Relevance of thyroid autoimmunity to prognosis of papillary thyroid carcinoma is still unsettled. We decided to investigate the impact of thyroid autoimmunity on prognosis of papillary thyroid carcinoma and the handling of TgAbs. We evaluated the clinical course of a large group of patients according to the presence (PTC-LT) or absence (PTC) of lymphocytic thyroiditis at histology. We studied 194 consecutive patients with a diagnosis of PTC and treated with total thyroidectomy plus ¹³¹I ablation between 2007 and 2009. Median follow-up (with 25th-75th percentiles) was 84·0 (56·4-118·0) months. The remission criteria were: basal Tg <0·2 ng/mL (or stimulated Tg <1), TgAbs <8 IU/mL (otherwise “decreasing TgAb trend”, a decline of ≥20% in sequential TgAb measurements) and unremarkable imaging. PTC-LT and PTC patients had comparable treatment.TgAbs were detectable in 72·5% of PTC-LT and 16·5% of PTC patients. Time to remission was longer in the detectable than in the undetectable TgAb cohort (28·5 vs· 7·5 months [median]; HR 0·54, CI 0·35-0·83, p=0·005). When comparing PTC-LT to PTC patients the difference was maintained in the detectable TgAb (29·3 vs 13·0 months; HR 0·38, CI 0·18-0·80; p=0·01), but not in the undetectable TgAb cohort (7·7 vs 7·3 months; HR 0·90, CI 0·55-1·47; p=0·68). Using the decreasing TgAb trend, the influence of detectable TgAbs on time to remission was abolished. Thyroid autoimmunity does not influence the prognosis of papillary thyroid carcinoma. A decreasing TgAb trend seems an appropriate criterion to establish the remission of papillary thyroid carcinoma.

SommarioSi definisce gozzo l’incremento diffuso o nodulare della ghiandola tiroidea. Il suo sviluppo è legato a fattori genetici e ambientali, di cui il più importante è rappresentato dalla carenza iodica. L’inquadramento clinico prevede un’attenta valutazione dei sintomi, dei segni, dei risultati degli esami ormonali, delle caratteristiche ecografiche e citologiche. Il trattamento deve essere poi individualizzato tenendo conto della disponibilità di molteplici opzioni terapeutiche.

Context Prognosis is excellent for the papillary thyroid carcinoma (PTC), noninvasive follicular thyroid neoplasia with papillary-like nuclear features (NIFT-P) and the follicular thyroid carcinoma (FTC) while is poor for the poorly differentiated thyroid carcinoma (PDTC) and the anaplastic thyroid carcinoma (ATC). Among PTC, the prognosis is more favorable for the follicular (FV-PTC) and the classic (CV-PTC) than for the tall cell (TCV-PTC) and the solid (SV-PTC) variants. Objectives To associate histotypes and variants of thyroid carcinoma with ultrasound and cytological features. Design Histology of 1018 benign tumors and 514 PTC (249 CV, 167 FV, 49 TC, 34 SV and 15 other variants), 52 NIFT-P, 50 FTC, 11 PDTC and 3 ATC was correlated to fine-needle aspiration biopsy categories (Italian classification: TIR1, TIR2, TIR3A, TIR3B, TIR4 and TIR5) and ultrasound features. Setting Endocrinology Unit, University Hospital of Pisa. Patients 1117 patients with thyroid nodule(s) who underwent thyroidectomy. Intervention None. Main Outcome Measure(s) None. Results Of PTC, 36.3% had an indeterminate cytology (TIR3A or TIR3B), 56.6% suspicious for malignancy or malignant (TIR4 or TIR5); 84.0% FTC and 69.3% NIFT-P were TIR3A or TIR3B. 72.5% FV-PTC and 73.6% SV-PTC were TIR3A or TIR3B, 79.9% CV-PTC and 95.9% TCV-PTC were TIR4 or TIR5. The association of a hypoechoic pattern, irregular margins and no microcalcifications was more frequent in TCV-PTC than in CV-PTC (p=0.02, PPV=38.9%; NPV=85.5%). Conclusions At cytology, most FTC, NIFT-P, FV-PTC and SV-PTC were indeterminate, most CV-PTC and TCV-PTC were suspicious for malignancy or malignant. Ultrasound can be helpful in ruling out TCV-PTC.