scholarly journals Can We Discharge Dynamically Risk-Stratified Low-Risk (Excellent Response to Treatment) Thyroid Cancer Patients After 5 Years of Follow-Up?

2019 ◽  
Vol 31 (4) ◽  
pp. 219-224 ◽  
Author(s):  
K. Seejore ◽  
G.E. Gerrard ◽  
V.M. Gill ◽  
R.D. Murray
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Low Risk ◽  
Response To Treatment ◽  
Excellent Response

scholarly journals Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

2020 ◽  
Vol 182 (5) ◽  
pp. D1-D16 ◽  
Author(s):  
Livia Lamartina ◽  
Daria Handkiewicz-Junak
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Differentiated Thyroid Carcinoma ◽  
Low Risk ◽  
Response To Treatment ◽  
Early Discontinuation ◽  
Risk Patients ◽  
Low Prevalence ◽  
Time Point

Each year, the proportion of thyroid cancer patients presenting with low-risk disease is increasing. The shift in the landscape of thyroid cancer presentation is forcing clinicians to re-evaluate not only management but also surveillance paradigms. During the follow-up, patients are stratified considering their response to treatment and classified into one of the following response categories: excellent, biochemical incomplete, structural incomplete, or indeterminate. These categories reflect a real-time prognosis and thereby substantially influence and personalise disease management. Although at present, no guideline recommends stopping differentiated thyroid carcinoma (DTC) surveillance at any particular time point, the relatively low prevalence of treatment failures in low-risk patients may prompt early discontinuation of surveillance in this subgroup. Therefore, this debate will present an overview of the controversies surrounding the surveillance of low-risk patients with DTC.

scholarly journals Evaluation of the response levels of non-metastatic thyroid cancer patients in the postoperative twelfth month

2020 ◽  
Vol 7 (8) ◽  
pp. 584-588
Author(s):  
Hasan İkbal Atılgan ◽  
Hülya Yalçın
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Radioactive Iodine ◽  
Thyroid Tissue ◽  
Thyroid Stimulating Hormone ◽  
Response To Therapy ◽  
Response Level ◽  
Excellent Response ◽  
Incomplete Response

Objective: Radioactive iodine (RAI) is used to ablate residual thyroid tissue after total thyroidectomy. The aim of this study was to evaluate the response according to the12th-month results of thyroid cancer patients and to investigate the changes in response level during follow-up. Materials and Methods: The study included 97 patients, comprising 88 (90.7%) females and 9 (9.3%) males, with a mean age of 41.68±13.25 years. None of the patients had lymph node or distant metastasis and all received RAI therapy. Thyroid-stimulating hormone (TSH), thyroglobulin (TG), and anti-TG levels and neck USG were examined in the 12th-month. Response to therapy was evaluated as an excellent response, biochemical incomplete response, structural incomplete response, or indeterminate response. Results: In the 12th month, 80 patients (82.47%) had excellent response, 13 patients (13.40%) had an indeterminate response, 3 patients (3.09%) had structural incomplete response and 1 patient (1.03 %) had biochemical incomplete response. Of the 80 patients with excellent response, 15 had no follow-up after the 12th month. The remaining 65 patients were followed up for 31.11±9.58 months. The response changed to indeterminate in the 18th month in 1 (1.54%) patient and to structural incomplete response in the 35th month in 1 (1.54%) patient. The 13 patients with indeterminate responses were followed up for 20.61±6.28 months. Conclusion: The TG level at 12th months provides accurate data about the course of the disease especially in patients with excellent responses. Patients with excellent response in the 12th month may be followed up less often and those with the indeterminate or incomplete responses should be followed up more often.

scholarly journals Thyroglobulin Levels in Patients who have Undergone Hemithyroidectomy for Differentiated Thyroid Cancer. An Assessment of Levels and Trends at a Tertiary Referral Centre

