Papillary Thyroid Carcinoma Patients Assessed to Be at Low or Intermediary Risk After Primary Treatment Are at Greater Risk of Long Term Recurrence If They Are Thyroglobulin Antibody Positive Or Do Not Have Distinctly Low Thyroglobulin at Initial Assessment

Soyluk, Ozlem; Boztepe, Harika; Aral, Feríhan; Alagöl, Faruk; Özbey, Neşe

doi:10.1089/thy.2011.0122

Cited by 33 publications

(18 citation statements)

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“…Although TgAb appear to be useful for longitudinal surveillance of thyroid cancer activity, the prognostic significance of TgAb status at diagnosis remains unclear. Some studies in adults suggest that TgAb may be associated with an increased risk of disease recurrence (10,11), whereas others find no such association (27,30). To address this issue in our pediatric cohort, we analyzed the prevalence of persistent/recurrent disease in the first 3 years after initial treatment in patients with or without TgAb at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Lymphocytic infiltration of the thyroid is common either within or remote from a thyroid tumor, and the presence and concentration of TgAb correlate with the degree of lymphocytic thyroiditis in adults with thyroid cancer (14). The fact that lymphocytic thyroiditis occurs in 42 to 88% of pediatric patients (10,(15)(16)(17) compared with 23 to 40% of adult patients (18)(19)(20) suggests that children may have a more robust autoimmune response to thyroid cancer, which could result in a higher prevalence of TgAb in children than in adults.…”

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confidence: 99%

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Prevalence and Significance of Thyroglobulin Antibodies in Pediatric Thyroid Cancer

Wassner

Vecchia

Jarolím

et al. 2017

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context: Circulating thyroglobulin antibodies (TgAb) can confound measurement of serum thyroglobulin and impair thyroid cancer surveillance. Few data exist on the significance of TgAb in pediatric thyroid cancer.Objective: To describe the prevalence, natural history, and clinical significance of TgAb in children with thyroid cancer.Design: Retrospective cohort study.Setting: Single academic pediatric center.Patients: Seventy-three consecutive children (#18 years) with nonmedullary thyroid cancer who had serum TgAb measured within 6 months after diagnosis.Main Outcome Measures: Prevalence and natural history of TgAb; association of TgAb status and resolution with patient and disease characteristics.Results: TgAb were detected in 41% of subjects (30 of 73) and were associated with lymph node metastasis (83% vs 53%, P = 0.01) but not distant metastasis. In patients with TgAb, resolution occurred in 44% (11 of 25) over a median follow-up of 3.8 years. Median time to clear TgAb was 10.7 months, and 10 of 11 patients who cleared (91%) did so within 2 years. Resolution of TgAb was associated with lower initial TgAb level (median 4.5 vs 76 normalized units, P = 0.003). TgAb positivity at diagnosis was not independently associated with persistent or recurrent disease (odds ratio 3.20, 95% confidence interval 0.95 to 10.80, P = 0.06).Conclusions: TgAb are common at diagnosis in children with thyroid cancer but resolve in nearly half of patients within 1 to 2 years. TgAb are associated with the presence of lymph node metastasis at diagnosis, but the long-term prognostic significance remains to be determined. (J Clin Endocrinol Metab 102: [3146][3147][3148][3149][3150][3151][3152][3153] 2017) T hyroid cancer is the most common endocrine malignancy in both children and adults. Although the risk of mortality from thyroid cancer is low, lifelong surveillance is mandatory due to the risk of disease recurrence, which may occur many years after initial treatment and apparent cure. This issue is especially salient in children with thyroid cancer because of the decades of monitoring required.Because many differentiated thyroid cancers produce thyroglobulin (Tg), measurement of serum Tg can detect thyroid cancer recurrence or progression and is therefore an important element of long-term surveillance in patients with thyroid cancer (1). However, circulating Tg antibodies (TgAb) can confound conventional Tg assays and thereby prevent accurate measurement of Tg levels (2, 3). TgAb therefore represent a significant clinical issue Abbreviations: NED, no evidence of disease; OR, odds ratio; RAI, radioactive iodine; Tg, thyroglobulin; TgAb, Tg antibody. 3146https://academic.oup.com/jcem

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Prevalence and Significance of Thyroglobulin Antibodies in Pediatric Thyroid Cancer

Wassner

Vecchia

Jarolím

et al. 2017

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…Most DTC patients with circulating TgAb have evidence of thyroid autoimmunity [66,89,90], although any causal relationship between Hashimoto's thyroiditis and PTC is unclear [90–92]. However, TgAb-positive PTC patients may be more likely to have extrathyroidal extension and a higher risk for persistent or recurrent disease than TgAb-negative PTC patients [14 ▪ ,93–95]. It follows that a preoperative TgAb measurement, and/or histologic evidence of lymphocytic infiltration in the surgical specimen, may be a risk factor and early indicator that postoperative Tg 2G IMA measurement may be unreliable because of TgAb interference [90,96,97].…”

Section: Postoperative Serum Thyroglobulin Monitoringmentioning

confidence: 99%

How sensitive (second-generation) thyroglobulin measurement is changing paradigms for monitoring patients with differentiated thyroid cancer, in the absence or presence of thyroglobulin autoantibodies

