Russian clinical practice guidelines for diagnosis and treatment of differentiated thyroid cancer

Бельцевич, Д. Г.; Германович, Бельцевич Дмитрий; Ванушко, В Э; Эдуардович, Ванушко Владимир; Мельниченко, Г. А.; Афанасьевна, Мельниченко Галина; Мудунов, А. М.; Мурадович, Мудунов Али; Rumyantsev, P O; Олегович, Румянцев Павел; Sleptsov, Ilya; Валерьевич, Слепцов Илья

doi:10.14341/serg201537-14

Cited by 8 publications

(5 citation statements)

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“…We first address some characteristics that differentiate this work from previous studies that also reported the results of s-Tg in patients with low b-Tg measured with second-generation assays. To increase clinical applicability, the present study evaluated the cut offs currently proposed by ATA [1] and other societies [2,4,12,13] to define the response to thyroidectomy followed by RAI, that is, 0.2 and 1 ng/ml for b-Tg and 1 and 10 ng/ml for s-Tg. As also currently recommended, US was obtained in all patients during initial evaluation [1-4, 12, 13].…”

Section: Discussionmentioning

confidence: 99%

Definition of the Response to Initial Therapy with Radioiodine in Patients with Differentiated Thyroid Carcinoma: Basal or Stimulated Thyroglobulin?

2019

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Basal thyroglobulin (b-Tg) measured with second-generation assay or stimulated Tg (s-Tg) can be used to define the response to therapy of differentiated thyroid carcinoma. However, they do not always define the same category and guidelines do not establish “if” or “when” s-Tg needs to be obtained. We studied 304 patients without clinically apparent disease or disease detected by neck ultrasonography and without anti-Tg antibodies 9–12 months after therapy. Based on b-Tg, 196 patients had an excellent response and 108 had an indeterminate response. Based on s-Tg, a change in category occurred in 10.2% of the patients with an initial excellent response (all to indeterminate response) and in half the patients with an initial indeterminate response (44.4% to excellent response and 5.5% to biochemical incomplete response). One case of recurrence was observed among patients with an initial excellent response but whose response changed to indeterminate after s-Tg, while no disease was detected among those who remained in the initial category; however, this difference was not significant. In patients with an initial indeterminate response, no recurrence was detected among those whose response changed to excellent after s-Tg, while 11.1 and 33.3% of those who remained in the initial category or whose response changed to biochemical incomplete, respectively, had structural disease. This study suggest that, in low- or intermediate-risk patients, s-Tg better defines the response to therapy with 131I when it is classified as indeterminate based on b-Tg using second-generation assay. However, s-Tg is not necessary when b-Tg defines the response as excellent.

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Section: Discussionmentioning

confidence: 99%

Definition of the Response to Initial Therapy with Radioiodine in Patients with Differentiated Thyroid Carcinoma: Basal or Stimulated Thyroglobulin?

2019

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“…[1] и Российских клинических рекомендациях 2016 г. [2]. Также в классификации TNM 8-го пересмотра внедрен ряд изменений в стадировании высокодифференцированного рака щитовидной железы (ВДРЩЖ) [3].…”

Section: обоснованиеunclassified

“…С другой стороны, центральная лимфодиссекция увеличивает процент осложнений, которые приводят к инвалидизации больного, таких как гипопаратиреоз и парезы гортани. В российских рекомендациях [2] консенсуса по данному вопросу достигнуто не было. В нашем исследовании мы продемонстрировали, что выполнение тиреоидэктомии с ЦЛД именно в группе пациентов с BRAF-положительными опухолями снижало риск рецидива заболевания.…”

Section: обсуждение основного результата исследованияunclassified

Surgical tactics optimization for treatment of BRAF positive papillary thyroid cancer

et al. 2018

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Backgraund. Papillary thyroid cancer (PTC) has a favorable course and low mortality rates. However, the incidence of morbidity and mortality continues to increase, especially in the high-risk group. BRAF mutation is a marker of the PTC aggressive course. Aims. Тo study the relationship between surgical treatment tactics and the BRAF positive PTC prognosis. Materials and methods. Our prospective study included 80 patients with BRAF positive PTC, operated from 2009 to 2016 y. Surgical tactics were determined by existing clinical guidelines. To the patients with BRAF positive thyroid cancer it is proposed to perform thyroidectomy with central compartment lymph node dissection. BRAF status was determined by the PCR method in fine needle aspiration biopsy material (FNAB). Results. Recurrence was detected in 7 of the 18 patients of the hemi/thyroidectomy group. Among 62 patients from the group of thyroidectomy with central compartment lymph node dissection recurrence was detected only in 3 cases. The mean recurrence time also differed significantly, and in the group of patients with (hemi)thyroidectomy without central compartment lymph node dissection is detected earlier (53 months and 59.61 months). Also, organ-preserving operations without central compartment lymph node dissection in BRAF positive tumor has worse result, regardless of T stage. Conclusions. In the presence of BRAF-positive PTC thyroidectomy with central compartment lymph node dissection is indicated.

