Thyroglobulin Antibodies as a Prognostic Factor in Papillary Thyroid
                    Carcinoma Patients with Indeterminate Response After Initial
                    Therapy

Landenberger, Giullia Menuci Chianca; Salerno, Marianna Lins de Souza; Golbert, Lenara; Meyer, Erika Laurini de Souza

doi:10.1055/a-1232-4575

Cited by 7 publications

(6 citation statements)

References 23 publications

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“…Finally, thyroglobulin antibodies, which have been recently suggested for monitoring the course of the disease or as a marker for the outcome, were not elevated or normalized in all patients in this study ( 26 , 27 ), even in the subgroup experiencing disease progress. This should be taken into account, when interpreting the present data.…”

Section: Discussionmentioning

confidence: 47%

Salvage surgery for cervical radioiodine refractory 18F-FDG-PET positive recurrence of papillary thyroid cancer

Chiapponi

Alakus

Faust

et al. 2021

Endocrine Connections

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Purpose: 5% of patients with differentiated thyroid cancer are diagnosed with radioiodine refractory relapse in the course of disease. For isolated or oligometastatic cervical recurrence, resection or another local treatment are recommended. In this study, the impact of surgical treatment of cervical radioiodine-refractory 18F-FDG-PET positive relapse of papillary thyroid cancer (PTC) was evaluated. Methods: Patients receiving radioiodine therapy between 2005 and 2015 at the University Hospital of Cologne, Germany for PTC were screened. The subgroup of patients undergoing surgery during the course of disease after recommendation by a multidisciplinary endocrine team for cervical radioiodine refractory 18F-FDG-PET positive recurrence was identified. Demographics, clinic-pathologic characteristics, oncologic treatment and outcome were analyzed. Results: 30 (3%) of 969 patients with PTC treated with radioiodine therapy at our institution underwent surgery for radioiodine refractory 18F-FDG-PET positive cervical recurrence during the course of disease. In 8 (26.6%) patients, more than one operation was performed. 16 (53%) patients received external beam radiation therapy (EBRT) after surgery. Follow-up was in average 79.2 ± 61.6 months after the last surgical treatment. Biochemical and radiological cure was seen in 12 (40%) patients. Remission was significantly more frequent in younger patients (p=0.0001) with lymph node rather than soft tissue tumor recurrence (p=0.004). Conclusions: Surgical treatment of radioiodine refractory 18F-FDG-PET positive cervical recurrence led to biochemical and radiological cure in about 40% of patients in this study. Further data is needed concerning risk stratification of potential subgroups benefitting of surgical approach and the possible role of EBRT after repetitive surgery.

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Section: Discussionmentioning

confidence: 47%

Salvage surgery for cervical radioiodine refractory 18F-FDG-PET positive recurrence of papillary thyroid cancer

Chiapponi

Alakus

Faust

et al. 2021

Endocrine Connections

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“…Malandrino et al [12] report 6.9% of structural disease; of note patients with positive TgAb were excluded from both studies. Other authors found higher frequency of structural disease, ranging from 10.6 to 19.5% [8][9][10][11] In the present series, patients with larger primary tumors, high risk of recurrence (as strati ed by ATA) and higher preablation Tg levels had a greater probability of structural/biochemical recurrence at the end of follow-up. Several studies found dynamic risk assessment [6] is a better predictor of structural disease than AJCC/UICC or ATA staging systems [9,[14][15][16]].…”

Section: Discussionsupporting

confidence: 45%

“…This points towards tailoring strategies of follow-up according to the type of IR, with more stringent controls in Tg (+) patients, while avoiding unnecessary procedures in patients with positive TgAb with a stable/descending tendency [20,21]. On the contrary, Landenberger et al reports a greater risk of structural incomplete response in the population of patients with IR due to positive TgAb (31.25% vs 2.63% and 8.3% in the Tg (+) and non-speci c ndings on imaging studies group respectively) [11]. It is relevant to mention that the tendency of TgAb (+) levels in this series was not informed.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of differentiated thyroid cancer patients with indeterminate response to initial treatment