Spencer

LoPresti

Fatemi

2014

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewTo discuss new insights regarding how sensitive (second-generation) thyroglobulin immunometric assays (Tg2GIMAs), (functional sensitivities ≤0.10 μg/L) necessitate different approaches for postoperative thyroglobulin monitoring of patients with differentiated thyroid cancer (DTC), depending on the presence of thyroglobulin autoantibodies (TgAbs).Recent findingsReliable low-range serum thyroglobulin measurement has both enhanced clinical utility and economic advantages, provided TgAb is absent (∼75% DTC patients). Basal [nonthyroid-stimulating hormone (TSH) stimulated] Tg2GIMA measurement obviates the need for recombinant human TSH stimulation because basal Tg2GIMA below 0.20 μg/L has comparable negative predictive value (>95%) to recombinant human TSH-stimulated thyroglobulin values below the cutoff of 2 μg/L. Now that radioiodine remnant ablation is no longer considered necessary to treat low-risk DTC, the trend and doubling time of low basal thyroglobulin values arising from postsurgical thyroid remnants have recognized prognostic significance. The major limitation of Tg2GIMA testing is interference by TgAb (∼25% DTC patients), causing Tg2GIMA underestimation that can mask disease. When TgAb is present, the trend in TgAb concentrations (measured by the same method) can serve as the primary (surrogate) tumor-marker and be augmented by thyroglobulin measured by a TgAb-resistant class of method (radioimmunoassay or liquid chromatography-tandem mass spectrometry).SummaryThe growing use of Tg2GIMA measurement is changing paradigms for postoperative DTC monitoring. When TgAb is absent, it is optimal to monitor the basal Tg2GIMA trend and doubling time (using the same method) in preference to recombinant human TSH-stimulated thyroglobulin testing. When TgAb is present, interference renders Tg2GIMA testing unreliable and the trend in serum TgAb concentrations per se (same method) can serve as a (surrogate) tumor-marker.

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“…Recent studies have also shown that never-smoking status reduces the risk of thyroid cancer (risk ratio [RR], 0.71; 95% confidence interval [CI], 0.60 to 0.83) [ 5 8 ]. Soyluk et al [ 9 ] showed that low- to intermediate-risk PTC patients were at an increased risk of recurrence if their initial post-ablative thyroglobulin (Tg) level in serum was ≥0.3 ng/mL or if they were positive for anti-thyroglobulin (anti-Tg) antibody. There are currently no international or local data on factors affecting disease recurrence among low-risk PTC patients.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with Disease Recurrence among Patients with Low-Risk Papillary Thyroid Cancer Treated at the University of the Philippines-Philippine General Hospital

2016

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BackgroundThe management of papillary thyroid carcinoma (PTC) in high-risk patients is well-standardized. However, this is not the case for low-risk patients. Filipinos show a high incidence of recurrence of thyroid cancer. Thus, the identification of risk factors for recurrence in this population could potentially identify individuals for whom radioactive iodine (RAI) therapy might be beneficial.MethodsWe reviewed the medical records of adult Filipinos with low-risk PTC who underwent near-total or total thyroidectomy at the University of the Philippines-Philippine General Hospital. Multivariate logistic regression analysis was used to determine risk factors for recurrence.ResultsRecurrence was documented in 51/145 of patients (35.17%) included in this study. Possible risk factors such as age, sex, family history, smoking history, tumor size, multifocality, prophylactic lymph node dissection, initial thyroglobulin (Tg) level, initial anti-thyroglobulin (anti-Tg) antibody concentration, suppression of thyroid stimulating hormone production, and RAI therapy were analyzed. Multivariate analysis revealed that a tumor diameter 2 to 4 cm (odds ratio [OR], 9.17; 95% confidence interval [CI], 1.62 to 51.88; P=0.012), a tumor diameter >4 cm (OR, 16.46; 95% CI, 1.14 to 237.31; P=0.04), and a family history of PTC (OR, 67.27; 95% CI, 2.03 to 2228.96; P=0.018) were significant predictors of recurrence. In addition, RAI therapy (OR, 0.026; 95% CI, 0.01 to 0.023; P≤0.005), an initial Tg level ≤2 ng/mL (OR, 0.049; 95% CI, 0.01 to 0.23; P≤0.005), and an anti-Tg antibody level ≤50 U/mL (OR, 0.087; 95% CI, 0.011 to 0.67; P=0.019) were significant protective factors.ConclusionA tumor diameter ≥2 cm and a family history of PTC are significant predictors of recurrence. RAI therapy and low initial titers of Tg and anti-Tg antibody are significant protective factors against disease recurrence among low-risk PTC patients.

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Papillary Thyroid Carcinoma Patients Assessed to Be at Low or Intermediary Risk After Primary Treatment Are at Greater Risk of Long Term Recurrence If They Are Thyroglobulin Antibody Positive Or Do Not Have Distinctly Low Thyroglobulin at Initial Assessment

Cited by 33 publications

References 17 publications

Prevalence and Significance of Thyroglobulin Antibodies in Pediatric Thyroid Cancer

Prevalence and Significance of Thyroglobulin Antibodies in Pediatric Thyroid Cancer

How sensitive (second-generation) thyroglobulin measurement is changing paradigms for monitoring patients with differentiated thyroid cancer, in the absence or presence of thyroglobulin autoantibodies

Risk Factors Associated with Disease Recurrence among Patients with Low-Risk Papillary Thyroid Cancer Treated at the University of the Philippines-Philippine General Hospital

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