Abstract
BackgroundTo investigate the association between postoperative lymph nodes (LNs) recurrence and distinct serum thyroglobulin (Tg) levels in patients with papillary thyroid carcinoma (PTC).MethodsThis study included PTC patients who underwent total thyroidectomy (TT) with at least central neck dissection and then re-operated due to recurrence of LNs between January 2013 and June 2018. These patients were grouped by negative or positive serum Tg levels according to the American Thyroid Association guidelines.ResultsOf the 60 included patients, 49 underwent radioactive iodine (RAI) treatment. Maximum unstimulated Tg (uTg) ≥ 0.2 ng/mL were associated with larger diameter of recurrent LNs (P = 0.027), and higher rate of metastatic LNs (P < 0.001). Serum-stimulated Tg (off-Tg) ≥ 1 ng/mL (P = 0.047) and unstimulated Tg (on-Tg) ≥ 0.2 ng/Ml (P = 0.013) were associated with larger diameter of recurrent LNs. Number of metastatic LNs ≥ 8 was an independent predictor for postoperative maximum uTg ≥ 0.2 ng/mL (OR = 8.767; 95% CI = 1.392–55.216; P = 0.021). Ratio of metastatic LNs ≥ 25% was an independent predictor for off-Tg ≥ 1 ng/mL (OR = 20.997; 95% CI = 1.649–267.384; P = 0.019).ConclusionPostoperative Tg-positive status was associated with larger size of recurrent LNs. Number of metastatic LNs ≥ 8 and ratio of metastatic LNs ≥ 25% were independent predicators for uTg-positive and off-Tg-positive status, respectively.
Highlights
To investigate the association between postoperative lymph nodes (LNs) recurrence and distinct serum thyroglobulin (Tg) levels in patients with papillary thyroid carcinoma (PTC)
Some studies demonstrated that Tg measurement could possibly serve as a useful negative predictor of persistent and recurrent PTC [9], while other authors reported serum Tg levels cannot be considered as reliable indicators for the absence of disease in patients already treated with radioactive iodine (RAI) [10]
body mass index (BMI) Body Mass Index, hashimoto’s thyroiditis (HD) Hashimoto’s disease, NG nodular goiter, iCND ipsilateral central neck dissection, bCND bilateral central neck dissection, iLND ipsilateral lateral neck dissection, bLND bilateral lateral neck dissection, LN lymph node (OR = 8.767; 95% confidence interval (CI) = 1.392–55.216; P = 0.021), while multifocality was an independent protective factor for maximum unstimulated Tg (uTg) ≥ 0.2 ng/mL (OR = 0.123; 95% CI = 0.020–0.762; P = 0.024)
Summary
To investigate the association between postoperative lymph nodes (LNs) recurrence and distinct serum thyroglobulin (Tg) levels in patients with papillary thyroid carcinoma (PTC). PTC is often associated with lymph nodes (LNs) metastases in the central neck compartment (level VI) and lateral neck compartment (level II to V) [2]. Tg measurement from this point on is useful for detecting persistent or recurrent diseases [5]. Some studies demonstrated that Tg measurement could possibly serve as a useful negative predictor of persistent and recurrent PTC [9], while other authors reported serum Tg levels cannot be considered as reliable indicators for the absence of disease in patients already treated with RAI [10]
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