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Giovanella L, D’Aurizio F, Petranović Ovčariček P, Görges R. Diagnostic, Theranostic and Prognostic Value of Thyroglobulin in Thyroid Cancer. J Clin Med 2024; 13:2463. [PMID: 38730992 PMCID: PMC11084486 DOI: 10.3390/jcm13092463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/12/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Thyroglobulin (Tg) is an iodinated glycoprotein, which is normally stored in the follicular colloid of the thyroid, being a substrate for thyroid hormone production. Since it is produced by well-differentiated thyroid cells, it is considered a reliable tumor marker for patients with differentiated thyroid carcinoma (DTC) during their follow-up after total thyroidectomy and radioiodine ablation. It is used to monitor residual disease and to detect recurrent disease. After total thyroid ablation, unstimulated highly sensitive Tg measurements are sufficiently accurate to avoid exogenous or endogenous thyrotropin (TSH) stimulation and provide accurate diagnostic and prognostic information in the great majority of DTC patients. Adopting sophisticated statistical analysis, i.e., decision tree models, the use of Tg before radioiodine theranostic administration was demonstrated to be useful in refining conventional, pathology-based risk stratification and providing personalized adjuvant or therapeutic radioiodine administrations. The follow-up of DTC patients aims to promptly identify patients with residual or recurrent disease following primary treatment. Our review paper covers the diagnostic, theranostic and prognostic value of thyroglobulin in DTC patients.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear Medicine, Gruppo Ospedaliero Moncucco SA, Clinica Moncucco, 6900 Lugano, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, 8006 Zurich, Switzerland
| | - Federica D’Aurizio
- Institute of Clinical Pathology, Department of Laboratory Medicine, University Hospital of Udine, 33100 Udine, Italy;
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Rainer Görges
- Clinic for Nuclear Medicine, University Hospital of Essen, 45147 Essen, Germany;
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Guastapaglia L, Chiamolera MI, Viana Lima Junior J, Ferrer CMDF, Godoy Viana L, Veiga Chang C, Andrade Siqueira R, Monteiro Barros Maciel R, Henriques Vieira JG, Biscolla RPM. False diagnosis of recurrent thyroid carcinoma: the importance of testing for heterophile antibodies. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230115. [PMID: 38456952 PMCID: PMC11081039 DOI: 10.20945/2359-4292-2023-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/18/2023] [Indexed: 03/09/2024]
Abstract
Thyroglobulin (Tg) levels are important to predict recurrence in differentiated thyroid cancer patients.However, false-positive results can hence the request of unnecessary tests and treatments. We reported two cases of interference in thyroglobulin measurement and the workup to investigate them. Both patients achieved an excellent response to therapy after total thyroidectomy and one patient had also received radioiodine treatment. During the follow-up, Tg levels increased and there was no evidence of recurrent disease in the imaging studies. The Tg levels by the Access platform were positive but the results by Elecsys platform and LC-MS/MS were undetectable, leading to the hypothesis of heterophile antibodies (HAbs) interference. The possibility of HAbs interference must be considered when the Tg levels do not fit in the clinical picture. The measurement of Tg by another immunoassay or by LC-MS/MS may be useful in these situations.
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Affiliation(s)
- Leila Guastapaglia
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Maria Izabel Chiamolera
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Grupo Fleury, São Paulo, SP, Brasil
| | | | | | | | - Claudia Veiga Chang
- Divisão de Endocrinologia,Faculdade do Instituto Superior de Medicina (ISMD),São Paulo, SP, Brasil
| | - Raquel Andrade Siqueira
- Divisão de Endocrinologia, Hospital Geral de Goiânia (Hospital Alberto Rassi), Goiânia, GO, Brasil
| | - Rui Monteiro Barros Maciel
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Grupo Fleury, São Paulo, SP, Brasil
| | - José Gilberto Henriques Vieira
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Grupo Fleury, São Paulo, SP, Brasil
| | - Rosa Paula Mello Biscolla
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil,
- Grupo Fleury, São Paulo, SP, Brasil
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Donnici A, Mirabelli M, Giuliano S, Misiti R, Tocci V, Greco M, Aiello V, Brunetti FS, Chiefari E, Aversa A, Foti DP, Brunetti A. Coexistence of Hashimoto's Thyroiditis in Differentiated Thyroid Cancer: Post-Operative Monitoring of Anti-Thyroglobulin Antibodies and Assessment of Treatment Response. Diagnostics (Basel) 2024; 14:166. [PMID: 38248043 PMCID: PMC10814696 DOI: 10.3390/diagnostics14020166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Differentiated thyroid carcinoma (DTC) is frequently found in conjunction with autoimmune thyroid disorders, particularly Hashimoto's thyroiditis (HT). This study investigates the impact of coexisting HT on the persistence of an indeterminate response to therapy due to positive anti-thyroglobulin antibodies (AbTg), measured via competitive immunoassay, in a consecutive patient series from Calabria, Southern Italy. METHODS This retrospective longitudinal study analyzed 259 consecutive DTC patients managed at the Endocrinology Unit of Renato Dulbecco Hospital (Catanzaro, Italy) up to 2023. Patients with medullary and undifferentiated thyroid carcinoma, partial thyroidectomy, less than six months of post-operative monitoring, or missing clinical data were excluded. Demographic information, histological findings, initial tumor stage, and ATA risk category were collected. The response to therapy was assessed based on ATA guidelines. RESULTS Among the 259 patients, 29% had coexisting HT. Patients with HT exhibited distinct characteristics: a higher proportion of females (87.0% vs. 74.7%), a shorter post-operative monitoring duration (median 3 vs. 5 years), and a higher prevalence of papillary thyroid carcinoma (PTC) (97.4% vs. 86.3%). The tumor size, lymph node involvement, and distant metastasis were similar between the groups, with patients without HT having a higher incidence of extrathyroidal tumor extension. However, the initial TNM stage and ATA risk category did not differ significantly. At the six-month follow-up, HT patients showed a higher rate of indeterminate responses, primarily due to positive AbTg. After 12 months, the response categories aligned, with decreasing AbTg levels in the HT group. After 24 months, most patients with long-term follow-up demonstrated an excellent response to DTC therapy, irrespective of HT coexistence. CONCLUSIONS While HT does not worsen DTC prognosis, it may result in indeterminate responses. AbTg measurements in the peri-operative period should be encouraged to facilitate post-operative monitoring, emphasizing the importance of using standardized assays. Further research in larger populations with extended follow-up is needed to comprehensively understand the HT-DTC relationship.
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Affiliation(s)
- Alessandra Donnici
- Endocrinology Unit, University Hospital “Renato Dulbecco” of Catanzaro, 88100 Catanzaro, Italy (A.A.)
| | - Maria Mirabelli
- Endocrinology Unit, University Hospital “Renato Dulbecco” of Catanzaro, 88100 Catanzaro, Italy (A.A.)
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Stefania Giuliano
- Endocrinology Unit, University Hospital “Renato Dulbecco” of Catanzaro, 88100 Catanzaro, Italy (A.A.)
| | - Roberta Misiti
- Clinical Pathology Unit, University Hospital “Renato Dulbecco” of Catanzaro, 88100 Catanzaro, Italy (M.G.)
- Department of Experimental and Clinical Medicine, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Vera Tocci
- Endocrinology Unit, University Hospital “Renato Dulbecco” of Catanzaro, 88100 Catanzaro, Italy (A.A.)
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Marta Greco
- Clinical Pathology Unit, University Hospital “Renato Dulbecco” of Catanzaro, 88100 Catanzaro, Italy (M.G.)
- Department of Experimental and Clinical Medicine, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Vincenzo Aiello
- Rheumatology Clinic ‘Madonna dello Scoglio’ Cotronei, 88900 Crotone, Italy
| | - Francesco S. Brunetti
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Eusebio Chiefari
- Endocrinology Unit, University Hospital “Renato Dulbecco” of Catanzaro, 88100 Catanzaro, Italy (A.A.)
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Antonio Aversa
- Endocrinology Unit, University Hospital “Renato Dulbecco” of Catanzaro, 88100 Catanzaro, Italy (A.A.)
- Department of Experimental and Clinical Medicine, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Daniela P. Foti
- Clinical Pathology Unit, University Hospital “Renato Dulbecco” of Catanzaro, 88100 Catanzaro, Italy (M.G.)
- Department of Experimental and Clinical Medicine, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Antonio Brunetti
- Endocrinology Unit, University Hospital “Renato Dulbecco” of Catanzaro, 88100 Catanzaro, Italy (A.A.)
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
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Spencer CA. Laboratory Thyroid Tests: A Historical Perspective. Thyroid 2023; 33:407-419. [PMID: 37037032 DOI: 10.1089/thy.2022.0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Background: This review presents a timeline showing how technical advances made over the last seven decades have impacted the development of laboratory thyroid tests. Summary: Thyroid tests have evolved from time-consuming manual procedures using isotopically labeled iodine as signals (131I and later 125I) performed in nuclear medicine laboratories, to automated nonisotopic tests performed on multianalyte instruments in routine clinical chemistry laboratories. The development of isotopic radioimmunoassay techniques around 1960, followed by the advent of monoclonal antibody technology in the mid-1970s, led to the development of a nonisotopic immunometric assay methodology that forms the backbone of present-day thyroid testing. This review discusses the development of methods for measuring total thyroxine and triiodothyronine, direct and indirect free thyroid hormone measurements and estimates (free thyroxine and free triiodothyronine), thyrotropin (TSH), thyroid autoantibodies (thyroperoxidase, thyroglobulin [Tg] and TSH receptor autoantibodies), and Tg protein. Despite progressive improvements made in sensitivity and specificity, current thyroid tests remain limited by between-method differences in the numeric values they report, as well as nonspecific interferences with test reagents and interferences from analyte autoantibodies. Conclusions: Thyroid disease affects ∼10% of the U.S. population and is mostly managed on an outpatient basis, generating 60% of endocrine laboratory tests. In future, it is hoped that interferences will be eliminated, and the standardization/harmonization of tests will facilitate the establishment of universal test reference ranges.
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Affiliation(s)
- Carole Ann Spencer
- Department of Endocrinology, University of Southern California, Los Angeles, California, USA
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Howard SR, Freeston S, Harrison B, Izatt L, Natu S, Newbold K, Pomplun S, Spoudeas HA, Wilne S, Kurzawinski TR, Gaze MN. Paediatric differentiated thyroid carcinoma: a UK National Clinical Practice Consensus Guideline. Endocr Relat Cancer 2022; 29:G1-G33. [PMID: 35900783 PMCID: PMC9513650 DOI: 10.1530/erc-22-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
This guideline is written as a reference document for clinicians presented with the challenge of managing paediatric patients with differentiated thyroid carcinoma up to the age of 19 years. Care of paediatric patients with differentiated thyroid carcinoma differs in key aspects from that of adults, and there have been several recent developments in the care pathways for this condition; this guideline has sought to identify and attend to these areas. It addresses the presentation, clinical assessment, diagnosis, management (both surgical and medical), genetic counselling, follow-up and prognosis of affected patients. The guideline development group formed of a multi-disciplinary panel of sub-speciality experts carried out a systematic primary literature review and Delphi Consensus exercise. The guideline was developed in accordance with The Appraisal of Guidelines Research and Evaluation Instrument II criteria, with input from stakeholders including charities and patient groups. Based on scientific evidence and expert opinion, 58 recommendations have been collected to produce a clear, pragmatic set of management guidelines. It is intended as an evidence base for future optimal management and to improve the quality of clinical care of paediatric patients with differentiated thyroid carcinoma.
