Clinical outcome of patients with differentiated thyroid cancer and raised antithyroglobulin antibody levels: a retrospective study

Manish Ora,Amitabh Arya,Sanjay Gambhir,Prasanta Kumar Pradhan,Aftab Hasan Nazar,Sukanta Barai,Prabhakar Mishra

doi:10.1186/s13044-021-00099-w

Manish Ora, Amitabh Arya + Show 5 more

Open Access

https://doi.org/10.1186/s13044-021-00099-w

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Abstract

BackgroundThyroglobulin (Tg) is a specific tumor marker for differentiated thyroid cancer (DTC). However, in the presence of an antithyroglobulin antibody (TgAb), it becomes unreliable. The purpose of the study was to assess the long-term outcome of DTC patients with raised TgAb.MethodIn a retrospective study, we included patients with DTC who had raised TgAb following total thyroidectomy. We excluded patients with persistently raised Tg (≥ 1 ng/ml) or radioiodine avid disease. Serial TgAb levels, excellent response (ER), incomplete response (IR), and anatomical recurrence were evaluated.ResultsA total of seventy-six patients were included in the study. Patients with IR had higher baseline TgAb (1071.27 ± 1216.17 vs. 99.61 ± 91.29 IU/ml, p < 0.001) and central compartment lymph node metastases (70.8% vs. 46.4%, p = 0.035) in comparison to those in the ER group. In the first follow-up, 64 (84.2%) patients had a stable or fall in the TgAb (0 to − 98.3%). Sixty-eight patients received high-dose radioiodine therapy (RIT). Out of these, 59 (86.5%) had transient, and 51 (75%) had a long-term fall in TgAb. After a follow-up period of 58.74 ± 26.26 months, 63.2% (48 out of 76) patients had IR. Nine (11.8%) patients had a rising TgAb level (3.7–170.9%) from baseline. Eleven patients underwent 18F-FDG PET/CT, and five of them demonstrated metabolically active recurrent disease. Three patients underwent cervical lymph nodes dissection. None of the patients died during the follow-up period.ConclusionHigh post-operative TgAb levels and central compartment lymph nodal metastases are risk factors for IR. RIT leads to a significant fall in the TgAb in these patients. The low level of raised TgAb is associated with an excellent outcome. Patients with recurrences had very high baseline TgAb > 1000 IU/ml. Raised TgAb was associated with good clinical outcomes and not associated with increased mortality.

Highlights

Differentiated thyroid cancer (DTC) is the most common of the endocrine cancers
Patients with incomplete response (IR) had higher baseline the presence of an antithyroglobulin antibody (TgAb) (1071.27 ± 1216.17 vs. 99.61 ± 91.29 IU/ml, p < 0.001) and central compartment lymph node metastases (70.8% vs. 46.4%, p = 0.035) in comparison to those in the excellent response (ER) group
Our study found that the history of lymph node dissection and lateral compartment lymph nodal metastasis were significantly associated with IR (45.8%, p = 0.01)

Summary

Introduction

Differentiated thyroid cancer (DTC) is the most common of the endocrine cancers. It accounts for 3.1% of all malignancies globally, with an age-standardizedTreatment of DTC consists of total thyroidectomy or lobectomy. Differentiated thyroid cancer (DTC) is the most common of the endocrine cancers. It accounts for 3.1% of all malignancies globally, with an age-standardized. Surgery is followed by evaluation of postoperative disease status. It consists of a diagnostic (2021) 14:8 whole-body radioiodine scan (WBS), serum thyroglobulin (Tg), and antithyroglobulin antibody (TgAb) assay [2]. Serial Tg and TgAb assays and neck ultrasonography (USG) with or without WBS are currently the mainstays of postoperative surveillance in patients with DTC. Thyroglobulin (Tg) is a specific tumor marker for differentiated thyroid cancer (DTC).

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