1
|
Anderson H, Lim KH, Gull S, Oprean R, Spence K, Cvasciuc T. Predicting clinical outcomes of patients with serum thyroglobulin antibodies after thyroidectomy for differentiated thyroid cancer: a retrospective study from a UK regional center. Minerva Endocrinol (Torino) 2024; 49:60-68. [PMID: 37428110 DOI: 10.23736/s2724-6507.23.03939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Twenty-twenty-five percent of patients with differentiated thyroid cancer (DTC) can have elevated thyroglobulin antibodies (TgAb). The study aimed to find any prognostic significance of elevated TgAb during follow-up. METHODS Ten-year retrospective study from a tertiary center including 79 patients with raised TgAb after total/staged thyroidectomy for DTC. We identified patients with stable (7.6%), increasing (15%) and decreasing levels of TgAb (77.2%); groups 1, 2 and 3 respectively. During follow-up we analyzed TgAb in subcategories by TgAb trend (>50% rise, <50% rise, >50% decline, <50% decline, positive to negative/normalization, negative to positive and stable levels), gender, age, surgery, autoimmune disease, histology, RAI uptake, distant metastases, and recurrence. RESULTS The incidence of raised TgAb levels was 33.2%, with female predominance. No connection was identified regarding other parameters. 11.4% had distant metastases. The highest mean maximum levels of TgAb was in group 2 (1918.75 IU/mL) and the lowest in group 3 (412.70 IU/mL). The recurrence rate changed significantly between the 3 groups: 50% in group 1, 75% in group 2, and 25% in group 3 (P=0.002). Recurrence rates decreased to 15% in the subcategory where TgAb became negative/normal from positive (P=0.0001). In patients with a negative to positive TgAb level trend or >50% rise, recurrence rates were 100% (P=0.041) and 70% (P=0.012) respectively. CONCLUSIONS Patients with increasing TgAb levels during follow-up have a higher rate of recurrence, distinctly for those with negative to positive trend and >50% rise in TgAb. These patients need closer follow-up, and TgAb may be used as a dynamic follow-up marker.
Collapse
Affiliation(s)
- Hannah Anderson
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK -
| | - Kah H Lim
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Sadaf Gull
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Raluca Oprean
- Department of Endocrinology, Royal Victoria Hospital, Belfast, UK
| | - Kirsty Spence
- Endocrine Laboratory, Royal Victoria Hospital, Belfast, UK
| | - Titus Cvasciuc
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| |
Collapse
|
2
|
Díaz-Roldán J, Martín-Jiménez MDC, Recio Moyano G, Rubio-Sánchez T, Román-Rando A. Applicability study of a preoperative prediction model for follicular thyroid carcinoma. Cir Esp 2022; 100:312-313. [PMID: 35491013 DOI: 10.1016/j.cireng.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Jorge Díaz-Roldán
- Unidad de Cirugía Endocrina, Departamento de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de Valme, Sevilla, Spain.
| | - María Del Carmen Martín-Jiménez
- Unidad de Cirugía Endocrina, Departamento de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Gumersindo Recio Moyano
- Unidad de Cirugía Endocrina, Departamento de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Teresa Rubio-Sánchez
- Departamento de Cirugía General y Aparato Digestivo, Complejo Asistencial Universitario, Institute for Biomedical Research of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Aarón Román-Rando
- Unidad de Cirugía Endocrina, Departamento de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de Valme, Sevilla, Spain
| |
Collapse
|
3
|
Zeng W, Lu J, Yan Z, Liu Y, Deng W, Zhou Y, Xu W, Wang Y, Xu J, Miao Y. Acute transient thyroid swelling after fine-needle aspiration biopsy: A case report of a rare complication and a literature review. Diagn Cytopathol 2022; 50:E193-E197. [PMID: 35234360 PMCID: PMC9310847 DOI: 10.1002/dc.24948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/12/2022]
Abstract
Fine-needle aspiration biopsy (FNAB) is a safe and effective thyroid examination method with rare complications. Herein, we report a rare case of acute transient thyroid swelling that occurred after ultrasound-guided FNAB. The patient experienced acute pain with rapid thyroid swelling. Ultrasound imaging revealed a nodule with a linear, hypoechoic, and "patch-like" appearance, indicating edema without hemorrhage. After receiving anti-anaphylaxis and detumescence therapy for 1 day, the swelling regressed. Acute transient thyroid swelling is an extremely rare event that occurs shortly after FNAB and may frighten patients; therefore, clinicians should be aware of this complication in this context.