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Affiliation(s)
- Sasha R Howard
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK
- Department of Paediatric Endocrinology, Barts Health NHS Trust, London, UK
| | - Sarah Freeston
- Whipps Cross Hospital, Barts Health NHS Trust, London, UK
| | | | - Louise Izatt
- Department of Clinical and Cancer Genetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sonali Natu
- Department of Pathology, University Hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - Kate Newbold
- Department of Clinical Oncology, Royal Marsden Hospital Foundation Trust, London, UK
| | - Sabine Pomplun
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Helen A Spoudeas
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sophie Wilne
- Department of Paediatric Oncology, Nottingham University Hospital’s NHS Trust, Nottingham, UK
| | - Tom R Kurzawinski
- Department of Endocrine Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Paediatric Endocrine Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mark N Gaze
- Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Clinical Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Rosario PW, Mourão GF. Natural history, predictive factors of apparent disease (structural or biochemical) and spontaneous excellent response in patients with papillary thyroid carcinoma and indeterminate response to initial therapy with radioiodine. Endocrine 2022; 76:671-676. [PMID: 35347578 DOI: 10.1007/s12020-022-03040-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND About 20% of patients with papillary thyroid carcinoma (PTC) submitted to total thyroidectomy followed by radioactive iodine (RAI) exhibit an indeterminate response to therapy. The aim was to evaluate the natural history, predictive factors of apparent disease (structural or biochemical), and spontaneous excellent response in patients with PTC and an initial indeterminate response to RAI therapy defined based on unstimulated Tg (u-Tg). METHODS We evaluated 164 patients who were initially treated with total thyroidectomy and RAI and who had an indeterminate response to therapy (u-Tg between 0.2 and 1 ng/ml, undetectable anti-Tg antibodies [TgAb], and neck ultrasonography [US] without anomalies). None of the patients received empirical therapy with RAI. The patients were followed up for 24 to 144 months (median 72 months). RESULTS Apparent disease occurred in 16 patients (9.7%), including 13 with structural disease and 3 with u-Tg elevation > 1 ng/ml, but no tumor was detected by the imaging methods (biochemical disease). A higher frequency of disease was observed in patients with >3 lymph node metastases (LNM) and initial u-Tg >0.35 ng/ml. The frequency was only 2% among patients with ≤3 LNM and u-Tg ≤0.35 ng/ml and 9.7% among patients with > 3 LNM or u-Tg >0.35 ng/ml, while the frequency was 27% in patients with >3 LNM and u-Tg >0.35 ng/ml. In the absence of any additional therapy, u-Tg was <0.2 ng/ml (excellent response) in the last assessment in 70 patients (42.7%). Only initial u-Tg was associated with a higher probability of spontaneously achieving an excellent response: 40/72 patients (55.5%) with u-Tg ≤0.35 ng/ml versus 30/92 patients (32.6%) with u-Tg >0.35 ng/ml. CONCLUSIONS A minority of patients with PTC and an initial indeterminate response to RAI defined based on u-Tg develop apparent disease (structural or biochemical) and many spontaneously achieve an excellent response. The risk of disease can be refined based on parameters such as the extent of lymph node involvement and initial Tg concentration.
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Kitamura Y, Narita S, Kuroda Y, Yagi S, Aoyagi K. A Novel Thyroglobulin Immunoassay Using the Specimen-Pretreatment Process Improves the Accuracy of Thyroglobulin Measurements in Anti-Thyroglobulin Positive Specimens. J Appl Lab Med 2021; 6:1463-1475. [PMID: 34580727 DOI: 10.1093/jalm/jfab083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Recently, second-generation thyroglobulin (Tg) sandwich immunoassays have been used in clinical laboratories to measure the serum Tg levels, which is a tumor marker used to monitor postoperative patients with differentiated thyroid cancers. However, these immunoassays are often subject to Tg autoantibody (TgAb) interference. TgAb interference is inevitable for almost all Tg immunoassays, resulting in unreliable Tg measurement values of TgAb-positive samples. METHODS To address TgAb interference, we have developed a novel immunoassay based on a fully automated chemiluminescent enzyme immunoassay system using the effective specimen-pretreatment process to inactivate TgAb in blood and evaluated its assay performance. RESULTS The developed assay was traceable to BCR457 IRMM reference material with a limit of quantification of 0.03 ng/mL. The pretreatment process inactivated almost all TgAb in specimens and allowed accurate Tg measurements in TgAb-positive samples in which TgAb interference was observed using the immunoassays. Size-exclusion chromatography analysis of immunoreactive Tg molecule in a TgAb-positive serum verified disruption of the Tg-TgAb immune complex by the pretreatment process. Good correlation of Tg values in TgAb-negative specimens was observed between the new Tg immunoassay and the second-generation sandwich immunoassays. However, there were numerous discrepant samples on bias plots between the new Tg immunoassay and the second-generation sandwich immunoassays for TgAb-positive specimens. CONCLUSIONS This study indicates the new Tg immunoassay with the specimen-pretreatment process is both robust and free from interference by TgAb. Thus, this novel assay is superior to second-generation sandwich immunoassays and gives accurate Tg concentrations even for TgAb-positive cases.
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Affiliation(s)
| | - Sho Narita
- Research and Development Division, FUJIREBIO INC., Tokyo, Japan
| | - Yu Kuroda
- Research and Development Division, FUJIREBIO INC., Tokyo, Japan
| | - Shintaro Yagi
- Research and Development Division, Advanced Life Science Institute, Inc., Tokyo, Japan
| | - Katsumi Aoyagi
- Research and Development Division, FUJIREBIO INC., Tokyo, Japan.,Research and Development Division, Advanced Life Science Institute, Inc., Tokyo, Japan
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Broecker-Preuss M, Mehnert I, Gilman E, Herrmann K, Weber M, Görges R. Evaluation of a new automated assay for high-sensitivity thyroglobulin measurement and comparison with two established high-sensitivity thyroglobulin assays. Pract Lab Med 2021; 26:e00250. [PMID: 34386567 PMCID: PMC8342782 DOI: 10.1016/j.plabm.2021.e00250] [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: 06/14/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Thyroglobulin (Tg) is an important tumor marker for therapy control and follow-up of differentiated thyroid carcinoma (DTC). Over the past decade, assays for highly sensitive Tg measurement have become increasingly established. We evaluated a newly developed high-sensitive Tg assay running on an automated platform (LIAISON® Tg II Gen assay, DiaSorin), with a limit of quantification of 0.10 ng/ml. Design and Methods Tg values of 166 sera from subjects without thyroid diseases and of more than 500 sera of well-defined DTC patients were determined with the new LIAISON® Tg II Gen assay and compared with two established assays (Elecsys® Tg II/Roche, and Medizym® Tg REM/Medipan). Results Tg reference values from healthy subjects were up to 37.93 ng/ml (women) resp. 24.59 ng/ml (men) with the LIAISON® Tg II Gen assay. Tg values showed good correlations in healthy subjects and patients with active tumorous disease. In contrast, Tg values in the very low range from cured thyroidectomized patients were poorly comparable between the three assays, while clinical differences between the cohorts were correctly reflected by all assays. Conclusions With the new LIAISON® Tg II Gen assay, another automated assay standardized against the first International Reference Preparation CRM-457 for highly sensitive measurement of Tg values is available.
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Affiliation(s)
- Martina Broecker-Preuss
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital of Essen, Germany
| | - Irina Mehnert
- Department of Nuclear Medicine, University Hospital of Essen, Germany
| | - Elena Gilman
- Gilman Biometrics, Consultant for Data Processing and Statistics, Köln, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital of Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital of Essen, Germany
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital of Essen, Germany
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Haddady S, Pinjic E, Lee SL. Prognostic Value of Serum Thyroglobulin Measured at 48 Hours Versus 72 Hours after Second Dose of Recombinant Human Thyrotropin in Surveillance of Well-Differentiated Thyroid Cancer. Endocr Pract 2021; 27:216-222. [PMID: 33779554 DOI: 10.1016/j.eprac.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The sensitivity of thyroglobulin (Tg) to detect differentiated thyroid cancer recurrence increases with the rise of the thyrotropin level. Since 1998, recombinant human thyrotropin (rhTSH) has been commercially available for this purpose. The traditional protocol for using rhTSH calls for 2 daily injections of rhTSH, followed by the measurement of Tg 72 hours after the second dose. In this study, we compared the performance of rhTSH-stimulated Tg (rhTSH-Tg) obtained at 48 versus 72 hours after the second rhTSH. METHODS A retrospective chart review of 1088 patients with thyroid cancer was conducted. Two hundred forty-nine rhTSH-Tg, without measurable Tg antibody, were identified, 134 of which were obtained at 48 hours (4-day test) and 115 at 72 hours after the second rhTSH (5-day test). The ability of rhTSH-Tg to identify recurrence or persistence of differentiated thyroid cancer and to predict response to therapy at the end of the study period was compared between the 2 groups. RESULTS The median duration of follow-up was 8 years. When recurrent/persistent cancer was present based on a combination of unstimulated Tg, imaging and procedures, the ratio of rhTSH-Tg ≥ 1 ng/mL was similar in both groups (P value: .153). The negative predictive value of rhTSH-Tg to predict response to therapy over the long term was 95% or higher in 4-day and 5-day tests. CONCLUSION Tg measured 48 and 72 hours after the second dose of rhTSH may provide a comparable prognostic value. These results encourage further studies to identify new protocols to obtain rhTSH-Tg.
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Affiliation(s)
- Shirin Haddady
- School of Medicine, Boston University, Department of Medicine and Division of Endocrinology, Diabetes and Weight Management, Boston, Massachusetts.
| | - Emma Pinjic
- Division of Rheumatology, Boston University School of Medicine, Boston, Massachusetts
| | - Stephanie L Lee
- School of Medicine, Boston University, Department of Medicine and Division of Endocrinology, Diabetes and Weight Management, Boston, Massachusetts
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Barbesino G, Algeciras-Schimnich A, Bornhorst JA. False Positives in Thyroglobulin Determinations Due to the Presence of Heterophile Antibodies: An Underrecognized and Consequential Clinical Problem. Endocr Pract 2021; 27:396-400. [PMID: 33581326 DOI: 10.1016/j.eprac.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/16/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report a case series of thyroid cancer patients in whom false positive results in immunometric assays for thyroglobulin (TgIMA) were caused by heterophilic antibody interference, describe the clinical scenario in which this interference should be suspected, and recommend methods to demonstrate the interference. METHODS Three patients with unexpectedly elevated thyroglobulin results (range, 1.6-75 ng/mL) were studied. In the first patient, thyroglobulin was elevated despite the presence of Tg antibody. In the second patient, suppressed thyroglobulin was higher than a recent stimulated thyroglobulin. In the third patient, thyroglobulin became detectable years after treatment and did not change after thyroid-stimulating hormone stimulation. TgIMA concentration determination was compared to determination by a mass spectrometry method (TgMS). Thyroglobulin was also remeasured after preabsorption with heterophile antibody blocking reagents and after serial dilutions. RESULTS In all cases, thyroglobulin was undetectable by TgMS. In 2 of 3 patients, dilutions provided nonlinear thyroglobulin results. After blocking agent preabsorption, thyroglobulin dropped by 35%, 45%, and 91% in the 3 samples. CONCLUSION False positive thyroglobulin concentrations from heterophilic antibody interference have significant impact on the management of thyroid cancer. Here we show that TgMS assays can be used to rule out heterophilic antibody interference. This interference should be suspected when a detectable thyroglobulin by TgIMA does not respond to thyroid-stimulating hormone or is discordant from the clinical assessment.
