Comparison of Seven Serum Thyroglobulin Assays in the Follow-Up of Papillary and Follicular Thyroid Cancer Patients

2007 ◽  
Vol 92 (7) ◽  
pp. 2487-2495 ◽  
Author(s):  
M. Schlumberger ◽  
A. Hitzel ◽  
M. E. Toubert ◽  
C. Corone ◽  
F. Troalen ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Initial Treatment ◽  
Recurrent Disease ◽  
Clinical Status ◽  
Serum Thyroglobulin ◽  
Radioiodine Ablation ◽  
Diagnostic Values ◽  
Tsh Stimulation

Abstract Background: Serum thyroglobulin (Tg) is the marker of differentiated thyroid cancer after initial treatment and TSH stimulation increases its sensitivity for the diagnosis of recurrent disease. Aim: The goal of the study is to compare the diagnostic values of seven methods for serum Tg measurement for detecting recurrent disease both during L-T4 treatment and after TSH stimulation. Methods: Thyroid cancer patients who had no evidence of persistent disease after initial treatment (total thyroidectomy and radioiodine ablation) were studied at 3 months on L-T4 treatment (Tg1) and then at 9–12 months after withdrawal or recombinant human TSH stimulation (Tg2). Sera with anti-Tg antibodies or with an abnormal recovery test result were excluded from Tg analysis with the corresponding assay. The results of serum Tg determination were compared to the clinical status of the patient at the end of follow-up. Results: Thirty recurrences were detected among 944 patients. A control 131I total body scan had a low sensitivity, a low specificity, and a low clinical impact. Assuming a common cutoff for all Tg assays at 0.9 ng/ml, sensitivity ranged from 19–40% and 68–76% and specificity ranged from 92–97% and 81–91% for Tg 1 and Tg2, respectively. Using assays with a functional sensitivity at 0.2–0.3 ng/ml, sensitivity was 54–63% and specificity was 89% for Tg1. Using the two methods with a lowest functional sensitivity at 0.02 and 0.11 ng/ml resulted in a higher sensitivity for Tg1 (81% and 78%), but at the expense of a loss of specificity (42% and 63%); finally, for these two methods, using an optimized functional sensitivity according to receiver operating characteristic curves at 0.22 and 0.27 ng/ml resulted in a sensitivity at 65% and specificity at 85–87% for Tg1. Conclusion: Using an assay with a lower functional sensitivity may give an earlier indication of the presence of Tg in the serum on L-T4 treatment and may be used to study the trend in serum Tg without performing any TSH stimulation. Serum Tg determination obtained after TSH stimulation still permits a more reliable assessment of cure and patient’s reassurance.

Sequential Follow-up of Serum Thyroglobulin and Whole Body Scan in Thyroid Cancer Patients without Initial Metastasis

Thyroid ◽  
2006 ◽  
Vol 16 (12) ◽  
pp. 1273-1278 ◽  
Author(s):  
Shu-Hua Huang ◽  
Pei-Wen Wang ◽  
Yu-Erh Huang ◽  
Fong-Fu Chou ◽  
Rue-Tsuan Liu ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Whole Body ◽  
Whole Body Scan ◽  
Body Scan ◽  
Serum Thyroglobulin ◽  
Initial Metastasis

scholarly journals Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients

2011 ◽  
Vol 165 (3) ◽  
pp. 441-446 ◽  
Author(s):  
Maria Grazia Castagna ◽  
Fabio Maino ◽  
Claudia Cipri ◽  
Valentina Belardini ◽  
Alexandra Theodoropoulou ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
Low Risk ◽  
Risk Category ◽  
Radioiodine Ablation ◽  
Risk Patients

IntroductionAfter initial treatment, differentiated thyroid cancer (DTC) patients are stratified as low and high risk based on clinical/pathological features. Recently, a risk stratification based on additional clinical data accumulated during follow-up has been proposed.ObjectiveTo evaluate the predictive value of delayed risk stratification (DRS) obtained at the time of the first diagnostic control (8–12 months after initial treatment).MethodsWe reviewed 512 patients with DTC whose risk assessment was initially defined according to the American (ATA) and European Thyroid Association (ETA) guidelines. At the time of the first control, 8–12 months after initial treatment, patients were re-stratified according to their clinical status: DRS.ResultsUsing DRS, about 50% of ATA/ETA intermediate/high-risk patients moved to DRS low-risk category, while about 10% of ATA/ETA low-risk patients moved to DRS high-risk category. The ability of the DRS to predict the final outcome was superior to that of ATA and ETA. Positive and negative predictive values for both ATA (39.2 and 90.6% respectively) and ETA (38.4 and 91.3% respectively) were significantly lower than that observed with the DRS (72.8 and 96.3% respectively,P<0.05). The observed variance in predicting final outcome was 25.4% for ATA, 19.1% for ETA, and 62.1% for DRS.ConclusionsDelaying the risk stratification of DTC patients at a time when the response to surgery and radioiodine ablation is evident allows to better define individual risk and to better modulate the subsequent follow-up.