Collapse
Affiliation(s)
- Wenli Zeng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinming Lu
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ziyan Yan
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanna Liu
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Wenfeng Deng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yi Zhou
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenwei Xu
- Department of Endocrinology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuchen Wang
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Xu
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yun Miao
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
4
|
Computer-Analyzed Ultrasound Predictors of the Treatment Efficacy of Radiofrequency Ablation for Benign Thyroid Nodules. World J Surg 2021; 46:112-120. [PMID: 34608544 DOI: 10.1007/s00268-021-06340-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
AIM Radiofrequency ablation (RFA) is a relatively safe and efficient alternative to surgery for patients with benign thyroid nodules. We investigated predictive factors associated with volume reduction using digital imaging analysis. METHODS In this retrospective study, a prospectively maintained database containing the data of patients who received treatment from April 2019 to March 2020 was analyzed. Computerized analysis for quantitative measurement of echogenicity, heterogeneity, and the proportion of cystic components was performed on ultrasonographic images. The volume reduction rate (VRR) was calculated during follow-up. Treatment efficacy was defined as a volume reduction greater than 50% of baseline volume. RESULTS The median volume of 58 benign thyroid nodules before RFA was 22.7 mL. Of 53 nodules with sufficient follow-up, the median VRR was 46.4%, 61.5%, 63.4%, and 67.4% at 1, 3, 6, and 12 months, respectively. Overall, at one-year follow-up, treatment efficacy was achieved in 39 (74%) nodules. In a multivariate regression analysis, the proportion of cystic components and RFA treatment time were independently associated with treatment efficacy. A subgroup analysis focusing on solid nodules indicated a negative correlation between echogenicity and VRR. CONCLUSIONS The proportion of cystic components in thyroid nodules is the main predictor of RFA treatment efficacy. In solid nodules, higher echogenicity is associated with a lower volume reduction.
Collapse
|
5
|
Dellal FD, Aydin C, Tam AA, Faki S, Alkan A, Polat SB, Dirikoc A, Topaloglu O, Ersoy R, Cakir B. The value of serum thyroglobulin alteration after ultrasonography-guided fine-needle biopsy of suspicious cervical lymph nodes in the diagnosis of metastasis in patients with differentiated thyroid cancer. Int J Clin Pract 2021; 75:e14218. [PMID: 33866655 DOI: 10.1111/ijcp.14218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/18/2021] [Accepted: 04/05/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND It is known that serum thyroglobulin (TG) can increase after fine-needle biopsy of thyroid nodules. We aimed to determine whether TG is increased after ultrasonography (US)-guided fine needle capillary biopsy (FNC) of suspicious cervical lymph nodes (LNs) in thyroidectomised patients and investigate the possible association between change in TG and cytology results. MATERIAL AND METHODS Data of 188 patients who underwent FNC of suspicious cervical LNs were retrospectively evaluated. Demographical, laboratory and ultrasonography features of LNs were noted. TG levels before FNC (TGb-FNC ), after FNC (TGa-FNC ), TGa-FNC /TGb-FNC ratio and the number of patients with increased TG were determined. Patients were grouped as benign, nondiagnostic, suspicious for malignancy and malignant according to the cytological results. RESULTS TGa-FNC , TGb-FNC /TGa-FNC and rate of patients with increased TG were significantly higher in malignant cytology group than other groups (P < .001). The optimal cut-off level of TG increase that was predictive for malignancy was 7.6% with a sensitivity of 73.7% and specificity of 85.2%. TG increase was not associated with age, sex, Thyroid-stimulating hormone (TSH) level, anti-TG positivity and US features of LNs while significantly lower in patients who received radioactive iodine (RAI) treatment. Among 31 patients with positive anti-TG, TGb-FNC /TGa-FNC , and rate of patients with increased TG were higher in malignant compared to benign and nondiagnostic cytology groups. CONCLUSIONS Serum TG increment and rate of patients with increased TG after FNC of suspicious cervical LNs were higher in patients with malignant cytology than with all other cytology results both in all study group and in sub-group of anti-TG positive patients. Increase in TG after FNC might be an additional tool for determining LN metastasis.
