Physician Confidence in Neck Ultrasonography for Surveillance of Differentiated Thyroid Cancer Recurrence

Kovatch, Kevin J.; Reyes‐Gastelum, David; Sipos, Jennifer A.; Caoili, Elaine M.; Hamilton, Ann S.; Ward, Kevin C.; Haymart, Megan R.

doi:10.1001/jamaoto.2020.4471

Cited by 8 publications

(11 citation statements)

References 39 publications

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“…Therefore, it is of great importance to explore the methods for early diagnosis and treatment of TC. At present, the clinical treatment options for patients with TC mainly include initial thyroidectomy, radioiodine therapy, and long-term suppression of thyroid-stimulating hormone (TSH)[ 3 - 5 ]. TSH is a glycoprotein hormone synthesized and secreted by thyroid cells in the anterior pituitary gland and plays a regulatory role by acting on the thyrotropin receptor (TSHR) on the cell surface.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the value and safety of thyroid-stimulating hormone in the clinical efficacy of patients with thyroid cancer

Liang¹,

Feng²,

Li³

et al. 2023

World J Clin Cases

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BACKGROUND Thyroid cancer (TC) is a common malignant tumor in the endocrine system. In recent years, the incidence and recurrence rates of TC have been raising due to increasing work pressure and irregular lifestyles. Thyroid-stimulating hormone (TSH) is a specific parameter for thyroid function screening. This study aims to explore the clinical value of TSH in regulating the progression of TC, so as to find a breakthrough for the early diagnosis and treatment of TC. AIM To explore the value and safety of TSH in the clinical efficacy of patients with TC. METHODS 75 patients with TC admitted to the Department of Thyroid and Breast Surgery of our hospital from September 2019 to September 2021 were selected as the observation group, and 50 healthy subjects were selected as the control group during the same period. The control group was treated with conventional thyroid replacement therapy, and the observation group was treated with TSH suppression therapy. The soluble interleukin (IL)-2 receptor (sIL-2R), IL-17, IL-35 levels, free triiodothyronine (FT 3 ), free tetraiodothyronine (FT 4 ), CD3 + , CD4 + , CD8 + , CD44V6, and tumor supplied group of factor (TSGF) levels were observed in the two groups. The occurrence of adverse reactions was compared between the two groups. RESULTS After treatment with different therapies, the levels of FT 3 , FT 4 , CD3 + , and CD4 + in the observation group and the control group were higher than those before treatment, while the levels of CD8 + , CD44V6, and TSGF were lower than those before treatment, and the differences were statistically significant ( P < 0.05). More importantly, the levels of sIL-2R and IL-17 in the observation group were lower than those in the control group after 4 wk of treatment, while the levels of IL-35 were higher than those in the control group, and the differences were statistically significant ( P < 0.05). The levels of FT 3 , FT 4 , CD3 + , and CD4 + in the observation group were higher than those in the control group, and the levels of CD8 + , CD44V6, and TSGF were lower than those in the control group. There was no significant difference in the overall incidence rate of adverse reactions between the two groups ( P > 0.05). CONCLUSION TSH suppression therapy can improve the immune function of patients with TC, lower the CD44V6 and TSGF levels, and improve serum FT 3 and FT 4 levels. It demo...

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Section: Introductionmentioning

confidence: 99%

Analysis of the value and safety of thyroid-stimulating hormone in the clinical efficacy of patients with thyroid cancer

Liang¹,

Feng²,

Li³

et al. 2023

World J Clin Cases

View full text Add to dashboard Cite

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“…Over 80% of thyroid cancer patients present with well-differentiated thyroid cancer which includes papillary and follicular tumours [ 2 ]. After initial surgery and adjuvant treatment, these patients are often followed indefinitely by an endocrinologist who monitors for cancer recurrence through periodic blood tests and neck ultrasounds [ 3 ]. However, with the rising incidence of thyroid cancer, the increased need for post-treatment follow-up among survivors, and the limited number of thyroid cancer specialists; there is the opportunity for primary care physicians (PCP) to play a larger role in providing follow-up care.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Early Transition of Low-Risk Thyroid Cancer Patients from Specialist to Primary Care

