Serial post-surgical stimulated and unstimulated highly sensitive thyroglobulin measurements in low- and intermediate-risk papillary thyroid carcinoma patients not receiving radioactive iodine

Kashat, Lawrence; Orlov, Steven; Orlov, David; Assi, Jasmeet; Salari, Farnaz; Walfish, Paul G.

doi:10.1007/s12020-016-0989-3

Cited by 12 publications

(5 citation statements)

References 18 publications

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“…In accordance with Giovanella et al, periodic (serial) highly sensitive, unstimulated thyroglobulin measurements could compensate for this shortcoming, because tumor recurrence is detected early on due to a continuous rise (8). The usefulness of this approach has already been confirmed by other publications (23,24,25).…”

Section: Discussionsupporting

confidence: 52%

Predictive value of highly sensitive basal versus stimulated thyroglobulin measurement in long-term follow-up of thyroid cancer

Pabst

Seifert

Hirmas

et al. 2023

Endocrine Connections

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Objective: Recurrence of differentiated thyroid cancer (DTC) is associated with reduced quality of life and early identification of patients at risk is urgently needed. Here we investigated the predictive power of various cut-off values of single stimulated thyroglobulin (s-Tg) and single highly sensitive measured, unstimulated thyroglobulin (u-hsTg) measurements close to the end of primary therapy for recurrence-free survival (RFS) in long-term follow-up (>10 years) of patients with DTC. Methods: In DTC patients with adjuvant radioiodine therapy, we assessed retrospectively u-hsTg (6±3 months before s-Tg measurement) and s-Tg measurements (≤24 months after last radioiodine therapy). Positive predictive (PPV)/negative predictive values (NPV) of various cut-off values (s-Tg: 0.5/1.0 ng/ml; u-hsTg: 0.09/0.2 ng/ml) for patient outcomes as well as additional factors associated with disease development were analyzed. Results: In total, 175 patients were retrospectively reviewed (tumor recurrence: n=14/complete remission: n=161). Examined cut-off values for s-Tg and u-hsTg showed significant predictive power for RFS (log-rank: all p<0.001). NPV/PPV for s-Tg were 98.6%/36.4%, respectively (0.5 ng/ml cut-off), and 96.7%/42.9%, respectively (1.0 ng/ml cut-off); those for u-hsTg were 97.3%/35.7%, respectively (0.09 ng/ml cut-off), and 95.2%/85.7%, respectively (0.2 ng/ml cut-off). U-hsTg (p<0.001) and patient age (p<0.05) were significantly associated with tumor recurrence. One-third of patients with tumor recurrence in the course initially showed undetectable u-hsTg after completion of primary therapy. Conclusion: With >10 years of follow-up, both s-Tg and u-hsTg have a comparably high predictive power for RFS, while only u-hsTg was significantly associated with a recurrence event. Serial u-hsTg measurements seem warranted since patients with tumor recurrence during follow-up may have an undetectable tumor marker at baseline.

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Section: Discussionsupporting

confidence: 52%

Predictive value of highly sensitive basal versus stimulated thyroglobulin measurement in long-term follow-up of thyroid cancer

Pabst

Seifert

Hirmas

et al. 2023

Endocrine Connections

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“…Stimulated and unstimulated Tg levels have been available for the last several decades as markers of disease surveillance, and are now utilized to determine post-operative treatment, specifically the need for radioactive iodine or the need for repeat surgical intervention (11). Several studies have shown that undetectable post-operative Tg levels correspond with a low incidence of recurrence, while elevated Tg levels are associated with recurrence (12–15).…”

Section: Discussionmentioning

confidence: 99%

Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease?

Bates

Lamas

Randle

et al. 2018

Surgery

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Background Papillary thyroid carcinoma (PTC) has excellent survival, yet recurrence remains a challenge. We sought to determine the proportion of re-operations performed for persistent, rather than truly recurrent disease. Methods We conducted a retrospective review of a prospectively maintained database. Patients with PTC that had re-operation for disease from 2000–2016 were included. We defined recurrence as disease that developed after a patient had an undetectable thyroglobulin and negative ultrasound within one year of surgery. Results A total of 69 patients underwent 92 re-operations. On initial pathology: mean tumor size was 2.6cm; 50.7% were multifocal; and 42% had extra-thyroidal extension. Half (46%) of the patients underwent a central/lateral neck dissection at initial surgery and 76.8% were treated with post-operative radioactive iodine. The median time to first re-operation was 21 months (range, 1–292), and 41.8% occurred within 1 year. Only three operations met criteria for true “recurrence”, while 71 operations were categorized as persistence. Conclusion Many re-operations for PTC are for management of persistent disease. Over half of the patients required re-operation within the first two years, which strongly suggests that improvements in the pre-operative assessment and adequacy of initial surgery need to be made to improve the care of patients with thyroid cancer.

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“…The introduction of highly sensitive Tg (hsTg), whose functional sensitivity is about 0.1 or 0.2 ng/mL, allows for the simplification of the follow-up protocol, avoiding the need for stimulated Tg (stTg). In fact, hsTg proved its equivalence in revealing distant metastases compared with stTg, even in patients without RRA [ 32 , 33 , 34 , 35 ].…”

Section: Radioiodine Treatment Goalsmentioning

confidence: 99%

Strategies for Radioiodine Treatment: What’s New

Sparano

Moog

Hadoux

et al. 2022

Cancers

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Radioiodine treatment (RAI) represents the most widespread and effective therapy for differentiated thyroid cancer (DTC). RAI goals encompass ablative (destruction of thyroid remnants, to enhance thyroglobulin predictive value), adjuvant (destruction of microscopic disease to reduce recurrences), and therapeutic (in case of macroscopic iodine avid lesions) purposes, but its use has evolved over time. Randomized trial results have enabled the refinement of RAI indications, moving from a standardized practice to a tailored approach. In most cases, low-risk patients may safely avoid RAI, but where necessary, a simplified protocol, based on lower iodine activities and human recombinant TSH preparation, proved to be just as effective, reducing overtreatment or useless impairment of quality of life. In pediatric DTC, RAI treatments may allow tumor healing even at the advanced stages. Finally, new challenges have arisen with the advancement in redifferentiation protocols, through which RAI still represents a leading therapy, even in former iodine refractory cases. RAI therapy is usually well-tolerated at low activities rates, but some concerns exist concerning higher cumulative doses and long-term outcomes. Despite these achievements, several issues still need to be addressed in terms of RAI indications and protocols, heading toward the RAI strategy of the future.

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Serial post-surgical stimulated and unstimulated highly sensitive thyroglobulin measurements in low- and intermediate-risk papillary thyroid carcinoma patients not receiving radioactive iodine

Cited by 12 publications

References 18 publications

Predictive value of highly sensitive basal versus stimulated thyroglobulin measurement in long-term follow-up of thyroid cancer

Predictive value of highly sensitive basal versus stimulated thyroglobulin measurement in long-term follow-up of thyroid cancer

Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease?

Strategies for Radioiodine Treatment: What’s New

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