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Affiliation(s)
- Giuseppe Barbesino
- Thyroid Unit, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.
| | | | - Joshua A Bornhorst
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Determination of thyroglobulin levels by radioimmunoassay method in anti thyroglobulin positive differentiated thyroid patients: One center clinical experience. Appl Radiat Isot 2020; 166:109400. [PMID: 32956923 DOI: 10.1016/j.apradiso.2020.109400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Abstract
It is very crucial to determine Tg accurately and precisely in thyroid cancer cases. Although there are many studies on the detection of Tg in thyroid cases in the literature, there are no sufficient clinical studies examining many cases with different features by using RIA methodology. Here, a radiometric and chromatographic method has been studied for the first time to eliminate the interference from anti-Tg positive patients. In this paper, radioimmunoassay (RIA) and immunoradiometric (IRMA) techniques were used for the analysis of 302 sera collected from patients for Tg and TgAb quantification. By the RIA technique, a reliable result was obtained by calculating the real Tg value quantitatively in 41 patients showing TgAb positivity out of 208 patients. Our findings show that the RIA assay is the most suitable approach for detection of changeable (low or undetectable) Tg value and metastases detected by post-therapeutic imaging in early-stage DTC cases showing preoperative and postoperative TgAb positivity. The new immunoradiometric method allows the real (%) Tg value to be reached in a part of TgAb-positive DTC. Even if TgAb positive in the metastatic and nonmetastatic DTC patient group. This allows the accurate clinical follow-up of patients.
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Cennamo M, La Civita E, Curci A, Liotti A, Braschi U, Terracciano D. Comparison between a new thyroglobulin assay with the well-established Beckman Access immunoassay: A preliminary report. J Clin Lab Anal 2020; 35:e23589. [PMID: 32951246 PMCID: PMC7891525 DOI: 10.1002/jcla.23589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Measurement of serum thyroglobulin (Tg) plays a key role in the post-thyroidectomy management of differentiated thyroid carcinoma (DTC). In this context, the performance of new-generation thyroglobulin assay has clinical implications in the follow-up of DTC patients. Aim of this study was to compare the new highly sensitive Liaison Tg II (Tg-L) with the well-established Tg Access assay (Tg-A). MATERIALS AND METHODS A total of 91 residual serum samples (23 positive and 68 negatives for Tg auto-antibodies) were tested by the Beckman Access and Diasorin Liaison assays. Study samples were from 21 patients with pathologically proven DTC and control samples from 70 (16 patients with benign thyroid disease and 54 apparently healthy subjects). RESULTS Our results showed that Tg-L was highly correlated with Tg-A for both values ranging between 0.2 and 50 ng/mL (Pearson's r = 0.933 [95%CI 0.894-0.958], P < .001) and higher than 50 ng/mL (Pearson's r = 0.849 [95%CI 0.609-0.946], P < .001). For Tg values lower than 0.2 ng/mL, the overall concordance rate was 92%. Moreover, we tested 7 fine-needle aspiration washout fluids (FNA), showing an overall concordance rate in discriminating negative and positive of 100%. Finally, we found no interference by Tg auto-antibodies (TgAbs) for both Tg-L and Tg-A. Conversely, rheumatoid factor (RF) interferes with Tg-A, but not with Tg-L in one patient with no relapsing thyroid carcinoma. CONCLUSIONS Liaison Tg II demonstrated a good correlation with Access Tg assay both for sera and FNAs. Further studies on larger population are needed to evaluate Tg-L clinical impact on DTC patient's follow-up.
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Affiliation(s)
- Michele Cennamo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Evelina La Civita
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Anna Curci
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonietta Liotti
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Umberto Braschi
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
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Circulating biomarkers for the detection of tumor recurrence in the postsurgical follow-up of differentiated thyroid carcinoma. Curr Opin Oncol 2020; 32:7-12. [PMID: 31599768 DOI: 10.1097/cco.0000000000000588] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW To discuss advances and challenges in thyroglobulin and Tg-antibody (TgAb) measurement and their impact on clinical management of differentiated thyroid carcinoma (DTC). RECENT FINDINGS Basal high-sensitive Tg (hsTg) measurement avoids the need for stimulation and greatly simplifies DTC patients' management. In addition, patients with undetectable hsTg after thyroid ablation are at a very low risk of recurrence and can be safely managed by periodic hsTg measurement alone. When TgAb is present, its trend over time serves as primary (surrogate) tumor marker. However, an undetectable hsTg measurement appears to indicate a complete remission of DTC even in the presence of TgAb. Finally, reliable reference values are not yet available for low-risk DTC who are treated with less than total thyroid ablation, and caution is needed before well-designed studies addressing these issues have been published. SUMMARY The use of hsTg assays has changed paradigms for DTC monitoring even in the presence of TgAb, and greatly reduced patients' discomfort and overall case-management costs. Reliable Tg interpretation criteria are urgently needed for patients treated with less than total thyroid ablation.
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Eilsberger F, Pfestroff A, Librizzi D, Luster M. [Follow-up of differentiated thyroid cancer]. Dtsch Med Wochenschr 2020; 145:1236-1244. [PMID: 32634842 DOI: 10.1055/a-1007-4121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The management of differentiated thyroid carcinoma has shown considerable changes in recent years, moving away from a fixed therapy regimen towards individual treatment strategies. The aim of our work (literature research) is to present current developments in the follow-up of differentiated thyroid cancer.For the management of individual follow-up, an initial evaluation and, at later time points, the re-evaluation of the risk of recurrence is crucial. The performance of I-131-diagnostics after radioiodine therapy can provide essential information and can be seen as a survey of a new baseline situation, in order to be able to draw a comparison in case of a rising Thyreoglobulin (Tg).The measurement of Tg with a highly sensitive assays shows a high negative predictive value. Negative Tg measurements with these assays seem to indicate complete remission even with Tg antibodies being present. An increasing Tg value in follow-up implies further diagnostic work-up, primarily neck ultrasonography. Sonographically suspicious findings should be subjected to fine needle biopsy, whereby in addition to cytological processing, determination of Tg from the sample can be recommended. If the suspicious lesion cannot be displayed sonographically and Tg values keep rising, computed tomography (CT) and magnetic resonance imaging (MRI) of the neck region can provide further information. FDG-PET/CT has also shown an excellent performance in this setting.The previously fixed therapy regimen has been realigned towards an individual treatment management. Current studies and guidelines lead to a repetitive recurrence risk evaluation and the adjustment of the aftercare planning to the individual risks with appropriately selected examination methods and personalized intervals of assessment.
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Blažeković I, Romić M, Bosak Butković M, Šiško Markoš I, Gladić Nenadić V, Vidranski V, Petranović Ovčariček P, Krilić D, Varjačić T, Staničić J, Granić R, Punda M, Mihaljević I, Jukić T, Franceschi M. Thyroglobulin Measurement in Needle Aspiration for Detection of Recurrences and Neck Metastases in Patients with Differentiated Thyroid Carcinoma: Significance of Anti-Tg Antibodies. Acta Clin Croat 2020; 59:9-17. [PMID: 34219879 PMCID: PMC8212602 DOI: 10.20471/acc.2020.59.s1.01] [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] [Indexed: 11/24/2022] Open
Abstract
The worldwide incidence of differentiated thyroid cancer (DTC) has increased in recent decades, likely due to frequent use of cervical ultrasonography (US) and US-guided fine needle aspiration biopsy (FNA)., US is performed during follow-up after thyroidectomy, and US-guided FNA with cytology is used if suspicious cervical lymph nodes (LN) or thyroid bed masses are detected. Knowing that serum anti-Tg antibodies (sTgAb) affect the use of serum Tg (sTg) as a tumor marker, the aim of our study was to assess the usefulness of Tg determination in needle aspirates (FNA-Tg) in presence of sTgAb. This retrospective study included 149 patients with DTC and 159 aspirations of suspicious LN and thyroid bed masses. As expected, there was a negative correlation between sTg and sTgAb levels (p<0.05), while FNA-Tg levels had a positive correlation with FNA-TgAb levels (p<0.05). Furthermore, we found a positive correlation between sTg and FNA-Tg levels (p<0.05), but not between sTgAb and FNA-TgAb or sTgAb and FNA-Tg. In conclusion, these results show that FNA-Tg values were not affected by sTgAb and that FNA-Tg measurement were highly effective in detecting cervical DTC metastases. However, combined use with cytology is suggested for neck evaluation because cytology could reveal metastases from other tumor sites.
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Affiliation(s)
- Ivan Blažeković
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Matija Romić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Marija Bosak Butković
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Ines Šiško Markoš
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Vedrana Gladić Nenadić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Valentina Vidranski
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Petra Petranović Ovčariček
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Dražena Krilić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Tea Varjačić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Josip Staničić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Roko Granić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Marija Punda
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Ivan Mihaljević
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Tomislav Jukić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Maja Franceschi
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
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Moreno I, Hirsch D, Duskin-Bitan H, Dicker-Cohen T, Shimon I, Robenshtok E. Response to Therapy Assessment in Intermediate-Risk Thyroid Cancer Patients: Is Thyroglobulin Stimulation Required? Thyroid 2020; 30:863-870. [PMID: 31928205 DOI: 10.1089/thy.2019.0431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: The 2015 American Thyroid Association (ATA) guidelines recommend response to therapy (RTT) assessment 1-2 years after initial treatment in differentiated thyroid cancer (DTC) patients to guide thyrotropin (TSH) goals and long-term follow-up. We hypothesized that data collected during the first 2 years of follow-up may be sufficient to determine RTT without thyroglobulin (Tg) stimulation. Materials and Methods: Patients treated with total thyroidectomy and radioiodine for intermediate-risk DTC, followed for >2 years, and had sufficient follow-up data were included. Data on Tg, ultrasound, scans, and long-term outcomes were collected. Results: One-hundred twenty patients met inclusion criteria, with 68% women and mean age 55 ± 15 years. Intermediate risk was due to lymph-node involvement (72%), extrathyroidal extension (51%), vascular invasion (12%), and high-risk histology (9%). At the end of follow-up of 7 ± 4 years, 26% had persistent disease (14% biochemical, 12% structural). According to the ATA RTT system (using stimulated-Tg), 56% had excellent RTT, of whom only 2% had disease at the end of follow-up. In the "nonstimulated" system (which includes basal Tg, post-131I therapy whole-body scan (TxWBS) for assessment of residual lymph-node metastases after surgery, and structural imaging studies), 57% had excellent response, of whom none had disease at the end of follow-up. Only eight patients (7%) were classified differently due to recombinant human thyrotropin stimulation (as either excellent or indeterminate response), with no difference in predictive value, with a receiver-operator characteristic area under the curve of 0.903 with Tg-stimulation and of 0.918 without. Conclusions: In patients with no evidence of disease during the first 2 years of follow-up, the addition of stimulated-Tg adds little prognostic information. We suggest the use of excellent RTT based on basal Tg together with TxWBS and structural imaging studies.