Collapse
Affiliation(s)
- Fatma Dilek Dellal
- Department of Endocrinology and Metabolism Disease, Ankara City Hospital, Ankara, Turkey
| | - Cevdet Aydin
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Sevgul Faki
- Department of Endocrinology and Metabolism Disease, Ankara City Hospital, Ankara, Turkey
| | - Afra Alkan
- Department of Biostatistics, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Sefika Burcak Polat
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ahmet Dirikoc
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| |
Collapse
|
6
|
Díaz-Roldán J, Martín-Jiménez MDC, Recio Moyano G, Rubio-Sánchez T, Román-Rando A. Applicability study of a preoperative prediction model for follicular thyroid carcinoma. Cir Esp 2021; 100:S0009-739X(21)00176-7. [PMID: 34059315 DOI: 10.1016/j.ciresp.2021.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Jorge Díaz-Roldán
- Unidad de Cirugía Endocrina, Departamento de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de Valme, Sevilla, España.
| | - María Del Carmen Martín-Jiménez
- Unidad de Cirugía Endocrina, Departamento de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de Valme, Sevilla, España
| | - Gumersindo Recio Moyano
- Unidad de Cirugía Endocrina, Departamento de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de Valme, Sevilla, España
| | - Teresa Rubio-Sánchez
- Departamento de Cirugía General y Aparato Digestivo, Complejo Asistencial Universitario, Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, España
| | - Aarón Román-Rando
- Unidad de Cirugía Endocrina, Departamento de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de Valme, Sevilla, España
| |
Collapse
|
7
|
Ora M, Nazar AH, Mishra P, Barai S, Arya A, Pradhan PK, Gambhir S. Clinical outcome of patients with differentiated thyroid cancer and raised antithyroglobulin antibody levels: a retrospective study. Thyroid Res 2021; 14:8. [PMID: 33858456 PMCID: PMC8048259 DOI: 10.1186/s13044-021-00099-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/02/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Thyroglobulin (Tg) is a specific tumor marker for differentiated thyroid cancer (DTC). However, in the presence of an antithyroglobulin antibody (TgAb), it becomes unreliable. The purpose of the study was to assess the long-term outcome of DTC patients with raised TgAb. METHOD In a retrospective study, we included patients with DTC who had raised TgAb following total thyroidectomy. We excluded patients with persistently raised Tg (≥ 1 ng/ml) or radioiodine avid disease. Serial TgAb levels, excellent response (ER), incomplete response (IR), and anatomical recurrence were evaluated. RESULTS A total of seventy-six patients were included in the study. Patients with IR had higher baseline TgAb (1071.27 ± 1216.17 vs. 99.61 ± 91.29 IU/ml, p < 0.001) and central compartment lymph node metastases (70.8% vs. 46.4%, p = 0.035) in comparison to those in the ER group. In the first follow-up, 64 (84.2%) patients had a stable or fall in the TgAb (0 to - 98.3%). Sixty-eight patients received high-dose radioiodine therapy (RIT). Out of these, 59 (86.5%) had transient, and 51 (75%) had a long-term fall in TgAb. After a follow-up period of 58.74 ± 26.26 months, 63.2% (48 out of 76) patients had IR. Nine (11.8%) patients had a rising TgAb level (3.7-170.9%) from baseline. Eleven patients underwent 18F-FDG PET/CT, and five of them demonstrated metabolically active recurrent disease. Three patients underwent cervical lymph nodes dissection. None of the patients died during the follow-up period. CONCLUSION High post-operative TgAb levels and central compartment lymph nodal metastases are risk factors for IR. RIT leads to a significant fall in the TgAb in these patients. The low level of raised TgAb is associated with an excellent outcome. Patients with recurrences had very high baseline TgAb > 1000 IU/ml. Raised TgAb was associated with good clinical outcomes and not associated with increased mortality.
