A Prospective Study Showing an Excellent Response of Patients with Low-Risk Differentiated Thyroid Cancer Who Did Not Undergo Radioiodine Remnant Ablation after Total Thyroidectomy

Abstract

ment, measuring Tg and making a WBS. The patients were then annually monitored with neck US and Tg measurement under TSH between 0.5 and 2.0 mIU/l for 36-84 months. Results: Neck US of all patients, 3 months after TT, presented no evidence of abnormal residual tissues or metastatic lymph nodes (negative neck US); at this time, the mean Tg level was 0.42 ng/ml. Six months after surgery, after rhTSH, the mean thyroid bed uptake was 1.82%, and Tg levels ranged from 0.10 to 22.30 ng/ml (mean, 2.89 ng/ml). The patients were followed up without any sign of recurrence (negative neck US and stable or decreasing Tg levels). During the ongoing follow-up, the Tg trend was stable or decreasing, independently of the initial suppressed or stimulated Tg level, or WBS uptake. Conclusions: In patients with low-risk differentiated thyroid cancer, who were operated by TT and who did not undergo RRA, an excellent response to treatment may be confirmed by annual neck US and Tg trend. Key WordsLow-risk thyroid carcinoma · Thyroglobulin · Thyroglobulin temporal trend · Radioiodine remnant ablation · Neck ultrasound Abstract Objectives: To prospectively evaluate the outcome of patients with low-risk papillary thyroid carcinoma treated with total thyroidectomy (TT) who did not undergo radioiodine remnant ablation (RRA). Study Design: We prospectively followed up 57 patients; 3 months after TT, thyroglobulin (Tg) assessment and neck ultrasonography (US) were performed while patients were taking L -T 4 , presenting suppressed TSH. Six months after TT, patients underwent stimulated Tg testing and whole-body scan (WBS) after recombinant TSH (rhTSH). Then, 18 months after TT, the patients were evaluated by neck US and Tg under TSH between 0.5 and 2.0 mIU/ ml. Two years after TT, we performed another rhTSH assess-

Clinical outcomes of low and intermediate risk differentiated thyroid cancer patients treated with 30mCi for ablation or without radioactive iodine therapy

“…Current second generation Tg assays (0.05-0.1 ng/mL) have shown that patients with lowrisk DTC with undetectable baseline Tg rarely recur (5). In this sense, study published in 2016 by Janovsky (1) concluded that an excellent response to treatment can be confirmed by the trend of Tg and US, these being the best follow-up approaches, showing that the use of RRA only to achieve negative levels of Tg for surveillance is not necessary because it is not an isolated value, but the tendency of Tg during follow-up, the determining factor for both (1). Therefore, based on the above, it should be emphasized that the trend of Tg is highly suggestive of being a predictor of disease-free follow-up.…”

“…O ver the last decades, the incidence of DTC has increased significantly, especially of tumors smaller than 2 cm (1)(2)(3). Despite this, most of these patients have an excellent prognosis and a long followup during their lifetime (4,5).…”

Ensuring Quality in Thyroid Cancer Surgery

“…26 Several studies show that undetectable postoperative Tg levels correspond with a low incidence of recurrence, while elevated Tg levels are associated with recurrence. 27,28 Rosario and colleagues demonstrated that Tg levels often detected recurrent papillary thyroid carcinoma, even prior to structurally detectable disease on ultrasound. 29 One study evaluating the risk of recurrent PTC demonstrated an increase in Tg more than twofold was seen in 80% of patients with recurrence and only 13% of patients without demonstrable recurrent PTC on imaging.…”

The Janus faces of thyroid carcinoma

“…On one hand, the majority of patients with recently detected DTC have PTMC, which is associated with excellent prognosis and, in general, no mortality. For these diseases, appropriate risk stratification to determine which cancers require specific treatment and ongoing continuous restratification are essential to avoid overtreatment (17). For a specifically selected subgroup of low-risk patients, simple surveillance, with no specific treatment, has been proposed and stimulated (12)(13)(14).…”