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Affiliation(s)
- Itamar Moreno
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Dania Hirsch
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
| | - Hadar Duskin-Bitan
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
| | - Talia Dicker-Cohen
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
| | - Ilan Shimon
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
| | - Eyal Robenshtok
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
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Sandúa A, Macias M, Perdomo C, Galofre JC, Ferrer R, Alegre E, González Á. Utility of recombinant human TSH stimulation test in the follow-up of patients with differentiated thyroid cancer depending on basal thyroglobulin results. ADVANCES IN LABORATORY MEDICINE 2020; 1:20190017. [PMID: 37362557 PMCID: PMC10197371 DOI: 10.1515/almed-2019-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/26/2019] [Indexed: 06/28/2023]
Abstract
Background Thyroglobulin (Tg) is fundamental for differentiated thyroid cancer (DTC) monitoring. Tg detection can be enhanced using recombinant human thyroid-stimulating hormone (TSH) (rhTSH). This study is aimed to evaluate the use of the rhTSH stimulation test when using a high-sensitivity Tg assay. Methods We retrospectively studied 181 rhTSH tests from 114 patients with DTC and negative for antithyroglobulin antibodies (anti-TgAb). Image studies were performed in all cases. Serum Tg and anti-TgAb were measured using specific immunoassays. Results rhTSH stimulation in patients with basal serum Tg (b-Tg) concentrations lower than 0.2 ng/mL always resulted in rhTSH-stimulated serum Tg (s-Tg) concentrations lower than 1.0 ng/mL and negative structural disease. In patients with b-Tg concentration between 0.2 and 1.0 ng/mL, s-Tg detected one patient (1/30) who showed biochemical incomplete response. Patients with negative images had lower s-Tg than those with nonspecific or abnormal findings (p<0.05). Receiver operating characteristic curve analysis of the s-Tg to detect altered images showed an area under the curve of 0.763 (p<0.05). With an s-Tg cutoff of 0.85 ng/mL, the sensitivity was 100%, decreasing to 96.15% with an s-Tg cutoff of 2 ng/mL. Conclusions Patients with DTC with b-Tg concentrations equal or higher than 0.2 ng/mL can benefit from the rhTSH stimulation test.
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Affiliation(s)
- Amaia Sandúa
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
| | - Monica Macias
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
| | - Carolina Perdomo
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan Carlos Galofre
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Roser Ferrer
- Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Estibaliz Alegre
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Álvaro González
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
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Jiang HJ, Hsiao PJ. Clinical application of the ultrasound-guided fine needle aspiration for thyroglobulin measurement to diagnose lymph node metastasis from differentiated thyroid carcinoma-literature review. Kaohsiung J Med Sci 2020; 36:236-243. [PMID: 31909556 DOI: 10.1002/kjm2.12173] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/01/2019] [Indexed: 11/06/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) generally has a good prognosis, but disease recurs in 25% to 30% of PTC patients and significantly reduces the survival rate. Lymph node metastasis (LNM) is reported in 20% to 50% of PTC patients, mainly in the neck, and 20% originates from recurrence. LNM of papillary thyroid carcinoma are a plausible prognostic factor to determine disease recurrence. Currently, fine needle lymph node aspiration for cytology (LN-FN-cytology) is the best modality to diagnose LNM but is limited by diagnostic sensitivity and sample error. Fine needle lymph node aspiration for thyroglobulin measurement (LN-FNA-Tg) could offer a reliable and quantitative diagnostic method for LNM. The combination of LN-FNA-cytology and LN-FNA-Tg could achieve almost 100% diagnostic sensitivity and specificity for LNM. Both treatment guidelines of the American Thyroid Association and European Thyroid Association recommend LN-FNA-Tg to diagnose LNM after total thyroidectomy. Diagnostic accuracy of the LN-FNA-Tg depends on optimal equipment, scanning protocol, skill, and experience of operators. Normal saline is mainly used for aspiration needle wash-out and buffer solution. And radioimmunoassay or immunoradiometric assay are widely used for the LN-FNA-Tg measurement. So far, there is no consensus about the diagnostic threshold of LN-FNA-Tg for positive LNM, but high LN-FNA-Tg, especially higher than 10 ng/mL, strongly favors LNM.
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Affiliation(s)
- He-Jiun Jiang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pi-Jung Hsiao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Jeong E, Yoon JK, Lee SJ, Soh EY, Lee J, Kim HK, An YS. Can the basal serum thyroglobulin level be used to predict the recombinant human TSH-stimulated thyroglobulin level in differentiated patients with thyroid cancer? Medicine (Baltimore) 2019; 98:e18437. [PMID: 31861014 PMCID: PMC6940117 DOI: 10.1097/md.0000000000018437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study investigated the correlation between basal thyroglobulin (Tg) and recombinant human thyroid-stimulating hormone (rhTSH)-stimulated Tg in differentiated patients with thyroid cancer, and sought to determine whether the basal Tg level predicts the rhTSH-stimulated Tg level.We retrospectively enrolled 177 patients with papillary thyroid cancer (mean age = 44 years; 50 males, 127 females) who received rhTSH before radioiodine therapy (RIT). Serum Tg levels were measured 7 days before the 1st rhTSH injection (basal Tg) and on the days of RIT (rhTSH-stimulated Tg). Patients were divided into 3 groups according to rhTSH-stimulated Tg cut-off levels of 2, 5, and 10 ng/mL. The correlation between basal Tg and rhTSH-stimulated Tg levels was assessed, and whether basal Tg was useful in predicting the rhTSH-stimulated Tg level was determined.A significant positive correlation was observed between basal and rhTSH-stimulated Tg levels (|rho| = 0.48, P < .0001). The basal Tg level had significant diagnostic ability in predicting an rhTSH-stimulated Tg level of 2 ng/mL or higher, and the optimal basal Tg level for this prediction was 0.3 ng/mL (AUC = 0.77, P < .0001). A basal Tg level of 0.5 ng/mL was optimal for predicting rhTSH-stimulated Tg levels of 5 ng/mL or higher (AUC = 0.81, P < .0001), and of 10 ng/mL or higher (AUC = 0.82, P = .0171).The basal Tg level was significantly correlated with the rhTSH-stimulated Tg level. If the basal Tg level is >0.3 or 0.5 ng/mL, then the rhTSH-stimulated Tg level can be expected to be sufficiently high to necessitate clinical examination.
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Affiliation(s)
- Eugene Jeong
- Department of Nuclear Medicine and Molecular Imaging
| | - Joon-Kee Yoon
- Department of Nuclear Medicine and Molecular Imaging
| | - Su Jin Lee
- Department of Nuclear Medicine and Molecular Imaging
| | - Euy Young Soh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jeonghun Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hyeung Kyoo Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging
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21
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Risk Factors for Indeterminate Response After Radioactive Iodine Therapy in Patients With Differentiated Thyroid Cancer. Clin Nucl Med 2019; 44:714-718. [DOI: 10.1097/rlu.0000000000002653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Role of thyroglobulin in the management of patients with differentiated thyroid cancer. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00325-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Tuttle RM, Ahuja S, Avram AM, Bernet VJ, Bourguet P, Daniels GH, Dillehay G, Draganescu C, Flux G, Führer D, Giovanella L, Greenspan B, Luster M, Muylle K, Smit JWA, Van Nostrand D, Verburg FA, Hegedüs L. Controversies, Consensus, and Collaboration in the Use of 131I Therapy in Differentiated Thyroid Cancer: A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association. Thyroid 2019; 29:461-470. [PMID: 30900516 DOI: 10.1089/thy.2018.0597] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Publication of the 2015 American Thyroid Association (ATA) management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer was met with disagreement by the extended nuclear medicine community with regard to some of the recommendations related to the diagnostic and therapeutic use of radioiodine (131I). Because of these concerns, the European Association of Nuclear Medicine and the Society of Nuclear Medicine and Molecular Imaging declined to endorse the ATA guidelines. As a result of these differences in opinion, patients and clinicians risk receiving conflicting advice with regard to several key thyroid cancer management issues. SUMMARY To address some of the differences in opinion and controversies associated with the therapeutic uses of 131I in differentiated thyroid cancer constructively, the ATA, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association each sent senior leadership and subject-matter experts to a two-day interactive meeting. The goals of this first meeting were to (i) formalize the dialogue and activities between the four societies; (ii) discuss indications for 131I adjuvant treatment; (iii) define the optimal prescribed activity of 131I for adjuvant treatment; and (iv) clarify the definition and classification of 131I-refractory thyroid cancer. CONCLUSION By fostering an open, productive, and evidence-based discussion, the Martinique meeting restored trust, confidence, and a sense of collegiality between individuals and organizations that are committed to optimal thyroid disease management. The result of this first meeting is a set of nine principles (The Martinique Principles) that (i) describe a commitment to proactive, purposeful, and inclusive interdisciplinary cooperation; (ii) define the goals of 131I therapy as remnant ablation, adjuvant treatment, or treatment of known disease; (iii) describe the importance of evaluating postoperative disease status and multiple other factors beyond clinicopathologic staging in 131I therapy decision making; (iv) recognize that the optimal administered activity of 131I adjuvant treatment cannot be definitely determined from the published literature; and (v) acknowledge that current definitions of 131I-refractory disease are suboptimal and do not represent definitive criteria to mandate whether 131I therapy should be recommended.
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Affiliation(s)
- R Michael Tuttle
- 1 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Sukhjeet Ahuja
- 2 Evidence and Quality, Society of Nuclear Medicine and Molecular Imaing, Reston, Virginia
| | - Anca M Avram
- 3 Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Victor J Bernet
- 4 Division of Endocrinology, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Patrick Bourguet
- 5 Department of Nuclear Medicine, University Hospital of Martinique, Fort de France, Martinique
- 6 University of Antilles, Pointe-à-Pitre, Guadeloupe
| | - Gilbert H Daniels
- 7 Thyroid Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Gary Dillehay
- 8 Department of Nuclear Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ciprian Draganescu
- 5 Department of Nuclear Medicine, University Hospital of Martinique, Fort de France, Martinique
| | - Glenn Flux
- 9 Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Dagmar Führer
- 10 Department of Endocrinology and Metabolism, University Hospital Essen, Essen, Germany
| | - Luca Giovanella
- 11 Clinic of Nuclear Medicine and Thyroid Center, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- 12 Clinic for Nuclear Medicine, University of Zürich, Zürich, Switzerland
| | | | - Markus Luster
- 14 Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Kristoff Muylle
- 15 Department of Nuclear Medicine, University Hospital Brussels (UZ Brussel, VUB), Brussels, Belgium
- 16 European Association of Nuclear Medicine, Vienna, Austria
| | - Johannes W A Smit
- 17 Department of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Douglas Van Nostrand
- 18 Georgetown University School of Medicine, Washington Hospital Center, Washington, DC
| | - Frederik A Verburg
- 14 Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Laszlo Hegedüs
- 19 Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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Flores-Rebollar A, Pérez-Díaz I, Lagunas-Bárcenas S, García-Martínez B, Rivera-Moscoso R, Fagundo-Sierra R. Clinical utility of an ultrasensitive thyroglobulin assay in the follow-up of patients with differentiated thyroid cancer: can the stimulation test be avoided in patients with an intermediate recurrence risk? ACTA ACUST UNITED AC 2019; 38:188-193. [PMID: 29984794 DOI: 10.14639/0392-100x-1494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 09/19/2017] [Indexed: 12/30/2022]
Abstract
SUMMARY Serum thyroglobulin (Tg) measurement during suppression with levothyroxine (LT4) using an ultrasensitive assay (OnT4-Tg) has been proposed as a replacement of TSH-stimulated Tg measurement (OffT4-Tg) in management of patients with differentiated thyroid cancer (DTC). The aim of this study is to evaluate the capacity of an ultrasensitive Tg assay in predicting an OffT4-Tg > 2.0 ng/mL based on the OnT4-Tg in patients with DTC and an intermediate recurrence risk. We analysed 101 patients with DTC and an intermediate (n = 92) or high risk of recurrence (n = 9) who were treated with total thyroidectomy and ablation with 131I, and followed for an average of 6 years. OnT4-Tg was undetectable in 64 of 101 patients; OffT4-Tg was #x003C; 2.0 ng/mL in 61 of these 64 patients, all with negative imaging results. Furthermore, 37 of 101 patients had detectable OnT4-Tg; 32 of these 37 patients also presented OffT4-Tg > 2.0 ng/mL, and only 3 of these 32 patients had metastases detected by neck ultrasound. Considering a cutoff point of 0.1 ng/mL for OnT4-Tg, the assay had a sensitivity of 91%, specificity of 92%, positive predictive value (PPV) of 86% and the negative predictive value (NPV) of 95% when predicting an OffT4-Tg > 2.0 ng/mL (biochemical disease). The use of an ultrasensitive Tg assay allows prediction of which patients will remain disease-free even if they are at an intermediate risk of recurrence, and to decrease the need for stimulated Tg assays in two-thirds of these patients.