Collapse
Affiliation(s)
- Manish Ora
- Department of Nuclear Medicine, SGPGIMS, Lucknow, India
| | | | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, India
| | - Sukanta Barai
- Department of Nuclear Medicine, SGPGIMS, Lucknow, India
| | - Amitabh Arya
- Department of Nuclear Medicine, SGPGIMS, Lucknow, India
| | | | - Sanjay Gambhir
- Department of Nuclear Medicine, SGPGIMS, Lucknow, India.
| |
Collapse
|
8
|
Zhu T, Yang Y, Ju H, Huang Y. Acute thyroid swelling after fine needle aspiration-a case report of a rare complication and a systematic review. BMC Surg 2021; 21:175. [PMID: 33789634 PMCID: PMC8011404 DOI: 10.1186/s12893-021-01160-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Thyroid fine needle aspiration (FNA) is the procedure of choice in the management of thyroid nodules. Acute thyroid swelling after FNA is a rare complication and is reported in a finite number of literatures. To the best of our knowledge, only seven reported cases exist in literatures. This study describes an addition case with an acute thyroid swelling after FNA, as well as puts forward a new hypothesis of this phenomenon. CASE PRESENTATION The case is presented of a 30-year-old female with an acute thyroid swelling after FNA, with funicular hypoechoic lesions in thyroid gland. The size of thyroid was 1.5-fold enlarged in the unilateral thyroid gland. No complains of pain or other discomforts with her and no signs of hemorrhage were found along the passage of the fine needle. The episode was recovered spontaneously. CONCLUSIONS An acute thyroid swelling is a rare complication of FNA. A hypothesis of anaphylactic reaction was suggested in our study. Physicians should pay more attention of this phenomenon and more information is needed to support our hypothesis.
Collapse
Affiliation(s)
- Tiantong Zhu
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Liaoning, Shenyang city, China
| | - Ye Yang
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Liaoning, Shenyang city, China
| | - Hao Ju
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Liaoning, Shenyang city, China
| | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Liaoning, Shenyang city, China.
| |
Collapse
|
9
|
Shao J, Zheng J, Zhang B. Deep Convolutional Neural Networks for Thyroid Tumor Grading using Ultrasound B-mode Images. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 148:1529. [PMID: 33003892 DOI: 10.1121/10.0001924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
The performances of deep convolutional neural network (DCNN) modeling and transfer learning (TF) for thyroid tumor grading using ultrasound imaging were evaluated. This retrospective study included input patient data (ultrasound B-mode image sets) assigned to the training group (115 participants) or testing group (28 participants). DCNN (ResNet50) and TF (ResNet50, ResNet101, ResNet152, VGG16, Inception V3, and DenseNet201), which trains a convolutional neural network that has been pre-trained on ImageNet, were used for image classification based on thyroid tumor grade. Supervised training was performed by using the DCNN or TF model to minimize the difference between the output data and clinical grading. The performances of the DCNN and TF models were assessed in the testing dataset with receiver operating characteristic analyses. Results showed that TF based on Resnet50 and VGG16 had better performance than DCNN (ResNet50) in differentiating thyroid tumor with areas under the receiver operating characteristic (AUCs) curve more than 0.8. However, TF based on ResNet101, ResNet152, InceptionV3, and Densenet201 had equal or worse performances than DCNN (ResNet50) in grading thyroid tumor with AUCs less than 0.5. TF based on ResNet50 and VGG16 had a superior performance compared to DCNN (ResNet50) model for grading thyroid tumors based on ultrasound images.
