scholarly journals An update on the management of low-risk differentiated thyroid cancer

2019 ◽  
Vol 26 (11) ◽  
pp. R597-R610 ◽  
Author(s):  
Livia Lamartina ◽  
Sophie Leboulleux ◽  
Marie Terroir ◽  
Dana Hartl ◽  
Martin Schlumberger
Keyword(s):  
Low Risk ◽  
Response To Treatment ◽  
Serum Thyroglobulin ◽  
Specialized Center ◽  
Prophylactic Lymph Node Dissection ◽  
Antibody Determination ◽  
Levothyroxine Treatment ◽  
Detectable Serum ◽  
Serum Tsh

Low-risk papillary cancers, which represent the vast majority of thyroid cancers diagnosed today, do not require aggressive treatment or follow-up. Initial treatment consists of a total thyroidectomy without prophylactic lymph node dissection. A hemithyroidectomy is an alternative in some patients with an intrathyroidal tumor and with a normal contralateral lobe at pre-operative neck ultrasonography. The use of post-operative radioiodine should be restricted to selected patients. Follow-up at 6–18 months is based on serum thyroglobulin (Tg), Tg-antibody determination and neck ultrasonography. In the absence of any abnormality (excellent response to treatment), the risk of recurrence is extremely low and follow-up may consist of serum TSH monitoring that is maintained in the normal range, and a Tg and Tg-antibody titer determination every year. There is no need for referral to a specialized center. In patients with detectable serum Tg or detectable Tg antibodies, the trend over time of these markers on levothyroxine treatment will dictate subsequent follow-up: a decreasing trend is reassuring, but an increasing trend should lead to imaging, starting with neck ultrasonography.

scholarly journals A Consensus Report of the Role of Serum Thyroglobulin as a Monitoring Method for Low-Risk Patients with Papillary Thyroid Carcinoma

2003 ◽  
Vol 88 (4) ◽  
pp. 1433-1441 ◽  
Author(s):  
E. L. Mazzaferri ◽  
R. J. Robbins ◽  
C. A. Spencer ◽  
L. E. Braverman ◽  
F. Pacini ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Hormone ◽  
Clinical Evidence ◽  
Low Risk ◽  
Whole Body ◽  
Serum Thyroglobulin ◽  
Thyroid Hormone Withdrawal ◽  
Body Scanning ◽  
Risk Patients

Recent studies have provided new information regarding the optimal surveillance protocols for low-risk patients with differentiated thyroid cancer (DTC). This article summarizes the main issues brought out in a consensus conference of thyroid cancer specialists who analyzed and discussed this new data. There is growing recognition of the value of serum thyroglobulin (Tg) as part of routine surveillance. An undetectable serum Tg measured during thyroid hormone suppression of TSH (THST) is often misleading. Eight studies show that 21% of 784 patients who had no clinical evidence of tumor with baseline serum Tg levels usually below 1 μg/liter during THST had, in response to recombinant human TSH (rhTSH), a rise in serum Tg to more than 2 μg/liter. When this happened, 36% of the patients were found to have metastases (36% at distant sites) that were identified in 91% by an rhTSH-stimulated Tg above 2 μg/liter. Diagnostic whole body scanning, after either rhTSH or thyroid hormone withdrawal, identified only 19% of the cases of metastases. Ten studies comprising 1599 patients demonstrate that a TSH-stimulated Tg test using a Tg cutoff of 2 μg/liter (either after thyroid hormone withdrawal or 72 h after rhTSH) is sufficiently sensitive to be used as the principal test in the follow-up management of low-risk patients with DTC and that the routine use of diagnostic whole body scanning in follow-up should be discouraged. On the basis of the foregoing, we propose a surveillance guideline using TSH-stimulated Tg levels for patients who have undergone total or near-total thyroidectomy and 131I ablation for DTC and have no clinical evidence of residual tumor with a serum Tg below 1 μg/liter during THST.

scholarly journals Utility of Stimulated Thyroglobulin in Reclassifying Low Risk Thyroid Cancer Patients’ Following Thyroidectomy and Radioactive Iodine Ablation: A 7-Year Prospective Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Anwar A. Jammah ◽  
Afshan Masood ◽  
Layan A. Akkielah ◽  
Shaimaa Alhaddad ◽  
Maath A. Alhaddad ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Prospective Trial ◽  
Low Risk ◽  
University Hospital ◽  
Serum Thyroglobulin ◽  
Risk Of Recurrence