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Affiliation(s)
- A Flores-Rebollar
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
| | - I Pérez-Díaz
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
| | - S Lagunas-Bárcenas
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
| | - B García-Martínez
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
| | - R Rivera-Moscoso
- Planning and Quality Improvement Division, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
| | - R Fagundo-Sierra
- Central Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
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25
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Lamartina L, Grani G, Durante C, Borget I, Filetti S, Schlumberger M. Follow-up of differentiated thyroid cancer - what should (and what should not) be done. Nat Rev Endocrinol 2018; 14:538-551. [PMID: 30069030 DOI: 10.1038/s41574-018-0068-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The treatment paradigm for thyroid cancer has shifted from a one-size-fits-all approach to more personalized protocols that range from active surveillance to total thyroidectomy followed by radioiodine remnant ablation. Accurate surveillance tools are available, but follow-up protocols vary widely between centres and clinicians, owing to the lack of clear, straightforward recommendations on the instruments and assessment schedule that health-care professionals should adopt. For most patients (that is, those who have had an excellent response to the initial treatment and have a low or intermediate risk of tumour recurrence), an infrequent assessment schedule is sufficient (such as a yearly determination of serum levels of TSH and thyroglobulin). Select patients will benefit from second-line imaging and more frequent assessments. This Review discusses the strengths and weaknesses of the surveillance tools and follow-up strategies that clinicians use as a function of the initial treatment and each patient's risk of recurrence.
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Affiliation(s)
- Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza", Rome, Italy
| | - Giorgio Grani
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza", Rome, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza", Rome, Italy
| | - Isabelle Borget
- Department of Biostatistic and Epidemiology, Gustave Roussy and University Paris-Saclay, Villejuif, France
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza", Rome, Italy
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Saclay, Villejuif, France.
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Algeciras-Schimnich A. Thyroglobulin measurement in the management of patients with differentiated thyroid cancer. Crit Rev Clin Lab Sci 2018; 55:205-218. [DOI: 10.1080/10408363.2018.1450830] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Trimboli P, Imperiali M, Piccardo A, CampennÌ A, Giordani I, Ruggeri RM, Baldari S, Orlandi F, Giovanella L. Multicentre clinical evaluation of the new highly sensitive Elecsys® thyroglobulin II assay in patients with differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2018; 88:295-302. [PMID: 28960391 DOI: 10.1111/cen.13487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A highly sensitive thyroglobulin assay (Elecsys® Tg II, Roche Diagnostics, Penzberg, Germany) has become available for monitoring patients with differentiated thyroid cancer (DTC). Here, we evaluated the clinical performance of Elecsys® Tg II assay in a multicentre patients series and compare it with the established Access® Tg assay (Beckman Coulter, Brea, CA, USA). DESIGN Retrospective analysis on prospectively selected patients in four thyroid cancer referral centres with uniform DTC management. PARTICIPANTS All DTC cases diagnosed, treated and followed up in four tertiary referral centres for thyroid cancer since January 2005 (n = 1456) were retrieved, and predefined selection criteria were applied to prevent relevant enrolment biases. A series of 204 patients was finally selected for this study. MEASUREMENTS Samples had been stored at -80°C. Tg was measured by fully automated immunometric Elecsys® Tg II and Access® Tg assays in a centralized laboratory. RESULTS Two hundred and four DTC were finally included. Of these, 10.8% had structural recurrence (sREC), and 81.4% showed no evidence of disease (NED) at the end of follow-up. There was a significant analytical bias between methods that cannot be used interchangeably. Using ROC curve analysis, the best basal and rhTSH-stimulated Tg cut-offs to detect sREC were 0.41 μg/L and 1.82 μg/L for Elecsys® and 0.36 μg/L and 1.62 μg/L for Access® assay, respectively. Using Cox proportional hazard regression, Tg was the only independent predictor of cancer relapse. CONCLUSIONS Using appropriate assay-specific cut-offs, the clinical performance of the Elecsys® Tg II assay was comparable to that provided by the well-established Access® Tg assay.
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Affiliation(s)
- P Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - M Imperiali
- Department of Clinical Chemistry and Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - A Piccardo
- Department of Nuclear Medicine, Ente Ospedaliero "Ospedali Galliera", Genova, Italy
| | - A CampennÌ
- Department of Biomedical and Dental Science and Morpho-Functional Images, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - I Giordani
- Department of Internal Medicine and Endocrinology, University of Torino, Torino, Italy
| | - R M Ruggeri
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Messina, Messina, Italy
| | - S Baldari
- Department of Biomedical and Dental Science and Morpho-Functional Images, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - F Orlandi
- Department of Internal Medicine and Endocrinology, University of Torino, Torino, Italy
| | - L Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Clinical Chemistry and Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Haymart MR, Esfandiari NH, Stang MT, Sosa JA. Controversies in the Management of Low-Risk Differentiated Thyroid Cancer. Endocr Rev 2017; 38. [PMID: 28633444 PMCID: PMC5546880 DOI: 10.1210/er.2017-00067] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Controversy exists over optimal management of low-risk differentiated thyroid cancer. This controversy occurs in all aspects of management, including surgery, use of radioactive iodine for remnant ablation, thyroid hormone supplementation, and long-term surveillance. Limited and conflicting data, treatment paradigm shifts, and differences in physician perceptions contribute to the controversy. This lack of physician consensus results in wide variation in patient care, with some patients at risk for over- or undertreatment. To reduce patient harm and unnecessary worry, there is a need to design and implement studies to address current knowledge gaps.
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Affiliation(s)
- Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109
| | - Michael T Stang
- Division of Endocrine Surgery, Department of Surgery, Duke University, Durham, North Carolina 27710
| | - Julia Ann Sosa
- Division of Endocrine Surgery, Department of Surgery, Duke University, Durham, North Carolina 27710
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29
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Trimboli P, Zilioli V, Imperiali M, Ceriani L, Giovanella L. High-sensitive basal serum thyroglobulin 6-12 months after thyroid ablation is strongly associated with early response to therapy and event-free survival in patients with low-to-intermediate risk differentiated thyroid carcinomas. Eur J Endocrinol 2017; 176:497-504. [PMID: 28137736 DOI: 10.1530/eje-16-1011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/12/2017] [Accepted: 01/30/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE High-sensitive thyroglobulin assays (hsTg) has decreased the need for stimulated Tg measurements in patients with differentiated thyroid carcinoma (DTC). However, multiple assays analyzing the same samples may report different values. Accordingly, appropriate assay-specific cut-off levels should be selected in representative patient series. Here, we evaluate the role of a new hsTg assay in low-to-intermediate risk DTC patients and select appropriate assay-specific clinical cut-off limits. DESIGN This was a retrospective study. The response to treatment was assessed according to ATA. METHODS Patients with low-to-intermediate risk DTC treated and regularly followed-up in our thyroid center. Tg was measured on the Kryptor Compact Plus Instrument (BRAHMS Thermo Fisher Scientific). RESULTS The study series comprised 201 DTC patients and excellent response (ER) was demonstrated in 184 (91.5%). Optimized threshold of basal Tg (onT4-Tg) measured 6-12 months after initial treatment was set by ROC curves analysis at 0.28 ng/mL. Having onT4-Tg <0.28 ng/mL at 6-12 months after treatment was associated with longer disease-free survival of Kaplan-Meier (P < 0.001), ER at early follow-up (odds ratio (OR): 165, P < 0.001) and absence of relapse during follow-up (OR: 328, P = 0.0001). CONCLUSIONS Patients with low- and intermediate-risk DTC could be considered cured when they have onT4-Tg levels <0.28 ng/mL coupled with negative imaging at their first post-ablation visit.
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Affiliation(s)
- P Trimboli
- Department of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - V Zilioli
- Department of Nuclear MedicineBolzano Regional Hospital, Bolzano, Italy
| | - M Imperiali
- Department of Laboratory MedicineEnte Ospedaliero Cantonale, Bellinzona, Switzerland
| | - L Ceriani
- Department of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Giovanella
- Department of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Laboratory MedicineEnte Ospedaliero Cantonale, Bellinzona, Switzerland
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30
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Parisi MT, Eslamy H, Mankoff D. Management of Differentiated Thyroid Cancer in Children: Focus on the American Thyroid Association Pediatric Guidelines. Semin Nucl Med 2016; 46:147-64. [PMID: 26897719 DOI: 10.1053/j.semnuclmed.2015.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
First introduced in 1946, radioactive iodine (I-131) produces short-range beta radiation with a half-life of 8 days. The physical properties of I-131 combined with the high degree of uptake in the differentiated thyroid cancers (DTCs) led to the use of I-131 as a therapeutic agent for DTC in adults. There are two indications for the potential use of I-131 therapy in pediatric thyroid disorders: nonsurgical treatment of hyperthyroidism owing to Graves' disease and the treatment of children with intermediate- and high-risk DTC. However, children are not just miniature adults. Not only are children and the pediatric thyroid gland more sensitive to radiation than adults but also the biologic behavior of DTC differs between children and adults as well. As opposed to adults, children with DTC typically present with advanced disease at diagnosis; yet, they respond rapidly to therapy and have an excellent prognosis that is significantly better than that in adult counterparts with advanced disease. Unfortunately, there are also higher rates of local and distant disease recurrence in children with DTC compared with adults, mandating lifelong surveillance. Further, children have a longer life expectancy during which the adverse effects of I-131 therapy may become manifest. Recognizing the differences between adults and children with DTC, the American Thyroid Association commissioned a task force of experts who developed and recently published a guideline to address the unique issues related to the management of thyroid nodules and DTC in children. This article reviews the epidemiology, diagnosis, staging, treatment, therapy-related effects, and suggestions for surveillance in children with DTC, focusing not only on the differences between adults and children with this disease but also on the latest recommendations from the inaugural pediatric management guidelines of the American Thyroid Association.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
| | - Hedieh Eslamy
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - David Mankoff
- Department of Nuclear Medicine, University of Pennsylvania, Philadelphia, PA
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31
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Low- and high-dose radioiodine therapy for low-/intermediate-risk differentiated thyroid cancer: a preliminary clinical trial. Ann Nucl Med 2016; 31:71-83. [DOI: 10.1007/s12149-016-1133-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
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Mujammami M, Hier MP, Payne RJ, Rochon L, Tamilia M. Long-Term Outcomes of Patients with Papillary Thyroid Cancer Undergoing Remnant Ablation with 30 milliCuries Radioiodine. Thyroid 2016; 26:951-8. [PMID: 27150203 DOI: 10.1089/thy.2016.0036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The study considered the long-term outcome of patients with papillary thyroid carcinoma treated with 30 mCi radioiodine. OBJECTIVE The aims of this study were to define and compare the remission rates of papillary thyroid carcinoma ablated with 30 mCi (131)I prepared by either thyroid hormone withdrawal (THW) or recombinant human thyrotropin (rhTSH; Thyrogen(®)), and to identify variables predictive of a favorable prognosis. METHOD An observational study was conducted at an academic medical center and a comparative summary of six studies is presented. Three hundred and seventy patients (THW group, n = 203; rhTSH group, n = 167) were recruited from a prospectively managed registry. The mean follow-up was 9.3 years (range 5.1-15.8 years) in the THW group and 7.1 years (range 5.0-9.7 years) in the rhTSH group. The primary endpoint was the long-term remission rates (no evidence of disease) in the THW group compared with the rhTH group. RESULTS The response at 12-18 months after 30 mCi remnant ablation was excellent in 79.3% and 76.0% of patients in the THW group and the rhTSH group, respectively (p > 0.05). The long-term remission rates also did not significantly differ between both groups at 95.6% and 97.0%. Although the surveillance period for the THW group exceeded that of the rhTSH group, no significant difference in recurrence-free survival was discerned by the Kaplan-Meier curves. In a multivariate analysis, an excellent response to therapy at 12-18 months correlated significantly with long-term remission rates in the THW group (p = 0.031, odds ratio [OR] = 2.6 [confidence interval (CI) 1.1-6.0]), the rhTSH group (p = 0.03, OR = 5.3 [CI 1.2-23.8]), and the pooled groups (p = 0.001, OR = 3.43 [CI 1.63-7.2]). The pre-ablation thyroglobulin level significantly correlated with remission rates only in the THW group (p = 0.035, OR = 5.5 [CI 1.1-27.1]). CONCLUSIONS The response to remnant ablation with 30 mCi radioiodine is often excellent, and the long-term remission rates can be expected to be high, independent of the method of delivery (i.e., THW or rhTSH).