Collapse
Affiliation(s)
- Juntao Shao
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
| | - Jingjing Zheng
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
| | - Bing Zhang
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
| |
Collapse
|
10
|
Ammendola S, Girolami I, Bovo C, Paini M, Castelli C, Bruno C, Schenal G, Brazzarola P, Mezzetto L, Veraldi GF, Novelli L, Brunelli M, Montemezzi S, Eccher A. Thyroid Fine-Needle Aspiration Cytology: Focusing on Adherence to Guidelines and Hospital Organization. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920933. [PMID: 32273492 PMCID: PMC7171366 DOI: 10.12659/ajcr.920933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Female, 39-year-old Final Diagnosis: Goiter with periprocedural complication Symptoms: None Medication:— Clinical Procedure: Fine-needle aspiration cytology Specialty: Radiology
Collapse
Affiliation(s)
- Serena Ammendola
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Ilaria Girolami
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Chiara Bovo
- Medical Direction, University and Hospital Trust of Verona, Verona, Italy
| | - Marina Paini
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Claudia Castelli
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Costanza Bruno
- Radiology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Giacomo Schenal
- Radiology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Paolo Brazzarola
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Gian Franco Veraldi
- Department of Vascular Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Novelli
- Institute for Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy
| | - Matteo Brunelli
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Stefania Montemezzi
- Radiology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Albino Eccher
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| |
Collapse
|
11
|
Bueno F, Falcone MGG, Peñaloza MA, Abelleira E, Pitoia F. Dynamics of serum antithyroglobulin antibodies in patients with differentiated thyroid cancer. Endocrine 2020; 67:387-396. [PMID: 31650394 DOI: 10.1007/s12020-019-02112-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/02/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE Serum antithyroglobulin antibodies (sTgAb) affect the reliability of Tg measurement in patients with thyroid cancer. We compared the outcome of patients with detectable and undetectable sTgAb, stratified according to the initial risk of recurrence (RR); also the response to treatment in patients with detectable sTgAb treated with total thyroidectomy (TT) with and without radioiodine remnant ablation (RA) and the sTgAb trend in the long-term follow-up according to the initial response. METHODS We included 432 patients submitted to TT, with or without RA; 106 patients had detectable sTgAb levels. Median follow-up was 53 months. RESULTS There were no statistically significant differences considering presentation between negative or positive sTgAb subjects. The frequency of structural incomplete response (SIR) in low, intermediate, and high RR was similar. Undetectable sTgAb in patients was achieved in a median of 16 months in ablated patients compared with 11 months in those without RA (p = 0.0232). Patients without RA had a higher rate of undetectable sTgAb during the first 12 months. A SIR was observed in 3% of patients with declining sTgAb, in 19% of those with stable levels, and in 43% with increasing sTgAb (p = 0.004). The status of no evidence of disease was achieved more frequently in patients with initial sTgAb levels < 200 mUI/l, independently of the initial RR. CONCLUSIONS There was no impact of sTgAb on the initial clinical presentation and the response to therapy in low-risk patients treated with or without RA. sTgAb trend is more useful than an absolute value to predict a SIR.
