillary carcinomas <1 cm were detected in 25 cases; in five of these cases (20%) contralateral carcinomas <1 cm were found. There were significant differences concerning the surgical radicalism: a range from hemithyroidectomy to radical thyroidectomy with lateral neck dissection. Analysis of the histopathologic reports revealed that lymph node dissection was not performed according to guidelines in 55% of all patients. The perioperative morbidity was lower in departments with a high case load. The postoperative dysfunction of the recurrent laryngeal nerve (mean: 7.9% total / 4.9% nerves at risk) variated highly, depending on differences in radicalism and hospitals. Up to now these variations in surgical treatment have shown no differences in their outcome and survival rates, when followed by radioiodine therapy. Conclusion: Current surgical regimes did not follow the guidelines in more than 50% of all cases. This low acceptance has to be discussed. The actual discussion about principles of treatment regarding, the socalled papillary microcarcinomas (old term) has to be respected within the current guidelines.

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Relationship between Thyroglobulin and Tumor Detectabilily with Thallium-201 in Differentiated Thyroid Cancer

Nuklearmedizin ◽

10.1055/s-0038-1632238 ◽

2000 ◽

Vol 39 (01) ◽

pp. 10-15 ◽

Cited By ~ 1

Author(s):

S. P. Müller ◽

Ch. Reiners ◽

A. Bockisch ◽

Katja Brandt-Mainz

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Roc Analysis ◽

Tsh Suppression ◽

Significant Difference ◽

Test Specificity ◽

The Relationship ◽

Tumor Scintigraphy ◽

Tsh Stimulation

Summary Aim: Tumor scintigraphy with 201-TICI is an established diagnostic method in the follow-up of differentiated thyroid cancer. We investigated the relationship between thyroglobulin (Tg) level and tumor detectability. Subject and methods: We analyzed the scans of 122 patients (66 patients with proven tumor). The patient population was divided into groups with Tg above (N = 33) and below (N = 33) 5 ng/ml under TSH suppression or above (N = 33) and below (N = 33) 50 ng/ml under TSH stimulation. Tumor detectability was compared by ROC-analysis (True-Positive-Fraction test, specificity 90%). Results: There was no significant difference (sensitivity 75% versus 64%; p = 0.55) for patients above and below 5 ng/ml under TSH suppression and a just significant difference (sensitivity 80% versus 58%; p = 0.04) for patients above and below 50 ng/ml under TSH stimulation. In 18 patients from our sample with tumor, Tg under TSH suppression was negative, but 201-TICI-scan was able to detect tumor in 12 patients. Conclusion: Our results demonstrate only a moderate dependence of tumor detectability on Tg level, probably without significant clinical relevance. Even in patients with slight Tg elevation 201-TICI scintigraphy is justified.

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