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Affiliation(s)
- Muhammad Mujammami
- 1 Department of Medicine Division of Endocrinology and Metabolism, Jewish General Hospital, McGill University , Montreal, Canada
- 2 Department of Medicine Division of Endocrinology and Metabolism, King Khalid University Hospital, King Saud University , Riyadh, Saudi Arabia
| | - Michael P Hier
- 3 Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University , Montreal, Canada
| | - Richard J Payne
- 3 Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University , Montreal, Canada
| | - Louise Rochon
- 4 Department of Pathology, Jewish General Hospital, McGill University , Montreal, Canada
| | - Michael Tamilia
- 1 Department of Medicine Division of Endocrinology and Metabolism, Jewish General Hospital, McGill University , Montreal, Canada
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Latrofa F, Ricci D, Sisti E, Piaggi P, Nencetti C, Marinò M, Vitti P. Significance of Low Levels of Thyroglobulin Autoantibodies Associated with Undetectable Thyroglobulin After Thyroidectomy for Differentiated Thyroid Carcinoma. Thyroid 2016; 26:798-806. [PMID: 27020734 DOI: 10.1089/thy.2015.0621] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The management of patients with differentiated thyroid carcinoma (DTC) showing low levels of serum thyroglobulin autoantibodies (TgAb) and undetectable Tg after thyroidectomy is unsettled. This study sought to elucidate the clinical significance of low levels of TgAb and to evaluate their interference with Tg measurement in vitro. METHODS Tg and TgAb levels were correlated with the post-thyroidectomy staging of 177 consecutive DTC patients undergoing (131)I ablation after total thyroidectomy (clinical study). Tg was measured by an immunometric assay (functional sensitivity: 0.1 ng/mL), and TgAb were evaluated by six assays (functional sensitivities: 1.2-96 IU/mL; positive cutoffs: 4-150 IU/mL). The changes in Tg concentration (Tg recovery) of diluted specimens from DTC patients were also measured after incubation with 67 sera from DTC patients with undetectable Tg and low levels of TgAb (in vitro study). DTC sera containing Tg were diluted serially (from 330 to 0.1 ng/mL) and incubated with TgAb samples; Tg was then measured. RESULTS In the clinical study: all patients had residual thyroid tissue, and 10 had metastatic disease. Depending on the TgAb assay, median Tg values were 7.0-10.9, 0.0-5.3, and 0.0-0.0 ng/mL in patients with undetectable, borderline (between functional sensitivities and positive cutoffs), and positive TgAb, respectively (p < 0.001). An undetectable Tg value was associated with borderline levels of TgAb in five assays. Only two patients with metastatic disease had undetectable Tg; both were TgAb positive by three or more assays. Conversely, no patient with undetectable Tg and undetectable or borderline TgAb by sensitive assays had metastatic disease. In the in vitro study, TgAb interfered significantly with Tg recovery (p < 0.001), but low levels of TgAb did not abolish Tg recovery. CONCLUSIONS While low levels of TgAb do not preclude Tg measurement in vitro, they can be associated with an undetectable Tg in DTC patients with residual thyroid tissue after thyroidectomy. However, the finding of low levels of TgAb by sensitive assays associated with an undetectable Tg rules out metastatic disease.
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Affiliation(s)
- Francesco Latrofa
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
| | - Debora Ricci
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
| | - Eleonora Sisti
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
| | - Paolo Piaggi
- 2 Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Phoenix, Arizona
| | - Chiara Nencetti
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
| | - Michele Marinò
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
| | - Paolo Vitti
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Pisa, Italy
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Bournaud C, Raverot V. Follow-up of differentiated thyroid carcinoma. ANNALES D'ENDOCRINOLOGIE 2016; 76:1S27-33. [PMID: 26826480 DOI: 10.1016/s0003-4266(16)30011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of follow-up of differentiated thyroid carcinoma (CTD) is the assessment of remission, and, in further steps, the early recognition of patients who develop a recurrence. Tools for the follow-up of CTD include the assessment of thyroglobulin and imaging procedures. Thyroglobulin (Tg) is a strong marker of persistent or recurrent disease, but it must be known that Tg antibodies may give falsely low Tg concentration. TSH stimulation, mainly by the mean of recombinant human TSH, improves the sensitivity of Tg determination. New highly sensitive assays may preclude the need for TSH stimulation, at least in some situations. In the last decades, (131)iodine whole body scan gave place to neck ultrasonography (US) as the most performing imaging procedure in the follow-up of CTD. Criteria to identify cervical lymph node suspect of metastasis have been described, and standardized procedures proposed. Finally, the proof of tumoral invasion is brought by cytological analysis of fine needle biopsies of suspicious lymph nodes. (18)FDG PET is a valuable tool for diagnosis and prognosis in metastatic patients, especially with negative (131)I WBS. Initial response to therapy, assessed by Tg determination and neck US, allows re-stratification of the risk of relapse. According to this "reassessed risk", adapted rhythms and modalities of follow-up have been recently proposed.
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Affiliation(s)
- C Bournaud
- Hospices civils de Lyon, Groupement hospitalier Est, Service de médecine nucléaire, 59, boulevard Pinel, 69677 Bron, Cedex, France
| | - V Raverot
- Laboratoire d'hormonologie, Groupement hospitalier Est, Centre de biologie Est, 59, boulevard Pinel, 69677 Bron, Cedex, France.
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8512] [Impact Index Per Article: 1064.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, Dinauer CA, Hamilton J, Hay ID, Luster M, Parisi MT, Rachmiel M, Thompson GB, Yamashita S. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2015; 25:716-59. [PMID: 25900731 PMCID: PMC4854274 DOI: 10.1089/thy.2014.0460] [Citation(s) in RCA: 699] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. METHODS A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. RESULTS These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided. CONCLUSIONS In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in children and adolescents. In our opinion, these represent the current optimal care for children and adolescents with these conditions.
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Affiliation(s)
- Gary L. Francis
- Division of Pediatric Endocrinology, Virginia Commonwealth University, Children's Hospital of Richmond, Richmond, Virginia
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders and Department of Pediatrics-Patient Care, Children's Cancer Hospital, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The University of Pennsylvania, The Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter Angelos
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Salvatore Benvenga
- University of Messina, Interdepartmental Program on Clinical & Molecular Endocrinology, and Women's Endocrine Health, A.O.U. Policlinico Universitario G. Martino, Messina, Italy
| | - Janete M. Cerutti
- Department of Morphology and Genetics. Division of Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Catherine A. Dinauer
- Department of Surgery, Division of Pediatric Surgery, Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, Connecticut
| | - Jill Hamilton
- Division of Endocrinology, University of Toronto, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian D. Hay
- Division of Endocrinology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Markus Luster
- University of Marburg, Marburg, Germany
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Department of Radiology, Seattle, Washington
| | - Marianna Rachmiel
- Pediatric Division, Assaf Haroffeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Geoffrey B. Thompson
- Department of Surgery, Division of Subspecialty GS (General Surgery), Mayo Clinic, Rochester, Minnesota
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Superiority of delayed risk stratification in differentiated thyroid cancer after total thyroidectomy and radioactive iodine ablation. Nucl Med Commun 2015; 35:1119-26. [PMID: 25144561 DOI: 10.1097/mnm.0000000000000183] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to validate the effectiveness of delayed risk stratification (DRS) in predicting structural progression and compare the predictive value of American Thyroid Association (ATA) risk stratification with that of DRS in patients with differentiated thyroid cancer (DTC). METHODS A total of 398 patients with DTC who underwent surgery followed by radioactive iodine ablation were enrolled. Patients were categorized as having excellent response, acceptable response, biochemical incomplete response, or structural incomplete response at 8-15 months' evaluation after radioactive iodine ablation for DRS. Effectiveness of DRS was evaluated according to structural progression-free survival (PFS; median follow-up, 10.7 years). RESULTS A total of 229 patients (57.5%) were classified as having excellent response, 78 (19.6%) as having acceptable response, 62 (15.6%) as having biochemical incomplete response, and 29 patients (7.3%) as having structural incomplete response. After DRS, 60.2% of intermediate-risk patients and 20.5% of high-risk patients were shifted to the excellent response category. Sixty-nine patients (17.3%) showed structural progression. DRS showed statistical difference in PFS (hazard ratio, 4.268; 95% confidence interval, 3.258-5.477; P<0.001). In multivariate analysis of ATA risk stratification and DRS, DRS was significantly associated with PFS (hazard ratio, 4.383; 95% confidence interval, 3.250-5.912; P<0.001), but ATA risk stratification was not. There was no significant difference in deviances between the use of DRS alone and the use of both DRS and ATA risk stratification (χ=0.103, d.f.=1, P=0.748). CONCLUSION DRS is superior to ATA risk stratification in predicting structural disease progression for DTC patients.