Collapse
Affiliation(s)
- Fernanda Bueno
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina
| | | | - Mirna Angela Peñaloza
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina
| | - Erika Abelleira
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina
| | - Fabián Pitoia
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina.
| |
Collapse
|
12
|
Hopp AM, Ranjitkar P, Colon-Franco JM. Unexpected Change in Thyroglobulin Concentration. Clin Chem 2017; 63:1775. [PMID: 29089325 DOI: 10.1373/clinchem.2017.274639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/18/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Amanda M Hopp
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI.
| | | | | |
Collapse
|
13
|
A Case Report of Dramatically Increased Thyroglobulin after Lymph Node Biopsy in Thyroid Carcinoma after Total Thyroidectomy and Radioiodine. Case Rep Endocrinol 2016; 2016:6471081. [PMID: 27034856 PMCID: PMC4789396 DOI: 10.1155/2016/6471081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/09/2016] [Indexed: 11/17/2022] Open
Abstract
Thyroglobulin (Tg) is an important modality for monitoring patients with thyroid cancers, especially after thyroidectomy followed by radioiodine (RAI). It is also used as a marker for burden of thyroid tissue whether malignant or benign. Although there have been several reports of rising serum Tg transiently after thyroid biopsy in intact glands and following palpation or trauma, there are no reports in the literature of elevation in Tg after biopsy of suspicious lesions in thyroidectomized patients. In this paper we report a fascinating case of a considerable and initially worrying, although ultimately transient, rise in Tg in a patient 2 years after total thyroidectomy and RAI ablation after fine needle aspiration (FNA) of a suspicious thyroid bed nodule that was proven positive.
Collapse
|
14
|
Spencer C, Fatemi S. Thyroglobulin antibody (TgAb) methods - Strengths, pitfalls and clinical utility for monitoring TgAb-positive patients with differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2013; 27:701-12. [PMID: 24094640 DOI: 10.1016/j.beem.2013.07.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Thyroglobulin autoantibodies (TgAb) are detected at diagnosis or during treatment in approximately 25% of patients with differentiated thyroid cancer (DTC). When present, TgAb interferes with thyroglobulin (Tg) measurement causing falsely low or undetectable Tg immunometric assay (IMA) values that can mask disease. Guidelines mandate that every Tg test have TgAb measured simultaneously and quantitatively by immunoassay and not a recovery test. The propensity and magnitude of TgAb-Tg interference relates to both Tg and TgAb concentrations and the class of Tg method used. Because the TgAb trend reflects changes in thyroid tissue mass, TgAb concentrations serve as a surrogate post-operative DTC tumor marker. A rising, or de novo appearance of TgAb may indicate recurrence, whereas a progressive decline suggests successful treatment. This review focuses on the technical limitations of current TgAb methods, characteristics of TgAb interference with different classes of Tg method, and the clinical value of monitoring TgAb trends as a surrogate DTC tumor marker.
Collapse
Affiliation(s)
- Carole Spencer
- University of Southern California, Los Angeles, CA, USA.
| | | |
Collapse
|
15
|
Anastasilakis AD, Polyzos SA, Delaroudis S, Toulis KA, Mandanas S, Avgerinidou C, Kampas L, Katsirmas B, Gerou S, Ballaouri I, Balaris C, Alevizaki M. Long-term effects of thyroid fine-needle biopsy on the thyroid-related biochemical parameters. Int J Clin Pract 2012; 66:602-9. [PMID: 22607512 DOI: 10.1111/j.1742-1241.2012.02919.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIMS Thyroid fine-needle biopsy (FNB) is a simple, reliable, inexpensive and generally safe diagnostic procedure in the management of thyroid nodules. FNB may trigger biochemical alterations through destruction of thyroid follicles. We aimed to investigate long-term post-FNB alterations in serum thyroid-related parameters. METHODS One hundred and ten consecutive patients with thyroid nodular disease were subjected to FNB. Thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3), thyroglobulin (Tg), thyroglobulin autoantibodies (anti-Tg), thyroid-peroxidase autoantibodies (anti-TPO) were measured in all subjects at baseline, 10 days, 2 and 6 months. Subsequently, patients were divided into subgroups according to the technique of FNB, the presence of disease characteristics as thyroid autoimmunity (Hashimoto's thyroiditis), goitre, singularity-maximum diameter-blood pattern of the nodule(-s), the number of passes and the administration of L-thyroxine (LT4). RESULTS A significant increase in Tg, anti-Tg and FT3 levels was observed. These alterations were more prominent within patients with dominant nodule's maximum diameter ≥ 2 cm or without Hashimoto's thyroiditis. Tg and anti-Tg levels were significantly increased only in patients not being on LT4. On the other hand, FNB technique did not affect any of the measured parameters. CONCLUSION Our data suggest that FNB results in statistically significant but clinically insignificant increases in Tg, anti-Tg and FT3 levels, implying a thyroid trauma of some level, more likely to happen in patients with larger nodules. The FNB technique used has no effect on the thyroid-related biochemical parameters.
