Influence of chronic lymphocytic thyroiditis on the risk of persistent and recurrent disease in patients with papillary thyroid carcinoma and elevated antithyroglobulin antibodies after initial therapy.

Marina Carvalho S Côrtes,Maria Regina Calsolari,Pedro Weslley Rosario,Gabriela Franco Mourão

doi:10.1016/j.bjorl.2017.05.005

Marina Carvalho S Côrtes, Maria Regina Calsolari + Show 2 more

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https://doi.org/10.1016/j.bjorl.2017.05.005

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Abstract

IntroductionIn patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies. Other studies suggest that the presence of chronic lymphocytic thyroiditis is associated with a lower risk of persistence/recurrence of papillary thyroid carcinoma.ObjectiveThis prospective study evaluated the influence of chronic lymphocytic thyroiditis on the risk of persistence and recurrence of papillary thyroid carcinoma in patients with negative thyroglobulin but elevated antithyroglobulin antibodies after initial therapy.MethodsThis was a prospective study. Patients with clinical examination showing no anomalies, basal Tg < 1 ng/mL, and elevated antithyroglobulin antibodies 8–12 months after ablation were selected. The patients were divided into two groups: Group A, with chronic lymphocytic thyroiditis on histology; Group B, without histological chronic lymphocytic thyroiditis.ResultsThe time of follow-up ranged from 60 to 140 months. Persistent disease was detected in 3 patients of Group A (6.6%) and in 6 of Group B (8.8%) (p = 1.0). During follow-up, recurrences were diagnosed in 2 patients of Group A (4.7%) and in 5 of Group B (8%) (p = 0.7). Considering both persistent and recurrent disease, structural disease was detected in 5 patients of Group A (11.1%) and in 11 of Group B (16.1%) (p = 0.58). There was no case of death related to the disease.ConclusionOur results do not support the hypothesis that chronic lymphocytic thyroiditis is associated with a lower risk of persistent or recurrent disease, at least in patients with persistently elevated antithyroglobulin antibodies after initial therapy for papillary thyroid carcinoma.

Highlights

In patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies
Influence of chronic lymphocytic thyroiditis on the risk of persistent and recurrent disease in patients with papillary thyroid carcinoma and elevated antithyroglobulin antibodies after initial therapy
Patients consecutively seen at our institution who met the following criteria were selected: (i) diagnosis of papillary thyroid carcinoma (PTC); (ii) submitted to total thyroidectomy followed by ablation with 131I (1.1---5.5 GBq); (iii) apparently complete tumor Resection and post-therapy Whole-Body Scanning (RxWBS) showing no ectopic uptake; and (iv) clinical examination showing no anomalies, basal Tg < 1 ng/mL, and elevated those with elevated antithyroglobulin antibodies (TgAb) 8---12 months after ablation.[8]

Summary

Introduction

In patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies. Objective: This prospective study evaluated the influence of chronic lymphocytic thyroiditis on the risk of persistence and recurrence of papillary thyroid carcinoma in patients with negative thyroglobulin but elevated antithyroglobulin antibodies after initial therapy. In patients with papillary thyroid carcinoma (PTC) who have negative serum thyroglobulin (Tg) after initial therapy, the risk of structural disease is significantly higher among those with elevated antithyroglobulin antibodies (TgAb) compared to patients without TgAb.1---3. Other studies suggest that the presence of chronic lymphocytic thyroiditis (CLT) is associated with a lower risk of persistence/recurrence of PTC.[4] the association of these findings (elevated TgAb and CLT) is common, many patients with elevated TgAb do not have CLT.1,2,5---7. Some studies have demonstrated this protective effect of CLT in patients with elevated TgAb.[5,7] other series found no influence of CLT on the evolution of these patients.[1,2] In contrast, one study demonstrated a higher risk of persistent/recurrent disease in patients with PTC and elevated TgAb when the latter were associated with CLT (compared to nonspecific TgAb and not related to CLT).[6]

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