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39
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Thyroglobulin in differentiated thyroid cancer. Clin Chim Acta 2015; 444:310-7. [DOI: 10.1016/j.cca.2014.10.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/21/2014] [Accepted: 10/24/2014] [Indexed: 12/17/2022]
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Spencer C, Petrovic I, Fatemi S, LoPresti J. Serum thyroglobulin (Tg) monitoring of patients with differentiated thyroid cancer using sensitive (second-generation) immunometric assays can be disrupted by false-negative and false-positive serum thyroglobulin autoantibody misclassifications. J Clin Endocrinol Metab 2014; 99:4589-99. [PMID: 25226290 PMCID: PMC4297889 DOI: 10.1210/jc.2014-1203] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Reliable thyroglobulin (Tg) autoantibody (TgAb) detection before Tg testing for differentiated thyroid cancer (DTC) is critical when TgAb status (positive/negative) is used to authenticate sensitive second-generation immunometric assay ((2G)IMA) measurements as free from TgAb interference and when reflexing "TgAb-positive" sera to TgAb-resistant, but less sensitive, Tg methodologies (radioimmunoassay [RIA] or liquid chromatography-tandem mass spectrometry [LC-MS/MS]). OBJECTIVE The purpose of this study was to assess how different Kronus (K) vs Roche (R) TgAb method cutoffs for "positivity" influence false-negative vs false-positive serum TgAb misclassifications that may reduce the clinical utility of reflex Tg testing. METHODS Serum Tg(2G)IMA, TgRIA, and TgLC-MS/MS measurements for 52 TgAb-positive and 37 TgAb-negative patients with persistent/recurrent DTC were compared. A total of 1426 DTC sera with TgRIA of ≥ 1.0 μg/L had false-negative and false-positive TgAb frequencies determined using low Tg(2G)IMA/TgRIA ratios (<75%) to indicate TgAb interference. RESULTS TgAb-negative patients with disease displayed Tg(2G)IMA, TgRIA, and TgLC-MS/MS serum discordances (% coefficient of variation = 24 ± 20%, range, 0%-100%). Of the TgAb-positive patients with disease, 98% had undetectable/lower Tg(2G)IMA vs either TgRIA or TgLC-MS/MS (P < .01), whereas 8 of 52 (15%) had undetectable Tg(2G)IMA + TgLC-MS/MS associated with TgRIA of ≥ 1.0 μg/L. Receiver operating characteristic curve analysis reported more sensitivity for TgAb method K vs R (81.9% vs 69.1%, P < .001), but receiver operating characteristic curve cutoffs (>0.6 kIU/L [K] vs >40 kIU/L [R]) had unacceptably high false-negative frequencies (22%-32%), whereas false positives approximated 12%. Functional sensitivity cutoffs minimized false negatives (13.5% [K] vs 21.3% [R], P < .01) and severe interferences (Tg(2G)IMA, <0.10 μg/L) (0.7% [K] vs 2.4% [R], P < .05) but false positives approximated 23%. CONCLUSIONS Reliable detection of interfering TgAbs is method and cutoff dependent. No cutoff eliminated both false-negative and false-positive TgAb misclassifications. Functional sensitivity cutoffs were optimal for minimizing false negatives but have inherent imprecision (20% coefficient of variation) that, exacerbated by TgAb biologic variability during DTC monitoring, could cause TgAb status to fluctuate for patients with low TgAb concentrations, prompting unnecessary Tg method changes and disrupting Tg monitoring. Laboratories using reflexing should limit Tg method changes by considering a patient's Tg + TgAb testing history in addition to current TgAb status before Tg method selection.
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Affiliation(s)
- Carole Spencer
- University of Southern California (C.S., I.P., J.L.), Los Angeles, California 90089; and Kaiser Permanente (S.F.), Panorama City, California 91402
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Spencer C, LoPresti J, Fatemi S. How sensitive (second-generation) thyroglobulin measurement is changing paradigms for monitoring patients with differentiated thyroid cancer, in the absence or presence of thyroglobulin autoantibodies. Curr Opin Endocrinol Diabetes Obes 2014; 21:394-404. [PMID: 25122493 PMCID: PMC4154792 DOI: 10.1097/med.0000000000000092] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW To discuss new insights regarding how sensitive (second-generation) thyroglobulin immunometric assays (TgIMAs), (functional sensitivities ≤0.10 μg/L) necessitate different approaches for postoperative thyroglobulin monitoring of patients with differentiated thyroid cancer (DTC), depending on the presence of thyroglobulin autoantibodies (TgAbs). RECENT FINDINGS Reliable low-range serum thyroglobulin measurement has both enhanced clinical utility and economic advantages, provided TgAb is absent (∼75% DTC patients). Basal [nonthyroid-stimulating hormone (TSH) stimulated] TgIMA measurement obviates the need for recombinant human TSH stimulation because basal TgIMA below 0.20 μg/L has comparable negative predictive value (>95%) to recombinant human TSH-stimulated thyroglobulin values below the cutoff of 2 μg/L. Now that radioiodine remnant ablation is no longer considered necessary to treat low-risk DTC, the trend and doubling time of low basal thyroglobulin values arising from postsurgical thyroid remnants have recognized prognostic significance. The major limitation of TgIMA testing is interference by TgAb (∼25% DTC patients), causing TgIMA underestimation that can mask disease. When TgAb is present, the trend in TgAb concentrations (measured by the same method) can serve as the primary (surrogate) tumor-marker and be augmented by thyroglobulin measured by a TgAb-resistant class of method (radioimmunoassay or liquid chromatography-tandem mass spectrometry). SUMMARY The growing use of TgIMA measurement is changing paradigms for postoperative DTC monitoring. When TgAb is absent, it is optimal to monitor the basal TgIMA trend and doubling time (using the same method) in preference to recombinant human TSH-stimulated thyroglobulin testing. When TgAb is present, interference renders TgIMA testing unreliable and the trend in serum TgAb concentrations per se (same method) can serve as a (surrogate) tumor-marker.
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Affiliation(s)
- Carole Spencer
- University of Southern California, Los Angeles, California, USA
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Kim TY, Kim WG, Kim WB, Shong YK. Current status and future perspectives in differentiated thyroid cancer. Endocrinol Metab (Seoul) 2014; 29:217-25. [PMID: 25309778 PMCID: PMC4192824 DOI: 10.3803/enm.2014.29.3.217] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Thyroid cancer is increasing all over the world. The exact cause of this increase is still debated and there are conflicting reports. Sophisticated molecular studies suggest that environmental chemicals may have effects of thyroid carcinogenesis. The development of powerful molecular biology techniques has enabled targeted next-generation sequencing for detection of mutations in thyroid cancer, and this technique can make a specific diagnosis of thyroid cancer in cytologically indeterminate cases. The initial treatment of well-differentiated thyroid cancer (DTC) is surgery followed by radioiodine remnant ablation. However, further studies are needed to determine the optimal dosage of radioactive iodine for DTC patients with lateral neck metastasis. DTC is an indolent tumor and may cause death even decades later. Thus, long-term follow-up is mandatory. Recently, dynamic risk stratification (DRS) has begun to use stimulated thyroglobulin level at 1 year after the initial treatment and restratified the risk in accordance with the response to the initial treatment. This DRS strategy accurately predicts disease free survival and can be widely used in daily clinical settings. For the iodine refractory metastatic disease, redifferentiation therapy and targeted therapy are two promising alternative treatments. Sorafenib is the first approved agent for the treatment of progressive iodine refractory advanced thyroid cancer in Korea and may be very helpful for radioactive-refractory locally advanced or metastatic DTC. Selumetinib may be an effective redifferentiating agent and could be used within several years.
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Affiliation(s)
- Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Roger C, Chikh K, Raverot V, Claustrat F, Borson-Chazot F, Bournaud-Salinas C, Charrié A. New-generation thyroglobulin assay: performance and implications for follow-up of differentiated thyroid carcinoma. ANNALES D'ENDOCRINOLOGIE 2014; 75:227-31. [PMID: 25168109 DOI: 10.1016/j.ando.2014.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 06/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Differentiated thyroid cancer (DTC) requires long-term follow-up by serum thyroglobulin assay and cervical ultrasound, due to the risk of recurrence. Guidelines recommend basal assay under hormone therapy at 3 months, repeated at 6-12 months post-surgery, with or without associated isotopic ablation, after stimulation by recombinant human TSH to improve assay sensitivity. It was hypothesized that a new-generation assay kit with lower limits of detection and quantification would improve the sensitivity of the basal assay, enhance detection of premature recurrence and decrease the rate of false-negatives, thereby avoiding the need for the complementary stimulation test. MATERIAL AND METHODS A validation study of the second-generation thyroglobulin serum assay was performed in the laboratory of the Lyon Sud Hospital Centre (Lyon, France), with comparison to stimulation test results. Low-concentration serum pools were constituted, including patients followed for stage I to III DTC for whom basal and post-stimulation samples were available in the serum bank. RESULTS The new assay proved robust and reliable, with good correlation with the technique presently used in the Lyon hospitals. None of the 54 patients showed false-negative results, which was the objective of our choice of threshold, and 5 were false-positive, for thyroglobulin thresholds of 0.1μg/L at baseline and 1.0μg/L post-stimulation. Positive and negative predictive values were 100% and 87.8% respectively. CONCLUSION These results allow an improvement in the follow-up algorithm for DTC, replacing the stimulation test by the new-generation thyroglobulin assay in post-therapeutic assessment.
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Affiliation(s)
- Christelle Roger
- Service fédéré de biochimie et biologie moléculaire, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - Karim Chikh
- Service fédéré de biochimie et biologie moléculaire, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, ISPB, 3, impasse du Presbytère, 69008 Lyon, France; CarMeN-Inserm U1060, université Claude-Bernard Lyon 1, 69921 Oullins, France
| | - Véronique Raverot
- Département de biochimie et biologie moléculaire, groupement hospitalier Est, 59, boulevard Pinel, 69500 Bron, France
| | - Francine Claustrat
- Département de biochimie et biologie moléculaire, groupement hospitalier Est, 59, boulevard Pinel, 69500 Bron, France
| | - Françoise Borson-Chazot
- Fédération d'endocrinologie, maladies métaboliques, diabète, nutrition, groupement hospitalier Est, 59, boulevard Pinel, 69500 Bron, France; Faculté de médecine Lyon Est, 8, avenue Rockefeller, 69373 Lyon cedex, France; Inserm U1052/CNRS UMR 5286, Centre de recherche en cancérologie de Lyon, faculté de médecine RTH Laennec, 7-11, rue Paradin, 69372 Lyon cedex 08, France
| | - Claire Bournaud-Salinas
- Service de médecine nucléaire, groupement hospitalier Est, 59, boulevard Pinel, 69500 Bron, France
| | - Anne Charrié
- Service fédéré de biochimie et biologie moléculaire, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; CarMeN-Inserm U1060, université Claude-Bernard Lyon 1, 69921 Oullins, France; Faculté de médecine et de maïeutique Lyon Sud-Charles Mérieux, 69921 Oullins, France
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Giovanella L, Clark PM, Chiovato L, Duntas L, Elisei R, Feldt-Rasmussen U, Leenhardt L, Luster M, Schalin-Jäntti C, Schott M, Seregni E, Rimmele H, Smit J, Verburg FA. Thyroglobulin measurement using highly sensitive assays in patients with differentiated thyroid cancer: a clinical position paper. Eur J Endocrinol 2014; 171:R33-46. [PMID: 24743400 PMCID: PMC4076114 DOI: 10.1530/eje-14-0148] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Differentiated thyroid cancer (DTC) is the most common endocrine cancer and its incidence has increased in recent decades. Initial treatment usually consists of total thyroidectomy followed by ablation of thyroid remnants by iodine-131. As thyroid cells are assumed to be the only source of thyroglobulin (Tg) in the human body, circulating Tg serves as a biochemical marker of persistent or recurrent disease in DTC follow-up. Currently, standard follow-up for DTC comprises Tg measurement and neck ultrasound combined, when indicated, with an additional radioiodine scan. Measurement of Tg after stimulation by endogenous or exogenous TSH is recommended by current clinical guidelines to detect occult disease with a maximum sensitivity due to the suboptimal sensitivity of older Tg assays. However, the development of new highly sensitive Tg assays with improved analytical sensitivity and precision at low concentrations now allows detection of very low Tg concentrations reflecting minimal amounts of thyroid tissue without the need for TSH stimulation. Use of these highly sensitive Tg assays has not yet been incorporated into clinical guidelines but they will, we believe, be used by physicians caring for patients with DTC. The aim of this clinical position paper is, therefore, to offer advice on the various aspects and implications of using these highly sensitive Tg assays in the clinical care of patients with DTC.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Penelope M Clark
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Luca Chiovato
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Leonidas Duntas
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Rossella Elisei
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Ulla Feldt-Rasmussen
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Laurence Leenhardt
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Markus Luster
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Camilla Schalin-Jäntti
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Matthias Schott
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Ettore Seregni
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Herald Rimmele
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Jan Smit
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Frederik A Verburg
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
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Tresoldi AS, Sburlati LF, Rodari M, Schinkelshoek MS, Perrino M, De Leo S, Montefusco L, Colombo P, Arosio M, Lania AGA, Fugazzola L, Chiti A. Radioiodine ablation with 1,850 MBq in association with rhTSH in patients with differentiated thyroid cancer. J Endocrinol Invest 2014; 37:709-714. [PMID: 24844565 DOI: 10.1007/s40618-014-0088-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/30/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of post-operative radioiodine ablation with 1,850 MBq after recombinant human thyrotropin (rhTSH) administration in patients with differentiated thyroid carcinoma (DTC). We also aimed to assess the prognostic role of several patient features on the outcome of ablation. METHODS We retrospectively analyzed data from a total of 125 patients with DTC who underwent post-operative radioiodine ablation with 1,850 MBq of ¹³¹I after preparation with rhTSH. One injection of 0.9 mg rhTSH was administered on each of two consecutive days; ¹³¹I therapy was delivered 24 h after the last injection, followed by a post-therapy whole-body scan. Successful ablation was assessed 6-12 months later and defined as an rhTSH-stimulated serum thyroglobulin (Tg) level ≤1.0 ng/ml and a normal neck ultrasound. RESULTS Patients were stratified according to the American Thyroid Association (ATA) Management Guidelines for Differentiated Thyroid Cancer. Successful ablation was achieved in 82.4 % of patients, with an ablation rate of 95.1 % in low-risk patients and 76.2 % in intermediate-risk patients. Analyzing the correlation between ablation outcome and patient characteristics, we found a statistically significant association between failure to ablate and class of risk based on ATA guidelines (p = 0.025) and a stimulated Tg value at ablation of above 5 ng/ml (p < 0.001). CONCLUSION The use of 1,850 MBq post-operative radioiodine thyroid remnant ablation in association with rhTSH is effective for low- and intermediate-risk patients. Moreover, in our study, we found a statistical correlation between failure to ablate and class of risk based on ATA guidelines for DTC and a stimulated Tg value at ablation.
