Immunoreactive thyroglobulin in sera and saliva of patients with various thyroid disorders: role of autoantibodies

Salivary Alterations in Autoimmune Thyroid Diseases: A Systematic Review

Autoimmune thyroid disease (AITD) is a dysregulation of the immune system that causes an attack on the thyroid gland. Two major clinical manifestations are Hashimoto's thyroiditis and Graves' disease. Saliva performs many functions and, importantly, has the potential for easy, non-invasive diagnostics of several systemic disorders. This systematic review was designed to answer the question whether salivary alterations are reliable for the diagnosis of autoimmune thyroid diseases. Following the inclusion and exclusion criteria, fifteen studies were included. Due to their heterogeneity, saliva analysis was divided into two subgroups: quantitative assessment analysing salivation and qualitative assessment concerning potential salivary biomarkers for AITD. In addition to detecting altered levels of thyroid hormones and antibodies, salivary changes were also observed in the concentrations of total protein, cytokines and chemokines, as well as markers of oxidative status. According to the saliva flow rate values, significantly reduced saliva secretion was observed in patients with HT. In conclusion, it is not possible to unequivocally state if salivary biomarkers can potentially be used in autoimmune thyroid disease diagnosis. Therefore, further investigations, including salivation disorders, are necessary to validate these findings.

Outcome after treatment for papillary thyroid cancer

BACKGROUND

To evaluate the results of treatment and the prognostic variables of papillary thyroid carcinoma patients after long-term follow-up.

PATIENTS AND METHODS

Retrospective review of 1,373 thyroid cancer patients. Of the 1,016 papillary thyroid cancer patients, 394 patients received follow-up for more than 5 years, including 305 women (mean age, 38.4 +/- 13.7 years) and 89 men (mean age, 44.0 +/- 13.4 years). Of these papillary thyroid carcinoma patients, 227, 76, 68, and 23 patients were categorized in clinical stages I, II, III, and IV, respectively, at the time of diagnosis.

RESULTS

After treatment, 36 (9.1%) patients died. Only 23 (5.8%) of them died of papillary thyroid carcinoma. The 1-, 5-, 10-, and 20-year survival rates were 0.980, 0.951, 0.901, and 0.731. Mortality factors of the papillary thyroid carcinoma patients related to age, gender, tumor size, and postoperative serum thyroglobulin (Tg) levels. Twenty-four patients progressed from clinical stages I, II, and III to stage IV during the follow-up period. Of these 24 patients, 12 died during the follow-up period. In this study, age, gender, 131I accumulated dose, postoperative serum Tg levels, and the survival rate were demonstrated to be statistically significant between the patients in early stage and advanced stage groups after treatment.

CONCLUSION

Twenty-four of the 47 papillary thyroid cancer patients with distant metastases were diagnosed during the follow-up period. This study suggests that distant metastasis may occur at a serum Tg level of 2.3 ng/mL with thyroxine replacement. Postoperative long-term close follow-up of these patients is recommended.

Factors related to the survival of papillary and follicular thyroid carcinoma patients with distant metastases

