Stimulated Thyroglobulin at Recombinant Human TSH-Aided Ablation Predicts Disease-free Status One Year Later

Melo, Miguel; Costa, Gracinda; Ribeiro, Cristina; Carrilho, Francisco; Martins, Maria João; Rocha, Adriana Gaspar da; Sobrinho-Simões, Manuel; Carvalheiro, Manuela; Soares, Paula

doi:10.1210/jc.2013-2267

Cited by 38 publications

(48 citation statements)

References 38 publications

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“…If the 10 ng/ml cutoff had been applied in the patients of our series, it would have yielded high sensitivity (90%) in the THW group but poor sensitivity (57%) in the rhTSH group. Recently, Melo et al (6) have reported a Tg cutoff at 7.2 ng/ml after rhTSH, a higher threshold than ours (2.8 ng/ml), which would also have provided low sensitivity (57%) in our rhTSH patients. Several explanations are possible.…”

Section: Discussioncontrasting

confidence: 65%

“…Several explanations are possible. First, the Tg level was measured 3 days after radioiodine treatment in the study by Melo et al (6) and before treatment in ours. Second, the group of patients prepared with rhTSH was at a higher risk of PRD in the study by Melo et al (6) than in ours, with a higher proportion of T3/T4 tumors (44 vs 13%) and of N1 patients (21 vs 11%).…”

Section: Discussionmentioning

confidence: 87%

“…Several factors including the thyroid-stimulating hormone (TSH) stimulation modalities (4), the burden of residual tumor disease, and the volume of the thyroid remnants potentially influence the stimulated serum Tg level. Stimulated Tg level cutoffs have been mainly established after thyroid hormone withdrawal (THW) (2,5), whereas data on stimulated Tg level after recombinant human TSH (rhTSH) stimulation are very limited (6).…”

Section: Introductionmentioning

confidence: 99%

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Stimulated thyroglobulin level at ablation in differentiated thyroid cancer: the impact of treatment preparation modalities and tumor burden

Ciappuccini¹,

Hardouin²,

Heutte³

et al. 2014

European Journal of Endocrinology

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Objective: In patients with differentiated thyroid cancer (DTC), the stimulated serum thyroglobulin (Tg) level at radioiodine ablation is a known predictive factor of persistent disease. This prognostic value is based on data obtained after thyroid hormone withdrawal (THW), but little is known about this prognostic value after recombinant human TSH (rhTSH) stimulation and about the relationship between the stimulated Tg level and the burden of persistent tumor. We aimed to assess the impact of both radioiodine preparation modalities and persistent tumor burden on stimulated Tg levels. Design and methods: The stimulated Tg level was measured at radioablation in 308 consecutive DTC patients without serum Tg antibodies. Of these, 123 (40%) were prepared with rhTSH and 185 with THW. Post-ablation scintigraphy included total-body scan and neck and thorax single photon emission computed tomography with computed tomography (SPECT-CT). During a mean follow-up of 43 months, persistent/recurrent disease (PRD) was found in 56 patients (18%). PRD was considered structural in the presence of lesions O1 cm and nonstructural otherwise. Results: Nonstructural PRD was more frequent in the rhTSH group than in the THW group (64 vs 26%, PZ0.01). Stimulated Tg levels were lower after rhTSH than after THW in patients with (13.5 vs 99.5 ng/ml, P!0.01) and without (1.2 vs 3.2 ng/ml, P!0.001) PRD. Also, Tg levels were lower in nonstructural disease than in structural disease in both rhTSH (3.8 vs 127.0 ng/ml, P!0.01) and THW (13.0 vs 143.5 ng/ml, P!0.0001) patients. The best Tg cutoff to predict PRD was 2.8 in rhTSH and 28 ng/ml in THW patients. Conclusion: Both radioiodine preparation modalities and the burden of persistent tumor affect the stimulated Tg level at ablation.

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Stimulated thyroglobulin level at ablation in differentiated thyroid cancer: the impact of treatment preparation modalities and tumor burden

Ciappuccini¹,

Hardouin²,

Heutte³

et al. 2014

European Journal of Endocrinology

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“…Thus, this diagnosis is often delayed by up to 1 year. Although the use of sTg before RIT and after surgery was initially questioned, because the remnant healthy thyroid tissue also contributes to its production, a number of studies have shown the prognostic value of sera sTg measured at this time point (13)(14)(15)(16)(17). The marker can be an early indicator of patient response, allowing treatment to be started immediately in the event of suspected unfavorable outcome.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, the utility of Tg measured immediately before ablative therapy with I 131 and after surgery (Tg before RIT) as a prognostic marker of disease progression has been confirmed (13)(14)(15)(16)(17). No previous studies, however, have sought to establish the relationship between Tg before RIT and the new dynamic risk stratification.…”

Section: Ifferentiated Thyroid Carcinomas (Dtc)mentioning

confidence: 99%

Thyroglobulin levels before radioactive iodine therapy and dynamic risk stratification after 1 year in patients with differentiated thyroid cancer

Bandeira

Padovani

Ticly

et al. 2017

Arch. Endocrinol. Metab.

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Objectives: We sought to assess the relationship between stimulated thyroglobulin (sTg) before radioactive iodine therapy (RIT), and the dynamic risk stratification 1 year after treatment, and to establish the utility of the sTg as a predictor of response to therapy in these patients. A retrospective chart review of patients with differentiated thyroid cancer (DTC) who underwent RIT after surgery and were followed for at least 1 year, was carried out. Subjects and methods: Patients were classified according to the dynamic risk stratification 1 year after initial treatment. The sTg values before RIT were compared among the groups. ROC curve analysis was performed. Results: Fifty-six patients were enrolled (mean age 44.7 ± 14.4 years, 80.7% had papillary carcinoma). Patients with excellent response had sTg = 2.1 ± 3.3 ng/mL, those with indeterminate response had sTg = 8.2 ± 9.2 ng/mL and those with incomplete response had sTg = 22.4 ± 28.3 ng/mL before RIT (p = 0.01). There was a difference in sTg between excellent and incomplete response groups (p = 0.009) while no difference was found between indeterminate and either excellent or incomplete groups. The ROC curve showed an area under the curve of 0.779 assuming a sTg value of 3.75 ng/mL. Conclusion: Our study results suggest that the higher the sTg before RIT, the greater the likelihood of an incomplete response to initial treatment. A sTg cut-off of 3.75 ng/mL was found to be a good predictor of response to initial treatment in patients with DTC. Arch Endocrinol Metab. 2017;61(6):590-9

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Radioiodine Ablation: Current Status

Pacini

Castagna

2018

Practical Management of Thyroid Cancer

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Stimulated Thyroglobulin at Recombinant Human TSH-Aided Ablation Predicts Disease-free Status One Year Later

Abstract: When rhTSH was used, stimulated Tg at ablation had independent predictive value for disease-free status 1 year later. A low stimulated Tg at rhTSH-aided ablation may be considered a favorable prognosis factor.

Cited by 38 publications

References 38 publications

Stimulated thyroglobulin level at ablation in differentiated thyroid cancer: the impact of treatment preparation modalities and tumor burden

Stimulated thyroglobulin level at ablation in differentiated thyroid cancer: the impact of treatment preparation modalities and tumor burden

Thyroglobulin levels before radioactive iodine therapy and dynamic risk stratification after 1 year in patients with differentiated thyroid cancer

Radioiodine Ablation: Current Status

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