Collapse
Affiliation(s)
- A D Anastasilakis
- Department of Endocrinology, 424 Military Hospital, Thessaloniki, Greece.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Polyzos SA, Anastasilakis AD. Infectious thyroiditis as a complication of fine-needle biopsy: a systematic review. Expert Rev Endocrinol Metab 2010; 5:673-679. [PMID: 30764021 DOI: 10.1586/eem.10.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thyroid fine-needle biopsy (FNB) is a simple, reliable and inexpensive procedure for the diagnosis of thyroid malignancy. Furthermore, it is a useful tool for the identification of the causative pathogen in cases of acute suppurative thyroiditis. However, it can also cause infectious thyroiditis, as bacterial seeding can occur. Post-FNB thyroid infection is a rare complication. Gram-positive bacteria predominate but other bacteria have also been isolated, especially in immunocompromised patients. Preventive measures include iodine skin preparation and alcohol cleansing of the skin before FNB and adequate aseptic conditions. The prognosis of post-FNB infectious thyroiditis depends on prompt recognition and treatment. The treatment of choice is antibiotics and pus drainage, but thyroid resection may be required in cases of persistent infection.
Collapse
Affiliation(s)
- Stergios A Polyzos
- a Second Medical Clinic, Medical School, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece.
| | | |
Collapse
|
17
|
Polyzos SA, Anastasilakis AD. A systematic review of cases reporting needle tract seeding following thyroid fine needle biopsy. World J Surg 2010; 34:844-51. [PMID: 20049437 DOI: 10.1007/s00268-009-0362-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Because of its accuracy and cost-effectiveness, thyroid fine needle biopsy (FNB) is the procedure of choice in the preoperative management of thyroid nodules. Needle tract seeding (NTS) has been a concern since the earliest days of FNB, contributing to the delayed acceptance of FNB as a safe procedure. In this review we tried to systematically record all reports of NTS after diagnostic thyroid FNB and provide useful hints to minimize the risk of NTS. METHODS Computerized advanced search for primary evidence was performed in the PubMed (Public/Publisher Medline) electronic database. The search was not limited by publication time or English language. RESULTS Ten relevant articles were found: eight case reports, one case in a surgical series, and one retrospective observational study. CONCLUSIONS Despite initial concerns about the risk of NTS, FNB is now considered to be a safe procedure. Although proper FNB technique can reduce its risk, NTS is an unavoidable complication of FNB, which clinicians should be aware of. However, the incidence of NTS is low and it doesn't seem to affect the prognosis because the seedings can be surgically removed without recurrence. The management of the thyroid nodules is to-date based on FNB, and the benefits from FNB (elimination of needless imaging and surgery) far outweigh the potential risk for NTS.
Collapse
Affiliation(s)
- Stergios A Polyzos
- Second Medical Clinic, Medical School, Aristotle University of Thessaloniki, Ippokration Hospital, 546 42, Thessaloniki, Greece.
| | | |
Collapse
|