scholarly journals The follow-up of patients with differentiated thyroid cancer and undetectable thyroglobulin (Tg) and Tg antibodies during ablation

2008 ◽  
Vol 158 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Ha T T Phan ◽  
Pieter L Jager ◽  
Jacqueline E van der Wal ◽  
Wim J Sluiter ◽  
John T M Plukker ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Recurrent Disease ◽  
Disease Free Survival ◽  
Serum Thyroglobulin ◽  
Primary Tumors ◽  
Histological Features ◽  
Number Of Patients ◽  
Age Range

ObjectiveThis retrospective study describes the role of serum thyroglobulin (Tg) in relation to tumor characteristics in the prediction of persistent/recurrent disease in patients with differentiated thyroid cancer (DTC) with negative Tg at the time of ablation.DesignBetween 1989 and 2006, 94 out of 346 (27%) patients with DTC had undetectable Tg at the time of 131I ablation and were included in this evaluation. The group of 94 patients consisted of 15 males and 79 females in the age range of 16–89 years with a median follow-up of 8 years (range 1–17). All medical records and follow-up parameters of the 94 patients were evaluated for the occurrence of persistent/recurrent disease. In patients with persistent/recurrent disease hematoxylin-eosin-stained slides of the primary tumors and/or metastatic lesions were also reviewed for histological features including immunostains for Tg.ResultsDuring follow-up, 8 out of 94 (8.5%) patients showed persistent/recurrent disease: in the course of the disease two patients showed Tg positivity, three showed Tg antibody (TgAb) positivity, and the other three showed persistently undetectable Tg and TgAb. Patients who developed Tg and/or TgAb positivity during follow-up had a significantly shorter disease-free survival period when compared with patients with persistently undetectable Tg and TgAb (P<0.006). Histological features were not able to predict the recurrent status.ConclusionsFollow-up of Tg and TgAb in patients with initially negative Tg and TgAb is useful since a number of patients had shown detectable Tg or TgAb during follow-up indicative for persistent/recurrent disease. Tg and TgAb negativity at the time of ablation is not a predictive determinant for future recurrent status.

scholarly journals Clinical use of recombinant human TSH in thyroid cancer patients

2000 ◽  
pp. 557-563 ◽  
Author(s):  
M Schlumberger ◽  
M Ricard ◽  
F Pacini
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Hormone ◽  
Cancer Patients ◽  
Recurrent Disease ◽  
Clinical Use ◽  
Follicular Thyroid Cancer ◽  
Safe Alternative ◽  
Thyroid Hormone Withdrawal ◽  
Recombinant Human Tsh

Recombinant human TSH (rhTSH) is an effective and safe alternative to thyroid hormone withdrawal during the post-surgical follow-up of papillary and follicular thyroid cancer. Its clinical efficiency for the detection of persistent and recurrent disease is similar to that of thyroid hormone withdrawal. The main purpose for its use is to avoid hypothyroidism.

scholarly journals Time to Separate Persistent From Recurrent Differentiated Thyroid Cancer: Different Conditions With Different Outcomes

2018 ◽  
Vol 104 (2) ◽  
pp. 258-265 ◽  
Author(s):  
Giulia Sapuppo ◽  
Martina Tavarelli ◽  
Antonino Belfiore ◽  
Riccardo Vigneri ◽  
Gabriella Pellegriti
Keyword(s):  
Thyroid Cancer ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
Recurrent Disease ◽  
Treatment Strategies ◽  
Distant Metastases ◽  
Persistent Disease ◽  
Tertiary Referral Center ◽  
N Status