There is limited clinical information comparing presentations and results of treatment of papillary and follicular thyroid carcinoma patients with distant metastases. We retrospectively analyzed data of 1,257 thyroid cancer patients who received their treatment and follow-up at Chang Gung Memorial Hospital. We found 992 patients with papillary carcinoma and 205 patients with follicular thyroid carcinoma. Of these, 68 patients with papillary thyroid carcinoma (6.9%) had distant metastases at the time of diagnosis or during the follow-up period. Of the follicular thyroid carcinoma patients, 69 (33.7%) had distant metastases. Of the 68 patients with papillary carcinoma, only 33 were categorized as stage IV at the time of diagnosis. Nine of the patients were categorized as clinical stage I carcinoma, 10 as stage II, and 16 as stage III. Sixteen patients (23.5%) died during the study period, all but 2 of thyroid cancer. Twelve of the 68 patients were disease-free after treatment. Of the 69 patients with follicular thyroid carcinoma, 58 were categorized as stage IV at the time of diagnosis. Six of the patients were categorized as clinical stage I carcinoma, 2 as stage II, and 3 as stage III at the time of diagnosis; all of these patients deteriorated to stage IV during the follow-up period. Of the 42 patients with follicular thyroid carcinoma involving bone, 24 presented with bone metastases during the initial diagnosis. After treatment, 25 of 69 patients with follicular carcinoma died of follicular carcinoma. Only 3 patients were disease-free after the treatment. In patients with follicular carcinoma, only tumor size was an important prognostic factor. In this study, 8 patients categorized as clinical stages I to III at the time of operation had thyroglobulin (Tg) levels less than 5 ng/mL and developed distant metastases during the follow-up period. In conclusion, at diagnosis a large group of Asian patients with metastatic well-differentiated thyroid cancer was more likely to have follicular than papillary histology, and that, as expected, metastases from follicular cancer were present earlier and more frequently, were more likely to involve bone, were more likely to be associated with mortality, and were linked to tumor size but not gender. Also unlike some other reports, treatment producing a low Tg did not always produce a good outcome. More aggressive surgical procedures may be able to improve outcomes.

Two-dimensional electrophoretic analysis of membranous protein from human thyroid tissues and cancer cell lines

Thyroid neoplasm is the most commonly encountered neoplastic disorder in endocrine clinics. Thyroid scan, ultrasonography, and fine needle aspiration cytology (FNAC) are used as diagnostic tools to differentiate a malignant nodule from a benign lesion. There are certain limitations and pitfalls in FNAC, especially in the diagnosing of follicular tumors. The lack of characteristic findings or a specific tumor marker are the most common problems in the preoperative diagnosis of thyroid follicular carcinoma. Although serum thyroglobulin level has been used as a tumor marker for post-operative, well-differentiated thyroid cancer, the assay cannot be used for preoperative diagnosis of thyroid carcinoma. In this study, various thyroid tissues and cancer cell lines including CGTH W-1, CGTH W-3, RO 82 W-1, SW 579 cell lines were used for the investigation of tumor markers. Specific spots were identified in the area near the 60 kDa molecular mass protein and isoelectric point (pI) 5.9 of the CGTH W-1 cell line. These spots could not be found in the papillary or anaplastic thyroid cancer cell lines. Another spot with a molecular weight of about 9.8 kDa with a low pI of 4.8 was present in the CGTH W-1 and RO 82 W-1 cell lines. This spot appeared to be a tumor marker of follicular cancer cells. This spot could not be found in the papillary and anaplastic cancer cell lines and other benign thyroid tissues. Specific proteins that were identified in this study may be useful as tumor markers for follicular thyroid carcinoma.

Factors that Predict Metastasis of Papillary and Follicular Thyroid Cancers in Taiwan

The purpose of this study is to explore the relationship of postoperative thyroglobulin level and other clinical factors with tumor metastasis. Analysis of 281 pathologic lesions verified patients with papillary and follicular thyroid cancer who received their primary treatment at Chang Gung Memorial Hospital. Clinical information—including postoperative thyroglobulin levels, age, sex, primary tumor size, clinical staging, surgical methods, surgical findings, chest x-ray findings, and 131I uptake—were stored in the computer. Actual survival rate and univariate and multivariate analyses of these factors with the relationship of distant metastases were undertaken. Twenty-three patients in this study died of distant metastases from the thyroid cancer. Of these patients, 30.4% were older than 60 years. In contrast only 8.5% of patients in the survival group were older than 60 years (p < 0.05 in χ 2 ). All of the papillary thyroid cancer patients with distant metastases displayed thyroglobulin levels higher than 25 ng/ml, but only 24% (41 of 173 cases) of those without distant metastases had thyroglobulin levels higher than 25 ng/ml. In 12 follicular thyroid cancer patients with distant metastases, 11 patients' serum thyroglobulin levels were higher than 25 ng/ml. In contrast, only 7 of 33 patients with follicular thyroid cancer without distant metastases displayed similar thyroglobulin levels. Univariate analysis revealed that age, postoperative thyroglobulin levels, chest x-ray findings, pathologic type, and tumor size are associated with distant metastases. One-month postoperative serum thyroglobulin level could be used as a prognostic factor for papillary and follicular thyroid cancer patients with distant metastases.