Calabretta

Iglesias

Califano

2023

Preprint

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Background: Data on long term outcomes of patients with differentiated thyroid cancer (DTC) with indeterminate response to initial treatment (IR) is lacking. Objective: a) to assess long term outcomes of patients with IR, b) to describe differences in evolution according to type of IR positive anti-thyroglobulin antibodies (TgAb) vs positive thyroglobulin (Tg) and c) to determine factors related to worse prognosis in this population Patients and methods: Retrospective study of 58 DTC patients with IR after total thyroidectomy and radioiodine ablation. Population was divided in two groups: TgAb (+) and Tg (+). Results: After a median follow-up of 6.2 years, structural disease was found in 3.4% of cases, all of them in the Tg (+) group. Final IR were more frequent in the TgAb (+) group (75% vs 23% in the Tg (+) group, p <0.0005), they were caused by declining TgAb levels in 83% of cases. Patients with final excellent and IR had smaller tumor at diagnosis (11.5 vs 44.4 mm, p 0.03), initial high risk was less frequent (14.8 vs 60%, p 0.02), and preablation Tg levels were lower (10.1 vs 42.9 ng/ml, p 0.03) compared with patients with structural or biochemical persistence. Conclusions: Most patients with IR had favorable outcomes. Structural disease was found only in patients with Tg (+). Patients with worse final outcomes had adverse initial parameters. Management strategies should be tailored according to these findings. Significance Statement: Our objective was to evaluate the long-term evolution of patients with an indeterminate response to initial treatment, to investigate differences in the final state between the different types of indeterminate response (positive antithyroglobulin antibodies vs. detectable thyroglobulin), and to determine factors that are associated with worse evolution in this population. We found it relevant to study this population given the little evidence published to date on this group of patients.

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“…An indeterminate response may be observed in 12%-23% of the patients with LRPTC, but 80%-90% of them will never experience disease recurrence ( 73 , 74 ). An analysis of stimulated Tg can be helpful in these cases.…”

Section: Follow-up Strategiesmentioning

confidence: 99%

Treatment strategies for low-risk papillary thyroid carcinoma: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM)

Ward¹,

Scheffel²,

Hoff³

et al. 2022

Archives of Endocrinology and Metabolism

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Increasingly sensitive diagnostic methods, better understanding of molecular pathophysiology, and well-conducted prospective studies have changed the current approach to patients with thyroid cancer, requiring the implementation of individualized management. Most patients with papillary thyroid carcinoma (PTC) are currently considered to have a low risk of mortality and disease persistence/recurrence. Consequently, current treatment recommendations for these patients include less invasive or intensive therapies. We used the most recent evidence to prepare a position statement providing guidance for decisions regarding the management of patients with low-risk PTC (LRPTC). This document summarizes the criteria defining LRPTC (including considerations regarding changes in the TNM staging system), indications and contraindications for active surveillance, and recommendations for follow-up and surgery. Active surveillance may be an appropriate initial choice in selected patients, and the criteria to recommend this approach are detailed. A section is dedicated to the current evidence regarding lobectomy versus total thyroidectomy and the potential pitfalls of each approach, considering the challenges during long-term follow-up. Indications for radioiodine (RAI) therapy are also addressed, along with the benefits and risks associated with this treatment, patient preparation, and dosage. Finally, this statement presents the best follow-up strategies for LRPTC after lobectomy and total thyroidectomy with or without RAI.

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Thyroglobulin Antibodies as a Prognostic Factor in Papillary Thyroid Carcinoma Patients with Indeterminate Response After Initial Therapy

Cited by 7 publications

References 23 publications

Salvage surgery for cervical radioiodine refractory 18F-FDG-PET positive recurrence of papillary thyroid cancer

Salvage surgery for cervical radioiodine refractory 18F-FDG-PET positive recurrence of papillary thyroid cancer

Outcome of differentiated thyroid cancer patients with indeterminate response to initial treatment

Treatment strategies for low-risk papillary thyroid carcinoma: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM)

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