Clinical outcome of patients with differentiated thyroid cancer and raised antithyroglobulin antibody levels: a retrospective study

Abstract

Background Thyroglobulin (Tg) is a specific tumor marker for differentiated thyroid cancer (DTC). However, in the presence of an antithyroglobulin antibody (TgAb), it becomes unreliable. The purpose of the study was to assess the long-term outcome of DTC patients with raised TgAb. Method In a retrospective study, we included patients with DTC who had raised TgAb following total thyroidectomy. We excluded patients with persistently raised Tg (≥ 1 ng/ml) or radioiodine avid disease. Serial TgAb levels, excellent response (ER), incomplete response (IR), and anatomical recurrence were evaluated. Results A total of seventy-six patients were included in the study. Patients with IR had higher baseline TgAb (1071.27 ± 1216.17 vs. 99.61 ± 91.29 IU/ml, p < 0.001) and central compartment lymph node metastases (70.8% vs. 46.4%, p = 0.035) in comparison to those in the ER group. In the first follow-up, 64 (84.2%) patients had a stable or fall in the TgAb (0 to − 98.3%). Sixty-eight patients received high-dose radioiodine therapy (RIT). Out of these, 59 (86.5%) had transient, and 51 (75%) had a long-term fall in TgAb. After a follow-up period of 58.74 ± 26.26 months, 63.2% (48 out of 76) patients had IR. Nine (11.8%) patients had a rising TgAb level (3.7–170.9%) from baseline. Eleven patients underwent 18F-FDG PET/CT, and five of them demonstrated metabolically active recurrent disease. Three patients underwent cervical lymph nodes dissection. None of the patients died during the follow-up period. Conclusion High post-operative TgAb levels and central compartment lymph nodal metastases are risk factors for IR. RIT leads to a significant fall in the TgAb in these patients. The low level of raised TgAb is associated with an excellent outcome. Patients with recurrences had very high baseline TgAb > 1000 IU/ml. Raised TgAb was associated with good clinical outcomes and not associated with increased mortality.

Prevalence and Clinical Significance of Preoperative Thyroglobulin Antibodies in Differentiated Thyroid Cancer Patients

“…Trimboli et al [23], Kim et al [13], and Seo et al [39] observed that positive preopTgAb was associated with the risk of disease recurrence as compared to preopTgAb negative patients. While Ora et al [38] observed an association between baseline TgAb value and treatment outcome, similar to results by Soyluk et al [18] and Patell et al [40], preopTgAb had no correlation with the outcome response in our study population. According to Ora et al [28], 35.52% and 67.05% recurrence was seen in patients with baseline TgAb of <100 and 500 IU/ml, respectively.…”

“…In such cases, alternate methods such as neck ultrasound or image explorations are sought [35]. Postoperatively, a reduction of >50% TgAb from the baseline value is indicative of a better prognosis [38]. A slow and steady decrease in the TgAb levels post-treatment suggests a good prognosis; while an increase TgAb indicates a poor prognosis [32].…”

“…In a study by Zavala et al [23], 68.3% showed an indeterminate response followed by an excellent response in 24.4% of patients, biochemical incomplete in 4.9%, and structural incomplete in 1%. Ora et al [38] suggested that high postoperativeTgAb and lateral compartment metastasis are risk factors for the persistence of high TgAb levels and incomplete treatment response in long-term follow-up. They observed an anatomical recurrence in patients with >1000 IU/mL TgAb values on longer follow-ups.…”

Stimulated Thyroglobulin and Pre-ablation Antithyroglobulin Antibody Product Can Predict the Response to Radioiodine Therapy in TgAb-positive Differentiated Thyroid Cancer Pa-tients: A Retrospective Study

“…In most of the previous studies, researchers mainly focused on the relationship between the time trend of TgAb after RAIT and clinical outcome of DTC, and revealed the trend of TgAb was more important for prognosis in TgAb-positive DTC patients [12][13][14][15][16]. However, it took time to observe the time trend of TgAb.…”

The Significance of PAX8‐PPARγ Expression in Thyroid Cancer and the Application of a PAX8‐PPARγ‐Targeted Ultrasound Contrast Agent in the Early Diagnosis of Thyroid Cancer

“…Currently, the clinical diagnosis of thyroid tumors is still based on pathological diagnosis as the gold standard, but surgical resection treatment is an invasive test. Ultrasound-guided thyroid aspiration cytology, which is widely used in clinical practice, has partially reduced the invasiveness, but many clinical challenges are often encountered, such as small tumors that are difficult to get to the location of the tumor, small amounts of tissue or tissue damage that makes pathology difficult to make a correct diagnosis, and surgical biopsy is an absolute contraindication for patients with bleeding tendency [ 3 ]. Therefore, it is important to study new methods for noninvasive and targeted diagnosis of thyroid tumors.…”