Thyrotropin receptor antibodies in parotid saliva

Parotid saliva was collected with a Carlson-Crittenden device, under citric acid stimulation, in 18 patients with autoimmune thyroid disease. Thyrotropin Receptor Antibodies (TRAb) were measured with a radioreceptor assay in parotid saliva and in serum in the same patients, and a statistical analysis of the data was performed. TRAb levels in parotid saliva were higher than in serum in the 3 pathologies studied (Graves' disease, Hashitoxicosis and Hashimoto's thyroiditis). There was good correlation between salivary and serum levels.

Comparison of membrane proteins from benign and malignant human thyroid tissues by two-dimensional polyacrylamide gel electrophoresis

In this study two-dimensional (2D) polyacrylamide gel electrophoresis with silver staining was used to analyze cellular membranous proteins of various normal and pathological human thyroid tissues. The aim was to understand the differences in cellular membranous proteins between these tissues, which would aid in the differential diagnosis of thyroid malignancy. Characteristic protein spots had a molecular mass of 50-64 kDa and a pI of 5.7-6.5. There were two groups of isoform protein spots in this area. The higher-molecular-mass group was found in follicular thyroid cancer tissues which and was not visible in normal thyroid tissues. The low-molecular-mass group was found in follicular carcinoma or adenoma tissues and was detected in one to three spots. The papillary thyroid carcinoma tissues gave different 2D gel maps. There were few spots of papillary thyroid carcinoma tissue membranous proteins within the examined area. The 2D gel maps may be used for differential diagnosis of follicular neoplasm. The characteristics of these protein spots require further investigation.

Thyroid cancer treated in Chang Gung Memorial Hospital (northern Taiwan) during the period 1979-1992: clinical presentation, pathological finding, analysis of prognostic variables, and results of treatment

This study is a retrospective analysis of 248 thyroid cancer patients who received their primary treatment in the Chang Gung Memorial Hospital during the period January 1979 to December 1992. Among these cases, there were 173 papillary thyroid cancers (69.8%), 52 cases of follicular thyroid cancer (21%), 7 cases of medullary thyroid cancer (2.8%), and 16 cases of anaplastic thyroid cancer (6.5%). The subjects included 184 female patients with a mean age of 40.7 +/- 14.3 years and 64 males patients with a mean age of 49.2 +/- 14.3 years. Most of the cases had a nearly total thyroidectomy after the diagnosis was confirmed by frozen section during the operation. During the follow-up period, 19 (8.2%) patients diagnosed with well-differentiated thyroid cancer died of thyroid cancer in contrast to 12 patients (75%) with anaplastic thyroid cancer. The 1-year Greenwood survival probabilities after the disease is diagnosed in papillary, follicular, and anaplastic thyroid cancer are 0.98, 0.86, and 0.25, respectively. For the analysis of prognostic variables in well-differentiated thyroid cancer patients, 16 factors were entered for univariate and multivariate analysis. Using a log-rank univariate analysis, survival was significantly associated with the cell type of the primary tumor, age, clinical staging, postoperative 131I pattern, tumor size, postoperative thyroglobulin (Tg) level and postoperative x-ray results. In the Cox multivariate regression analysis the combination factors that gave the best prognostic value were the association of x-ray finding (P = .004), age (P = .017), and Tg level (P = 0.19). In conclusion, thyroid cancer is not an unusual disease in Taiwan. As previously reported anaplastic thyroid cancer has a poor prognosis. In this limited period of follow-up study, the patients' age with postoperative first positive x-ray finding and Tg level may provide the prognostic factors for patients with well-differentiated thyroid cancer.