2021 ◽  
Author(s):  
Ashwini Munnagi ◽  
Vijay Pillai ◽  
R. Vidhya Bushan ◽  
Vivek Shetty ◽  
Narayana Subramaniam ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Thyroid Stimulating Hormone ◽  
Response To Treatment ◽  
American Thyroid Association ◽  
Tertiary Referral Centre ◽  
Serum Thyroglobulin ◽  
Excellent Response ◽  
Thyroid Lobectomy

AbstractSerum thyroglobulin (Tg) and thyroglobulin antibody (TgAb) levels are used to monitor patients with differentiated thyroid cancer (DTC) after total thyroidectomy with or without radioiodine (RAI) ablation. However, they are also measured in patients who are treated with thyroid lobectomy (TL)/hemithyroidectomy (HT). Data on the levels of Tg and its trend in those undergoing TL/HT is sparse in India. We reviewed retrospective data of DTC patients who underwent TL/HT and were followed-up with postoperative Tg levels between 2015 and 2020. Out of 247 patients, 17 had undergone either TL or HT, which included papillary thyroid cancer (n = 12), follicular thyroid cancer (n = 4), and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 1 patient. All patients with DTC had tumor size < 4 cm (T1/2, clinical N0, Mx). The median follow-up was 15 months (range, 1–125) and the median Tg level was 7.5 ng/mL (interquartile range [IQR]; 3.6, 7.5) and ranged from 0.9 to 36.7 ng/mL. The median thyroid-stimulating hormone (TSH) level was 2.03 IU/L (IQR; 1.21, 3.59) and it ranged from 0.05 to 8.54 IU/L. As of last follow-up, none of them underwent completion thyroidectomy; however, eight patients had a decline in Tg ranging from 8 to 64%, four patients had increase in Tg ranging from 14 to 145%, three patients had stable Tg, and one of them had an increase in TgAb titers. As per American Thyroid Association (ATA) response-to-treatment category, six patients had indeterminate response, five patients had biochemical incomplete response, four patients had excellent response, and two did not have follow-up Tg and TgAb levels. While absolute values of Tg were well below 30 ng/mL in almost all patients with HT/TL, the Tg trends were difficult to predict, and only 23% of patients were able to satisfy the criteria for “excellent response” on follow-up. We suggest keeping this factor in mind in follow-up and while counselling for HT in patients with low-risk DTC.

scholarly journals Dynamic risk stratification in the follow-up of thyroid cancer: what is still to be discovered in 2017?

2017 ◽  
Vol 24 (11) ◽  
pp. R387-R402 ◽  
Author(s):  
Jolanta Krajewska ◽  
Ewa Chmielik ◽  
Barbara Jarząb
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Risk Stratification ◽  
Prospective Studies ◽  
Response To Treatment ◽  
Dynamic Risk ◽  
Primary Surgery ◽  
Risk Patients ◽  
Near Future

The adequate risk stratification in thyroid carcinoma is crucial to avoid on one hand the overtreatment of low-risk and on the other hand the undertreatment of high-risk patients. The question how to properly assess the risk of relapse has been discussed during recent years and resulted in a substantial change in our approach to risk stratification in differentiated thyroid cancer, proposed by the newest ATA guidelines. First initial risk stratification, based on histopathological data is carried out just after primary surgery. It should be emphasized, that a high quality of histopathological report is crucial for proper risk stratification. Next, during the follow-up, patients are restratified considering their response to treatment applied and classified to one of the following categories: excellent response, biochemical incomplete response, structural incomplete or indeterminate response. This new approach is called dynamic risk stratification as, in contrary to the previous rigid evaluation performed at diagnosis, reflects a real-time prognosis and thereby substantially influences and personalizes disease management. In this review, we raise some unresolved questions, among them the lack of prospective studies, fulfilling evidence-based criteria, necessary to validate this model of risk stratification. We also provided some data concerning the use of dynamic risk stratification in medullary thyroid cancer, not yet reflected in ATA guidelines. In conclusion, dynamic risk stratification allows for better prediction of the risk of recurrence in thyroid carcinoma, what has been demonstrated in numerous retrospective analyses. However, the validation of this approach in prospective studies seems to be our task for near future.

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