et al. 2022

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Background: Recently published clinical pathways for management of thyroid cancer outlined the criteria for transitioning low-risk patients to primary care within one to five years from diagnosis. However, discharge patterns among endocrinologists remain heterogeneous as there lacks a consensus regarding post-treatment care for thyroid cancer patients. Objective: This study described general characteristics and outcomes of thyroid cancer patients who were discharged from specialist care and transitioned to a primary care-based follow-up clinic. Methods: Thyroid cancer patients seen in the After Cancer Treatment Transition (ACTT) clinic at Women’s College Hospital (Toronto, Canada) were included in the study. Electronic medical records were reviewed between May and October 2021 to collect patient characteristics and outcomes. Descriptive statistics were calculated. Results: The study cohort included 148 thyroid cancer patients and 76% were female. All cases were papillary thyroid cancer and most diagnoses were classified as T2 (42%), N0 (55%), M0 (91%), and stage 1 (83%). Nearly all patients (n = 147) had complete thyroidectomy. Levels of thyroglobulin and thyroglobulin antibodies (TgAb) were low overall, with only 5% of the study cohort deemed TgAb positive. Mean levels of thyroid stimulating hormone (TSH) measured at 2 time points (1.37 mIU/L, 1.42 mIU/L) were within normal range. About 91% of the study cohort had normal TSH levels and 82% met target TSH levels. There were 2 cases of recurrence; however, investigation determined that they were not initially appropriate candidates for transition to primary care. Nearly 99% (n = 146) of patients had excellent response to therapy, showed no evidence of disease recurrence, and have not required re-referral to specialist care. Conclusions: These findings may reassure specialists that low-risk, stable thyroid cancer patients can be safely transitioned to primary care for post-treatment follow-up.

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“…The authors found that only 1 in 5 physicians reported having high confidence in their own ability to use ultrasonography to detect lymph nodes suggestive of recurrence; 3 in 5 reported having high confidence in a radiologist's ability to detect recurrence; and 1 in 3 did not have high confidence in either their own or a radiologist's ability to detect recurrence. 3 As with many other aspects of clinical practice, confidence increases with expertise, resources, and experience. Since only 27% of the physicians in the study by Kovatch and colleagues 3 reported performing ultrasonography themselves, we are not surprised by their low confidence.…”

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confidence: 99%

“…3 As with many other aspects of clinical practice, confidence increases with expertise, resources, and experience. Since only 27% of the physicians in the study by Kovatch and colleagues 3 reported performing ultrasonography themselves, we are not surprised by their low confidence. Those who have elected to have a radiologist obtain and interpret the ultrasonography images may feel daunted by the complexity of detecting suggestive findings or by the high number of neck nodes, which could reduce sensitivity.…”

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confidence: 99%

“…Ultrasonography is the modality of choice for neck nodal surveillance after thyroidectomy for patients with differentiated thyroid cancer (DTC), according to the American Thyroid Association and the European Thyroid Association . In a cross-sectional survey study published in this issue of JAMA Otolaryngology–Head & Neck Surgery , Kovatch and colleagues draw attention to low confidence in ultrasonography among a cohort of 320 endocrinologists, general surgeons, and otolaryngologists. The authors found that only 1 in 5 physicians reported having high confidence in their own ability to use ultrasonography to detect lymph nodes suggestive of recurrence; 3 in 5 reported having high confidence in a radiologist's ability to detect recurrence; and 1 in 3 did not have high confidence in either their own or a radiologist’s ability to detect recurrence …”

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confidence: 99%

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Increasing Confidence in Detecting Metastatic Thyroid Cancer With Neck Ultrasonography

Azadi

Hoang

2021

JAMA Otolaryngol Head Neck Surg

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Physician Confidence in Neck Ultrasonography for Surveillance of Differentiated Thyroid Cancer Recurrence

Cited by 8 publications

References 39 publications

Analysis of the value and safety of thyroid-stimulating hormone in the clinical efficacy of patients with thyroid cancer

Analysis of the value and safety of thyroid-stimulating hormone in the clinical efficacy of patients with thyroid cancer

Outcomes of Early Transition of Low-Risk Thyroid Cancer Patients from Specialist to Primary Care

Increasing Confidence in Detecting Metastatic Thyroid Cancer With Neck Ultrasonography

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