Postoperative serum thyroglobulin and neck ultrasound to drive decisions about iodine-131 therapy in patients with differentiated thyroid carcinoma: an evidence-based strategy?

Giovanella, Luca; Avram, Anca M.; Clerc, Jérôme; Hindié, Elif; Taïeb, David; Verburg, Frederik A.

doi:10.1007/s00259-018-4110-4

Cited by 13 publications

(8 citation statements)

References 24 publications

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“…Importantly, several studies have shown an obvious link between the mass of thyroid tissue and the level of TG, which means lower volumes of thyroid tissue are associated with lower stimulated TG levels [30]. Whole-body 131 I scanning may be very sensitive in detecting the too-small thyroid tissue that produces minute amounts of TG, particularly post-ablation [31]. The present findings reveal a correlation between TGAb levels and recurrence, which is in harmony with a previous study compared the antithyroglobulin antibody concentrations before and after ablation with 131I as a possible predictor of structural disease in differentiated thyroid carcinoma patients TgAb [32].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Serum Thyroglobulin and Anti-Thyroglobulin Antibody in Thyroid Carcinoma Patients following Thyroidectomy

et al. 2021

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Well-differentiated thyroid cancer (WDTC) is a malignant head and neck tumor with a very high incidence. Thyroidectomized WDTC patients have been referred to nuclear medicine for radioactive iodine (RAI) ablation therapy and/or annual follow-up with diagnostic whole-body imaging. Serum thyroglobulin (TG) and thyroglobulin antibodies (TGAb) are biochemical tumor markers used to monitor WDTC. A global rise in the prevalence of WDTC is increasing the number of thyroidectomized patients requiring lifelong monitoring for persistent or recurrent diseases. The present study aimed to identify the most successful prognostic factors in well-defined thyroid carcinoma patients following total thyroidectomy and RAI therapy, followed by an estimation of the cutoff value of TG and TGAb. In this context, a total of 100 subjects were recruited and classified as follows: 60 thyroid carcinoma patients underwent total thyroidectomy and successful RAI therapy, while 40 normal healthy individuals matched for age, sex, and socioeconomic status constituted the control group. Interestingly, the levels of TG did not differ significantly between the relapsed and non-relapsed cases, but the levels of TGAb differed significantly between the relapsed and non-relapsed cases. Collectively, TG and TGAb are considered the most successful prognostic factors in well-defined thyroid carcinoma patients after total thyroidectomy and RAI therapy. The present study also concluded that the TGAb determination was better than that of the TG level, with a cutoff value of 10 ng/mL. These findings provide baseline information for follow-up and lifelong monitoring of thyroidectomized WDTC patients. Further research is warranted to explore more about serum TG and TGAb in thyroid carcinoma patients on a larger scale.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Serum Thyroglobulin and Anti-Thyroglobulin Antibody in Thyroid Carcinoma Patients following Thyroidectomy

et al. 2021

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“…Significantly lower RAI uptake ratios were recorded in patients treated by high-volume indicating the completeness of resection and properly informing the use of Tg as tumor marker [15]. Such data suggest that the use of serum Tg to predict metastases and properly inform RAI treatment cannot be generalized due to the relevant confounding role of the amount of postoperative residual thyroid tissue [11617]. In this context we proved here, as the main result of our study, that preablation 99m Tc-pertechnetate scintigraphy performs better than sTg in predicting successful ablation after administration of fixed low RAI activity (i.e., 1.1 GBq).…”