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MESH Headings
- Adenocarcinoma, Follicular/drug therapy
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/radiotherapy
- Adenocarcinoma, Follicular/surgery
- Adult
- Carcinoma/drug therapy
- Carcinoma/pathology
- Carcinoma/radiotherapy
- Carcinoma/surgery
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/radiotherapy
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary, Follicular/drug therapy
- Carcinoma, Papillary, Follicular/pathology
- Carcinoma, Papillary, Follicular/radiotherapy
- Carcinoma, Papillary, Follicular/surgery
- Chemoradiotherapy, Adjuvant
- Combined Modality Therapy
- Female
- Humans
- Iodine Radioisotopes/therapeutic use
- Italy/epidemiology
- Male
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Neoplasm, Residual/epidemiology
- Neoplasm, Residual/prevention & control
- Radiopharmaceuticals/therapeutic use
- Recombinant Proteins/therapeutic use
- Retrospective Studies
- Risk
- Thyroid Cancer, Papillary
- Thyroid Gland/drug effects
- Thyroid Gland/pathology
- Thyroid Gland/radiation effects
- Thyroid Gland/surgery
- Thyroid Neoplasms/drug therapy
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/radiotherapy
- Thyroid Neoplasms/surgery
- Thyroidectomy
- Thyrotropin/genetics
- Thyrotropin/therapeutic use
- Whole Body Imaging
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Affiliation(s)
| | - Laura F Sburlati
- Unit of Endocrinology, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Marcello Rodari
- Nuclear Medicine Department, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, MI, Italy
| | | | - Michela Perrino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Simone De Leo
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Laura Montefusco
- Unit of Endocrine Diseases and Diabetology, Ospedale San Giuseppe Multimedica, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Colombo
- Unit of Endocrinology, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Maura Arosio
- Unit of Endocrine Diseases and Diabetology, Ospedale San Giuseppe Multimedica, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Gerardo Antonio Lania
- Unit of Endocrinology, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Laura Fugazzola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Arturo Chiti
- Nuclear Medicine Department, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, MI, Italy.
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46
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Abstract
BACKGROUND Thyroglobulin, produced exclusively by the thyroid gland, has been proposed to be a more sensitive biomarker of iodine status than thyrotropin or the thyroid hormones triiodothyronine and thyroxine. However, evidence on the usefulness of thyroglobulin (Tg) to assess iodine status has not been extensively reviewed, particularly in pregnant women and adults. SUMMARY An electronic literature search was conducted using the Cochrane CENTRAL, Web of Science, PubMed, and Medline to locate relevant studies on Tg as a biomarker of iodine status. Since urinary iodine concentration (UIC) is the recommended method to assess iodine status in populations, only studies that clearly reported both Tg and UIC were included. For the purpose of this review, a median Tg <13 μg/L and a median UIC ≥100 μg/L (UIC ≥150 μg/L for pregnant women) were used to indicate adequate iodine status. We excluded studies conducted in subjects with either known thyroid disease or those with thyroglobulin antibodies. The search strategy and selection criteria yielded 34 articles of which nine were intervention studies. The majority of studies (six of eight) reported that iodine-deficient pregnant women had a median Tg ≥13 μg/L. However, large observational studies of pregnant women, including women with adequate and inadequate iodine status, as well as well-designed intervention trials that include both Tg and UIC, are needed. In adults, the results were equivocal because iodine-deficient adults were reported to have median Tg values of either <13 or ≥13 μg/L. Only studies in school-aged children showed that iodine-sufficient children typically had a median Tg <13 μg/L. Some of the inconsistent results may be partially explained by the use of different methodological assays and failure to assess assay accuracy using a certified reference material. CONCLUSIONS These data suggest that Tg does hold promise as a biomarker of iodine deficiency. However, it is associated with limitations. A median Tg cutoff of 13 μg/L warrants further investigation, particularly in adults or pregnant women, as there is a lack of both observational and intervention studies in these groups.
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Affiliation(s)
- Zheng Feei Ma
- Department of Human Nutrition, University of Otago , Dunedin, New Zealand
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47
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Angell TE, Spencer CA, Rubino BD, Nicoloff JT, LoPresti JS. In search of an unstimulated thyroglobulin baseline value in low-risk papillary thyroid carcinoma patients not receiving radioactive iodine ablation. Thyroid 2014; 24:1127-33. [PMID: 24697314 DOI: 10.1089/thy.2013.0691] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The clinical use of serum thyroglobulin (Tg) as a tumor marker in papillary thyroid cancer (PTC) patients following total thyroidectomy continues to evolve, due in part to the introduction of more sensitive (second generation) Tg immunometric assays (Tg(2G)IMA, functional sensitivity ≤ 0.10 ng/mL), and the implementation of new recommendations against radioactive iodine ablation (RAIA) for patients at the lowest risk of recurrence. As a result, there is a need to establish the optimal timing and interpretation of serum Tg values while on levothyroxine-induced suppression of thyrotropin (TSH) in thyroidectomized PTC patients with a thyroid remnant. This study examines the pattern of decline and eventual baseline value of unstimulated Tg (uTg) concentrations following total thyroidectomy in patients with low-risk PTC who did not receive RAIA. METHODS The medical records of consecutive patients with thyroid cancer seen at the Los Angeles County + USC Medical Center were retrospectively reviewed. Serial uTg and TSH values from Tg-antibody negative low-risk PTC patients treated with total thyroidectomy and no RAIA were analyzed. Patients were stratified by degree of TSH suppression to assess the effect on uTg. Serial postoperative uTg values were evaluated for the temporal pattern of decline and ultimate baseline. Patients with medullary thyroid cancer (MTC) were studied as a surgical reference group. RESULTS Records from 577 consecutive thyroid cancer patients were reviewed, of which 36 met all criteria for inclusion. By 6 months, uTg fell to <0.5 ng/mL in 61% of patients and all patients demonstrated uTg < 0.5 ng/mL 2 years after surgery. During a median follow up of 5.7 years, uTg values remained below this level. The median uTg values in patients with papillary microcarcinoma, PTC, and MTC were similar at 0.11, 0.12, and 0.09 ng/mL, respectively. Further decline in uTg was not observed once the TSH was <0.5 mIU/L. CONCLUSIONS The uTg values during TSH suppression in Tg antibody-negative, low-risk PTC patients who did not receive RAIA were below 0.5 ng/mL by 6 months postoperatively in most cases and remained stable over the duration of patient follow-up.
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Affiliation(s)
- Trevor E Angell
- 1 Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California , Los Angeles, California
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48
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Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 Suppl 1:1-122. [PMID: 24989897 DOI: 10.1111/cen.12515] [Citation(s) in RCA: 726] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Petros Perros
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
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49
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Elisei R, Agate L, Viola D, Matrone A, Biagini A, Molinaro E. How to manage patients with differentiated thyroid cancer and a rising serum thyroglobulin level. Endocrinol Metab Clin North Am 2014; 43:331-44. [PMID: 24891165 DOI: 10.1016/j.ecl.2014.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Serum thyroglobulin (sTg) is the marker for monitoring persistence/recurrence of differentiated thyroid cancer, in patients without sTg antibodies. Patients with undetectable basal sTg or peak sTg <2 ng/mL are cured with low risk to recur. Newly detectable level of sTg indicates the recurrence. The significance of increasing sTg in patients treated with emithyroidectomy or total-thyroidectomy but not ablated with radioiodine is undefined. A doubling time <1 year may be a poor prognostic factor, but this is more relevant in cases with high levels of sTg. Because of its sensitivity, neck ultrasound should be performed at any visit, especially when an increased sTg is seen.
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Affiliation(s)
- Rossella Elisei
- Endocrinology Unit, Department of Clinical and Experimental Medicine, WHO Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic Disorders, University of Pisa, Via Paradisa 2, Pisa 56124, Italy.
| | - Laura Agate
- Endocrinology Unit, Department of Clinical and Experimental Medicine, WHO Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic Disorders, University of Pisa, Via Paradisa 2, Pisa 56124, Italy
| | - David Viola
- Endocrinology Unit, Department of Clinical and Experimental Medicine, WHO Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic Disorders, University of Pisa, Via Paradisa 2, Pisa 56124, Italy
| | - Antonio Matrone
- Endocrinology Unit, Department of Clinical and Experimental Medicine, WHO Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic Disorders, University of Pisa, Via Paradisa 2, Pisa 56124, Italy
| | - Agnese Biagini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, WHO Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic Disorders, University of Pisa, Via Paradisa 2, Pisa 56124, Italy
| | - Eleonora Molinaro
- Endocrinology Unit, Department of Clinical and Experimental Medicine, WHO Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic Disorders, University of Pisa, Via Paradisa 2, Pisa 56124, Italy
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50
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Abstract
In this review, we demonstrate how initial estimates of the risk of disease-specific mortality and recurrent/persistent disease should be used to guide initial treatment recommendations and early management decisions and to set appropriate patient expectations with regard to likely outcomes after initial therapy of thyroid cancer. The use of ongoing risk stratification to modify these initial risk estimates is also discussed. Novel response to therapy definitions are proposed that can be used for ongoing risk stratification in thyroid cancer patients treated with lobectomy or total thyroidectomy without radioactive iodine remnant ablation.
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Affiliation(s)
- Denise P Momesso
- Endocrinology Service, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Eduardo Guinle, 20/904 Rio de Janeiro, RJ 22260-090, Brazil
| | - R Michael Tuttle
- Endocrinology, Memorial Sloan Kettering Cancer Center, Zuckerman Building, Room 590, 1275 York Avenue, New York, NY 10065, USA.
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