ContextFollowing total thyroidectomy and radioactive iodine (RAI) ablation, serum thyroglobulin levels should be undetectable to assure that patients are excellent responders and at very low risk of recurrence.ObjectiveTo assess the utility of stimulated (sTg) and non-stimulated (nsTg) thyroglobulin levels in prediction of patients outcomes with differentiated thyroid cancer (DTC) following total thyroidectomy and RAI ablation.MethodA prospective observational study conducted at a University Hospital in Saudi Arabia. Patients diagnosed with differentiated thyroid cancer and were post total thyroidectomy and RAI ablation. Thyroglobulin levels (nsTg and sTg) were estimated 3–6 months post-RAI. Patients with nsTg <2 ng/ml were stratified based on their levels and were followed-up for 5 years and clinical responses were measured.ResultsOf 196 patients, nsTg levels were <0.1 ng/ml in 122 (62%) patients and 0.1–2.0 ng/ml in 74 (38%). Of 122 patients with nsTg <0.1 ng/ml, 120 (98%) had sTg levels <1 ng/ml, with no structural or functional disease. sTg levels >1 occurred in 26 (35%) of patients with nsTg 0.1–2.0 ng/ml, 11 (15%) had structural incomplete response. None of the patients with sTg levels <1 ng/ml developed structural or functional disease over the follow-up period.ConclusionSuppressed thyroglobulin (nsTg < 0.1 ng/ml) indicates a very low risk of recurrence that does not require stimulation. Stimulated thyroglobulin is beneficial with nsTg 0.1–2 ng/ml for re-classifying patients and estimating their risk for incomplete responses over a 7 years follow-up period.

scholarly journals Serum levels of Interleukin 22 and Interleukin 6 decrease after treatment in patients with rheumatoid arthritis

2020 ◽  
pp. 40-50
Author(s):  
María Clara Álvarez Ferreira ◽  
Vanina Alejandra Alamino ◽  
Cristina del Valle Acosta ◽  
Laura Beatriz Onetti ◽  
Eduardo Daniel Musssano ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Treatment Initiation ◽  
Serum Levels ◽  
Response To Treatment ◽  
Additional Tool ◽  
Interleukin 22 ◽  
Cytokine Levels ◽  
Th17 Cytokines ◽  
Detectable Serum

Introduction: Rheumatoid arthritis is characterized by synovium inflammation due to the infiltration of immune cells that secrete Th17 cytokines like IL-22 and IL-6. The dynamics of these cytokines during the treatment remain unknown. The aim of this study was to evaluate the levels of IL-22 and IL-6 serum and synovial fluid (SF) in correlation with different biochemical and clinical parameters and treatment-associated changes. Material and methods: Seventy-seven RA patients and 30 controls were recruited. Thirty patients were evaluated after 3 months of treatment and SF was collected of 12 patients. ESR, CRP, RF, anti-CCP hs, IL-22 e IL-6 were measured. DAS28 was used to assess disease activity and response to treatment followed EULAR criteria. Results: There were not differences in serum IL-22 and IL-6 levels between patients and controls. Cytokine levels decreased after treatment, mainly in responder patients. IL-22 was decreased and IL-6 was increased in SF compared to serum. IL-6 correlated positively with CRP and anti-CCPhs. ESR, CRP and DAS28 were increased in patients with detectable IL-6 compared to those with undetectable IL-6. Conclusion: In patients with detectable serum IL-22 and IL-6 levels before treatment initiation, follow-up of cytokine levels could be an useful additional tool to evaluate treatment response.

scholarly journals 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

2017 ◽  
Vol 176 (5) ◽  
pp. 497-504 ◽  
Author(s):  
P Trimboli ◽  
V Zilioli ◽  
M Imperiali ◽  
L Ceriani ◽  
L Giovanella
Keyword(s):  
Disease Free Survival ◽  
Roc Curves ◽  
Early Response ◽  
Differentiated Thyroid Carcinoma ◽  
Response To Therapy ◽  
Response To Treatment ◽  
Intermediate Risk ◽  
Serum Thyroglobulin ◽  
Free Survival

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.

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.

Thyroglobulin Changes are Highly Dependent on TSH in Low-risk DTC Patients not Treated with Radioiodine

2020 ◽  
Vol 105 (8) ◽  
pp. e2845-e2852
Author(s):  
Antonio Matrone ◽  
Alessio Faranda ◽  
Francesco Latrofa ◽  
Carla Gambale ◽  
Delio Stefani Donati ◽  
...  
Keyword(s):  
Differentiated Thyroid Cancer ◽  
Thyroid Stimulating Hormone ◽  
Low Risk ◽  
Serum Thyroglobulin ◽  
Pooled Data ◽  
Group A ◽  
Group B ◽  
Weighted Values ◽  
Tsh Levels

Abstract Introduction Low-risk differentiated thyroid cancer (DTC) is currently rarely treated with radioiodine (131I) to ablate the postoperative remnant. Therefore, the interpretation of the serum thyroglobulin (Tg) values should be reconsidered. The aim of our study was to evaluate the changes in Tg values during follow-up with regard to the changing values in thyroid stimulating hormone (TSH). Materials and Methods We evaluated 271 low-risk DTC patients, treated with total thyroidectomy but not 131I. To be included, patients had to be negative for Tg antibodies and have at least 3 evaluations in our department. All patients were on levothyroxine (L-T4) therapy. Results After a median follow-up of 73 months, the overall Tg values were stable, while TSH values slightly increased. Therefore, we pooled data of Tg and TSH from all evaluations and a significant positive correlation was demonstrated (R = 0.2; P &lt; 0.01), and was also demonstrated when we performed the analysis using time-weighted values (R = 0.14; P = 0.02). Moreover, when dividing patients into 3 groups according to first postoperative Tg (Group A [Tg &lt; 0.2 ng/ml], Group B [Tg 0.2–1 ng/ml], and Group C [Tg &gt; 1 ng/ml]) most patients showed stable values of Tg at the end of follow-up but TSH variations had a clear impact on the changes in Tg among the groups. Conclusion We demonstrated that in low-risk DTC not treated with 131I, serum Tg remains substantially stable over time, and the variations observed were correlated with the concomitant variations of TSH levels, mainly due to the modification of LT-4 therapy performed according to the ongoing risk stratification.