Abstract Context Differentiated thyroid cancer (DTC) has an excellent prognosis, but up to 20% of patients with DTC have disease events after initial treatment, indistinctly defined as persistent/recurrent disease. Objective To evaluate the prevalence and outcome of “recurrent” disease (relapse after being 12 months disease-free) compared with “persistent” disease (present ab initio since diagnosis). Design Retrospective analysis of persistent/recurrent disease in patients with DTC (1990 to 2016) with 6.5 years of mean follow-up. Setting Tertiary referral center for thyroid cancer. Patients In total, 4292 patients all underwent surgery ± 131I treatment of DTC. Main Outcome Measures DTC cure of disease persistence or recurrence. Results A total of 639 of 4292 (14.9%) patients had disease events after initial treatment, most (498/639, 78%) with persistent disease and 141 (22%) with recurrent disease. Relative to patients with recurrent disease, patients with persistent disease were significantly older (mean age 46.9 vs 45.7 years) and with a lower female to male ratio (1.9/1 vs 4.8/1). Moreover, in this group, structured disease was more frequent (65.7% vs 41.1%), and more important, distant metastases were significantly more frequent (38.4% vs 17.0%). At multivariate analysis, male sex (OR = 1.7), age (OR = 1.02), follicular histotype (OR = 1.5), T status (T3; OR = 3), and N status (N1b; OR = 7.7) were independently associated with persistent disease. Only the N status was associated with recurrent disease (N1b; OR = 2.5). Conclusions In patients with DTC not cured after initial treatment, persistent disease is more common and has a worse outcome than recurrent disease. Postoperative status evaluated during first-year follow-up may have important clinical implications for planning tailored treatment strategies and long-term follow-up procedures.

Outcome of differentiated thyroid cancer after initial treatment

2011 ◽  
Vol 152 (43) ◽  
pp. 1731-1738 ◽  
Author(s):  
András Konrády ◽  
Zsuzsa Bencsik ◽  
Zoltán Lőcsey ◽  
Tamás Bénik
Keyword(s):  
Thyroid Cancer ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
First Year ◽  
Thyroid Hormone Withdrawal ◽  
Radioiodine Ablation ◽  
Thyroglobulin Antibody ◽  
Ablation Success ◽  
Recombinant Human Thyrotropin

Incidence of differentiated thyroid cancer has increased in the last two decades. This type of cancer is now being diagnosed at an earlier stage. Treatment strategy has been modified. Aims: The goals of this study were to analyze the outcome of differentiated thyroid cancer after initial treatment (surgery and radioiodine ablation) in patients evaluated and followed up in a single centre between l999 and 2009, to compare these results with others as well as to monitor the adoption of international recommendation. 107 patients having T1-T2 differentiated thyroid cancer were studied. Mean follow-up time was 63 months. Results: After surgery patients were prepared using thyroid hormone withdrawal or recombinant human thyrotropin, then 1.1-3.7 GBq 131-iodine was administered. First year evaluation consisted of ultrasound as well as serum thyrotropin and thyroglobulin (plus thyroglobulin antibody) determinations. Ablation success rate was 83% and the five year survival was 100%. There was not any cancer specific death. Conclusion: In the future somewhat more radical surgery and less remnant ablation is needed with unified follow-up protocol. Orv. Hetil., 2011, 152, 1731–1738.

scholarly journals Performance of the American Thyroid Association Risk Classification in a Single Center Cohort of Pediatric Patients with Differentiated Thyroid Cancer: A Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Raad Alwithenani ◽  
Sarah DeBrabandere ◽  
Irina Rachinsky ◽  
S. Danielle MacNeil ◽  
Mahmoud Badreddine ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
High Risk ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
Recurrent Disease ◽  
Risk Classification ◽  
American Thyroid Association ◽  
Persistent Disease

Introduction. Differentiated thyroid cancer (DTC) is the most common endocrine malignancy in children. Retrospective studies show conflicting results regarding predictors of persistent and recurrent disease after initial therapy. In 2015, the American Thyroid Association (ATA) proposed a clinical classification system to identify pediatric thyroid cancer patients at risk for persistent/recurrent disease. Material and Methods. We retrospectively included all patients in our registry diagnosed with papillary DTC at ≤ 18 years of age. We analyzed the prognostic performance of the ATA classification and other risk factors for predicting response to initial treatment and final outcome in pediatric DTC. Results. We included 41 patients, 34 females and 7 males, diagnosed with papillary DTC at a mean (SD) age of 16.2 (1.8) years. Based on the ATA pediatric risk classification, patients were categorized as low (61%), intermediate (10%), or high risk (29%). The median follow-up period was 7.3 (1-41) years. After initial treatment, disease free status was achieved in 92%, 50%, and 42% of the low, intermediate, and high risk groups, respectively (P <0.01). At the last visit, persistent disease was present in 12%, 25%, and 33% (P=0.27). Assessing other risk factors, only the presence of distant metastases at diagnosis resulted in increased presence of persistent disease at last follow-up (P=0.03). Conclusion. This study supports the clinical relevance of the ATA risk classification for predicting the response to initial treatment. There was no clear prediction of long-term outcome, but this may be due to limited power caused by the small number of patients.

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