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“…Для обеспечения высокого захвата йода остаточной тиреоидной тканью, которая в том или ином количестве всегда остается после хирургического удаления органа, а также опухолевыми клетками высокодифференцированной карциномы щитовидной железы, чаще всего сохраняющими йоднакопительную способность, необходимо обеспечить уровень ТТГ в крови более 30 мМЕ/мл [4,5]. Традиционным методом подготовки пациентов к радиойоддиагностике (РЙД) и радиойодблации (РЙА) является эндогенная стимуляция синтеза ТТГ посредством отмены левотироксина натрия на срок 3-4 нед (у взрослых -на 4 нед, у детей -на 3 нед) [6].…”

Section: основные эффекты ттг на клетки щитовидной железы [3]unclassified

Recombinant human thyrotropin in radioiodine diagnostics and radioiodine ablation of patients with well-differentiated thyroid cancer: the first experience in Russia

et al. 2018

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Background. Traditional endogenous stimulation of thyroid-stimulating hormone (TSH) by means of long-term withdrawal of thyroid hormones for radioiodine diagnostics and radioiodine therapy causes severe hypothyroidism, which worsens patients’ general well-being and may lead to side effects and cause tumor growth and dissemination. Exogenous stimulation with recombinant human TSH (rh-TSH, thyrotropin-alfa) causes short-term increases in TSH levels and does not have the above-mentioned side effects. Purpose. To estimate the efficacy and safety of rh-TSH in preparation of patients with well-differentiated thyroid cancer for radioiodine diagnostics and radioiodine therapy. Methods. We conducted an interventional single-center prospective unblinded uncontrolled study of the efficacy and safety of thyrotropin-alfa to prepare patients with well-differentiated thyroid cancer to radioiodine diagnostics and post-surgery radioiodine ablation. The study included 88 patients with well-differentiated thyroid cancer: 54 patients were prepared for post-surgery radioiodine ablation; 34 patients – for radioiodine diagnostics to evaluate combined treatment efficacy and exclusion of tumor recurrence. The level of TSH, thyroglobulin, antibodies to thyroglobulin, whole body scintigraphy, and side effects were measured during exogenous stimulation with thyrotropin-alfa. Results. The level of TSH reached or exceed the target level (30 mIU/ml) 24 hours after the first injection of recombinant thyrotropin-alfa in 86% of patients; after 48 hours in 100%, the level exceeding 100 IU/ml was observed in 66 (75.1%) patients. The maximum levels of thyroglobulin and antibodies to thyroglobulin were reached 72 and 48 hours after the first injection, respectively. The injections of thyrotropin-alfa were well-tolerated by the patients. In the group for radioiodine diagnostics 2 (5.8%) patients complained of fatigue, 1 (2.9%) patient had signs of dyspeptic disorder, while in the group for radioiodine ablation 4 (7.4%) patients complained of fatigue, 1 (1.8%) patient had marked memory problems that disappeared later (they must have been caused by the patient’s advanced age (82 years)). Conclusions. Exogenous recombinant human thyroid-stimulating hormone (thyrotropin-alpha) is highly effective in preparation of patients with well-differentiated thyroid cancer for radioiodine diagnostics and radioiodine ablation. It does not have side effects, which are typical of withdrawal of thyroid hormones. The levels of thyroglobulin and antibodies to thyroglobulin measured 72 hours after the first injection of thyrotropin-alfa have the biggest diagnostic informative value.

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Russian clinical practice guidelines for diagnosis and treatment of differentiated thyroid cancer

Cited by 8 publications

References 0 publications

Definition of the Response to Initial Therapy with Radioiodine in Patients with Differentiated Thyroid Carcinoma: Basal or Stimulated Thyroglobulin?

Definition of the Response to Initial Therapy with Radioiodine in Patients with Differentiated Thyroid Carcinoma: Basal or Stimulated Thyroglobulin?

Surgical tactics optimization for treatment of BRAF positive papillary thyroid cancer

Recombinant human thyrotropin in radioiodine diagnostics and radioiodine ablation of patients with well-differentiated thyroid cancer: the first experience in Russia

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