Section: Discussionmentioning

confidence: 99%

^99mTc-Pertechnetate Scintigraphy Predicts Successful Postoperative Ablation in Differentiated Thyroid Carcinoma Patients Treated with Low Radioiodine Activities

et al. 2019

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BackgroundPostoperative routine radioiodine (RAI) treatment is currently debated for patients with low-risk differentiated thyroid carcinoma (DTC) patients. If performed, a low 131I activity (i.e., 1 to 2 GBq) is recommended with the aim to ablate thyroid remnant and facilitate subsequent follow-up by thyroglobulin measurement. The purpose of this study was to evaluate the relationship between postsurgical technetium-99m (99mTc)-pertechnetate scintigraphy and the rate of successful remnant ablation after low activity radioiodine ablation in patients with DTC.MethodsEnrolled were 193 patients with low risk DTC who underwent total thyroidectomy and RAI ablation with a fixed 1.1 GBq activity of 131I. 99mTc-pertechnetate scans were done and thyrotropin stimulated thyroglobulin (sTg) levels measured just before ablation. Ablation effectiveness was assessed 6 to 12 months later by sTg measurement, neck ultrasound and diagnostic whole body scan.ResultsA negative 99mTc-perthecnetate scans was the best predictor of successful ablation (P<0.001) followed by preablative sTg levels <0.8 ng/mL (P=0.008) and 99mTc-pertechnetate uptake rate values <0.9% (P=0.065). Neither sex nor age of the patient at the time of ablation or tumor histology and size showed a significant association with the rate of successful ablation.ConclusionThe 99mTc-pertechnetate scintigraphy is a simple and feasible tool to predict effectiveness of low activity 131I thyroid to ablate thyroid remnants in patients with DTC.

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“…Generally, a very low Tg level is associated with a low likelihood of metastatic disease thus, in the setting of a low‐risk tumor and an excellent response, RAI is not usually recommended 83,84 . There are opinions that caution against this conservative approach citing rare cases of detecting distant metastases despite low postoperative Tg level 85 . This may be most relevant for patients who achieve an excellent response but have tumors with intermediate/high‐risk pathology features.…”

Section: Systemic Therapies For Thyroid Cancermentioning

confidence: 99%

“…83,84 There are opinions that caution against this conservative approach citing rare cases of detecting distant metastases despite low postoperative Tg level. 85 This may be most relevant for patients who achieve an excellent response but have tumors with intermediate/high-risk pathology features. For these individuals, the risk-adaptive approach may impact the dose of RAI administered more than a decision of treating vs not treating.…”

Section: Radioactive Iodine In Low-risk Thyroid Cancermentioning

confidence: 99%

Thyroid cancer, recent advances in diagnosis and therapy

Nabhan

Dedhia

Ringel

2021

Intl Journal of Cancer

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Over the past several decades, the approach to the diagnosis and management of patients with follicular cell-derived thyroid cancer has evolved based on improved classification of patients better matching clinical outcomes, as well as advances in imaging, laboratory, molecular technologies and knowledge. While thyroid surgery, radioactive iodine therapy and TSH suppression remain the mainstays of treatment, this expansion of knowledge has enabled de-escalation of therapy for individuals diagnosed with low-risk well-differentiated thyroid cancer; better definition of treatment choices for patients with more aggressive disease; and improved ability to optimize treatments for patients with persistent and/or progressive disease. Most recently, the advancement of knowledge regarding the molecular aspects of thyroid cancer has improved thyroid cancer diagnosis and has enabled individualized therapeutic options for selected patients with the most aggressive forms of the disease.Guidelines from multiple societies across the world reflect these changes, which focus on taking a more individualized approach to clinical management. In this review, we discuss the current more personalized approach to patients with follicular cell-derived thyroid cancer and point toward areas of future research still needed in the field.

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Postoperative serum thyroglobulin and neck ultrasound to drive decisions about iodine-131 therapy in patients with differentiated thyroid carcinoma: an evidence-based strategy?

Cited by 13 publications

References 24 publications

Prognostic Value of Serum Thyroglobulin and Anti-Thyroglobulin Antibody in Thyroid Carcinoma Patients following Thyroidectomy

Prognostic Value of Serum Thyroglobulin and Anti-Thyroglobulin Antibody in Thyroid Carcinoma Patients following Thyroidectomy

^99mTc-Pertechnetate Scintigraphy Predicts Successful Postoperative Ablation in Differentiated Thyroid Carcinoma Patients Treated with Low Radioiodine Activities

Thyroid cancer, recent advances in diagnosis and therapy

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