scholarly journals Ultrasensitive serum thyroglobulin measurement is useful for the follow-up of patients treated with total thyroidectomy without radioactive iodine ablation

2013 ◽  
Vol 169 (5) ◽  
pp. 689-693 ◽  
Author(s):  
C Nascimento ◽  
I Borget ◽  
F Troalen ◽  
A Al Ghuzlan ◽  
D Deandreis ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Radioactive Iodine ◽  
Malignant Potential ◽  
Uncertain Malignant Potential ◽  
Serum Thyroglobulin ◽  
Normal Neck ◽  
Mean Time ◽  
Levothyroxine Treatment ◽  
Radioactive Iodine Ablation

ContextThyroglobulin (Tg) measurement is a major tool for the follow-up of differentiated thyroid cancer (DTC) patients; however, in patients who do not undergo radioactive iodine (RAI) ablation, normal ultrasensitive Tg levels measured under levothyroxine treatment (usTg/l-T4) are not well defined.Objective and designThis single-center retrospective study assessed usTg/l-T4 level in 86 consecutive patients treated with total thyroidectomy without RAI ablation for low-risk DTC (n=77) or for tumors of uncertain malignant potential (TUMP) (n=9).ResultsDTCs were classified as pT1, pT2, and pT3 in 75, 1, and 1 case respectively and pN0, pN1, and pNx in 40, 6, and 31 respectively. Following surgery, ten patients had Tg antibodies (TgAb). Among those without TgAb, the first usTg/l-T4 determination obtained at a mean time of 9 months after surgery was ≤0.1 ng/ml in 62% of cases, ≤0.3 ng/ml in 82% of cases, ≤1 ng/ml in 91%, and ≤2 ng/ml in 96% of cases. After a median follow-up of 2.5 years (range: 0.6–7.2 years), one patient had persistent disease with an usTg/l-T4 at 11 ng/ml and an abnormal neck ultrasonography (US) and two patients had usTg/l-T4 level >2 ng/ml (3.9 and 4.9 ng/ml) with a normal neck US. Within the first 2 years following total thyroidectomy without RAI ablation, usTg/l-T4 level is ≤2 ng/ml in 96% of the cases.ConclusionAfter total thyroidectomy, sensitive serum Tg/l-T4 level is ≤2 ng/ml in most patients and can be used for patient follow-up.

scholarly journals ADHERENCE, ADVERSE DRUG REACTION AND EFFECTIVENESS OF THE HEPATITIS C CHRONIC TREATMENT

2020 ◽  
Vol 20 (38) ◽  
pp. 86-93
Author(s):  
Karin Schwambach ◽  
Carine Raquel Blatt
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Hepatitis C ◽  
Treatment Time ◽  
Medication Possession Ratio ◽  
High Response Rate ◽  
Response To Treatment ◽  
Specialized Center ◽  
Direct Acting

Objective: To assess adherence, adverse drug reaction and Sustained Virological Response (SVR) in the therapy for hepatitis C. This follow-up retrospective observational study was conducted in a specialized center for hepatitis treatment in Southern Brazil. Methods: This research included 257 patients under hepatitis C treatment with all‐oral direct‐acting antivirals  in a clinical setting from March to August 2016. The data was obtained from medical records. Adherence was measured by medicines refill and Medication Possession Ratio. Results: Of the 253 patients evaluated, 8,7% had some problem with adherence to the treatment. No cases of treatment discontinuation due to adverse drug reaction was observed.  However, 1433 adverse drug reactions were identified and classified as mild, with an average of 5,6 per patient. The most frequent reactions were headache (55,7%), asthenia (47,3%), altered appetite (41,9%), dry skin (37,2%), and nausea/vomiting (35,9%). The overall SVR rate was 90,9%. Other outcomes were no response to treatment (2,0%), relapsed (2,0%), dead (0,4%), dropout (0,4%) and lost to follow-up (4,3%). In the multivariate analysis, hepatitis C virus and  human immunodeficiency virus co-infection and longer treatment time were associated with higher SVR (p = 0,028 and p = 0,020, respectively). Conclusion: The treatments evaluated have high response rate and were well tolerated by the patients. Adherence to treatment proved to be adequate and contributed to the results. The care offered in a specialized center provides the appropriate management of the patients’ needs, contributing thus to a successful therapy.

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