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Ramos da Silva F, Rosario PW, Mourão GF. Indication for radioactive iodine in patients with papillary thyroid carcinoma without apparent disease after total thyroidectomy but with elevated antithyroglobulin antibodies. Clin Endocrinol (Oxf) 2022; 96:82-88. [PMID: 34323308 DOI: 10.1111/cen.14570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate a criterion for the selective indication of radioactive iodine (RAI) based on the short-term behaviour of antithyroglobulin antibodies (TgAb) in patients with papillary thyroid carcinoma (PTC) who have negative thyroglobulin (Tg) and neck ultrasonography (US) without abnormalities after total thyroidectomy but elevated TgAb. DESIGN This was a prospective study that evaluated 216 patients with low- or intermediate-risk PTC who had nonstimulated Tg ≤ 0.2 ng/ml and no US abnormalities but elevated TgAb 3 months after thyroidectomy. RAI was not indicated in patients with negative TgAb or a >50% reduction in TgAb concentrations 6 months after initial assessment followed by a negative test or an additional reduction (also >50%) after 12 months. RESULTS Only two of the 114 patients who did not receive RAI developed recurrences; another 108 patients met the criterion of an excellent response to therapy in the last assessment and TgAb persisted in four patients but there was an additional reduction in their concentration during follow-up. Among the 102 patients who received RAI, post-therapy whole-body scanning (RxWBS) detected persistent disease in 8 (8%). Two of the 94 patients without persistent disease on RxWBS developed recurrences. In the last assessment, in the absence of additional treatment, 54/92 patients (58.7%) without structural recurrence had negative TgAb. CONCLUSIONS The indication for RAI can be based on the short-term behaviour of TgAb in patients with PTC and elevated TgAb after thyroidectomy who are not high risk and who do not have apparent disease (nonstimulated Tg ≤ 0.2 ng/ml and no US abnormalities).
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Affiliation(s)
| | - Pedro W Rosario
- Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
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Zou Y, Zhang H, Li W, Guo Y, Sun F, Shi Y, Gong Y, Lu X, Wang W, Xia S. Prediction of ipsilateral lateral cervical lymph node metastasis in papillary thyroid carcinoma: a combined dual-energy CT and thyroid function indicators study. BMC Cancer 2021; 21:221. [PMID: 33663422 PMCID: PMC7934388 DOI: 10.1186/s12885-021-07951-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Predicting the possibility of ipsilateral lateral cervical lymph node metastasis (ipsi-LLNM) was crucial to the operation plan for patients with papillary thyroid carcinoma (PTC). This study aimed to investigate the independent risk factors for ipsi-LLNM in PTC patients by combining dual-energy computed tomography (DECT) with thyroid function indicators. METHODS We retrospectively enrolled 406 patients with a pathological diagnosis of PTC from Jan 2016 to Dec 2019. Ensure the DECT images were clear and the thyroid function indicators were complete. Univariate and multivariate logistic analyses explored the independent risk factors for ipsi-LLNM. To evaluate the cutoff value of each risk factor by using receiver operating characteristic (ROC) curves. RESULTS A total of 406 patients with PTC were analyzed, including 128 with ipsi-LLNM and 278 without ipsi-LLNM. There were statistical differences of parameters between the two groups (P < .0001), including serum Tg, Anti-Tg, Anti-TPO, the volume of the primary lesion, calcification, extrathyroidal extension (ETE), and iodine concentration (IC) in the arterial and the venous phases. Independent risk factors for ipsi-LLNM included serum Tg, Anti-Tg, ETE, and IC in the arterial and the venous phases (P < .05). The combined application of the above independent risk factors can predict the possibility of ipsi-LLNM, with an AUC of 0.834. Ipsi-LLNM was more likely to occur when the following conditions were met: with ETE, Tg > 100.01 ng/mL, Anti-Tg > 89.43 IU/mL, IC in arterial phase > 3.4 mg/mL and IC in venous phase > 3.1 mg/mL. CONCLUSIONS The combined application of DECT quantitative parameters and thyroid function indicators can help clinicians accurately predict ipsi-LLNM before surgery, thereby assisting the individualized formulation of surgical procedures.
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Affiliation(s)
- Ying Zou
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin, 300193, China.,Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China
| | - Huanlei Zhang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China.,Department of Radiology, Yidu central hospital of Weifang, No. 4138 Linglongshan nan Road, Qing Zhou City, Shandong, 262500, China
| | - Wenfei Li
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China.,Department of Radiology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Haigang District, Qinhuangdao, 066000, China
| | - Yu Guo
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China
| | - Fang Sun
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China.,Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, 256603, Shandong, China
| | - Yan Shi
- Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, 256603, Shandong, China
| | - Yan Gong
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China.,Department of Radiology, Tianjin Hospital of ITCWM Nan Kai Hospital, No.6 Changjiang Road, Nan Kai District, Tianjin, 300100, China
| | - Xiudi Lu
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin, 300193, China.,Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China
| | - Wei Wang
- Department of Otorhinolaryngology, Tianjin First Central Hospital, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China.
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Liu H, Yang D, Li L, Tu Y, Chen C, Sun S. Appraisal of radioiodine refractory thyroid cancer: advances and challenges. Am J Cancer Res 2020; 10:1923-1936. [PMID: 32774993 PMCID: PMC7407348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023] Open
Abstract
The incidence of thyroid cancer ranks top among all endocrine cancers, which has increased worldwide. Some patients suffer from recurrent/residual diseases after primary treatment. The recurrent/residual disease often turns out to be radioiodine refractory and shows poor response to radioiodine therapy. A lot of studies have explored the precise appraisal of radioiodine refractory disease in recent years. The mechanism of iodine uptake and the definition of radioiodine refractory disease have been summarized and discussed. The advances in tumor characteristics, histologies, and mutant conditions have been explored for a more accurate method in the early-stage appraisal. We then offer a review of opinions in the evaluation of refractory disease during follow-up, including Tg doubling time, 18F PET/CT, 131I WBS, and others. The sensitivity and specificity have been compared between different diagnostic methods. Some novel methods may be introduced for more precise appraisal, such as a scoring system and RNA expression profiling. This review aims to provide physicians a broad insight into the appraisal of radioiodine refractory disease and to pave way for future study.
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Affiliation(s)
- Hanqing Liu
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan UniversityWuhan 430060, PR China
| | - Dan Yang
- Department of Cardiology, Renmin Hospital of Wuhan UniversityWuhan 430060, PR China
- Hubei Key Laboratory of Metabolic and Chronic DiseasesWuhan 430060, PR China
| | - Lingrui Li
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan UniversityWuhan 430060, PR China
| | - Yi Tu
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan UniversityWuhan 430060, PR China
| | - Chuang Chen
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan UniversityWuhan 430060, PR China
| | - Shengrong Sun
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan UniversityWuhan 430060, PR China
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