Abstract
ObjectiveThe baseline treatment of differentiated thyroid cancer (DTC) consists of thyroidectomy followed by postoperative risk-adapted radioiodine therapy (RAIT) when indicated. The choice of most appropriate RAI activities to administer with the aim to reach an efficient remnant ablation and reduce the risk of recurrence is yet an open issue and the detection of basal factors that may predict treatment response seems fundamental. The aim of this study was to investigate the potential role of Hashimoto thyroiditis (HT) in predicting 1-year and 5-year treatment response after RAIT and prognosis.MethodsWe retrospectively included 314 consecutive patients (174 low-risk and 140 intermediate-risk) who received thyroidectomy plus RAIT. One-year and 5-year disease status was evaluated according to 2015 ATA categories response based upon biochemical and structural findings.ResultsHT was reported histopathologically in 120 patients (38%). DTC patients with concomitant HT received a higher number of RAITs and cumulative RAI activities. Initial RAIT reached an excellent response in 63% after one year and 84% after 5 years. The rate of excellent response one year and 5-year after first RAIT was significantly lower in HT groups, compared to not HT (p < 0.001). Instead, HT did not have a prognostic role considering PFS and OS; while stimulate thyroglobulin (sTg) at ablation was significantly related to survival.ConclusionsHT may affect the efficacy of RAIT in low to intermediate risk DTC, particularly reducing the successful rate of excellent response after RAIT. Instead, HT did not have a prognostic impact such as stimulated sTg.
Highlights
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, accounting for 1% of all cancers diagnosed each year [1, 2] and it is considered a slowly growing cancer with an overall good outcome, except of cases with distant metastases or radioiodine-refractory disease [3, 4]
Hashimoto thyroiditis (HT) is the most common autoimmune inflammatory thyroid disease with a worldwide annual incidence of 0.3–1.5 cases for 1000 persons and it is considered the first cause of hypothyroidism in the iodine-sufficient areas of the world [24]
HT brings a chronic inflammatory condition that awakens an immune response leading to a continuous damage of surrounding stromal cells; overall this phenomenon causes potential genetic alterations, an inappropriate cell proliferation, and increases the risk of neoplastic transformation
Summary
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, accounting for 1% of all cancers diagnosed each year [1, 2] and it is considered a slowly growing cancer with an overall good outcome, except of cases with distant metastases or radioiodine-refractory disease [3, 4]. The choice of most appropriate RAI activities to administer with the aim to reach an efficient remnant ablation and reduce the risk of recurrence is yet an open issue This point is even more debated in low-risk and intermediate-risk DTC, where it seems crucial to find the best balance between the effective cure and the risk of side effects (reduced radiation exposure, cost, time of hospitalization) [6,7,8,9]. The main aim of this study was to retrospectively investigate in a consecutive cohort of patients with low- to intermediate-risk DTC treated with total thyroidectomy and RAIT, the role of HT in predicting 1-year and 5-year treatment response and disease status. The second aim was to analyze the potential prognostic role of HT in this population
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