Serum Thyroglobulin Concentration Research Articles

The alternative value of thyroid stimulating hormone instead of thyroglobulin in differentiation of follicular thyroid neoplasm in Hashimoto’s thyroiditis

PurposesTo provide novel aspects for the preoperative diagnosis and appropriate differentiation strategies for follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA).MethodsAmong 25,765 cases, a total of 326 patients with follicular thyroid neoplasms between 2013 and 2019 were enrolled. Patient demographics, perioperative parameters, surgical profiles and oncologic outcomes were collected and analyzed.ResultsThere were no significant differences in preoperative ultrasound findings between FTA and FTC patients. The true positive rate (sensitivity) and true negative rate (specificity) of fine needle aspiration (FNA) for FTA patients were 0.6956 and 0.5000, respectively, and those for FTC patients were 0.0714 and 0.9348, respectively. Patients with FTC presented significantly higher serum thyroglobulin (TG) levels than patients with FTA. Preoperative TG level was positively related to tumor invasiveness and recurrence or distant metastases in FTC patients. There were 55 patients with Hashimoto’s thyroiditis (HT), accounting for 16.87% of enrolled patients. HT patients had significantly lower serum TG concentrations than antibody-negative patients. Among HT patients, no significant differences were observed in TG levels between the FTA and FTC groups. Instead, FTA patients had significantly higher serum thyroid stimulating hormone (TSH) levels and lower serum T3 (Triiodothyronine) levels compared to FTC patients. Serum TSH level >1.736U/L was associated with benign follicular neoplasms in HT patients according to the receiver operating characteristic (ROC) curve.ConclusionDistinguishing FTC from FTA remains a challenge for ultrasonography and FNA. Serum TG should be measured as a risk factor of FTC. However, in HT patients, serum TSH levels can serve as a more reliable indicator for differentiating FTC from FTA preoperatively.

Clinical implications of changing thyroglobulin and antithyroglobulin antibodies analytical methods in the follow-up of patients with differentiated thyroid carcinoma

Background and aimsPatients’ response to treatment in differentiated thyroid cancer (DTC) is classified according to serum thyroglobulin concentrations (Tg), usually using the American Thyroid Association guidelines and considering potential interfering anti-thyroglobulin antibodies (Ab-Tg). We aim to evaluate the clinical implications of changing Tg and Ab-Tg quantification method. Material and methodsTg and Ab-Tg were quantified in 82 serum samples (60 from DTC patients) by Elecsys and Access immunoassays. ResultsElecsys immunoassay rendered higher values of Tg than Access: mean bias 5.03 ng/mL (95%CI:-14.14–24.21). In DTC patients, there was an almost perfect agreement for response classification (kappa index = 0.833). Discrepancies appeared in patients with undetermined response, with a more tendency to subclassification with Access. Ab-Tg showed a poor correlation (r = 0.5394). When Elecsys cut-off was reduced to 43 IU/mL, agreement for positive/negative classification improved from a kappa index of 0.607 to 0.650. Prospective study with personalized follow-up showed that only 6.3% of Tg results required an analytical confirmation, being confirmed 93% of them. ConclusionsDespite the biases observed, clinical impact of an analytical change is minimal in patients’ management. However, cautious and personalized follow-up period after the change is still mandatory, especially in patients with Tg levels between 0.2 and 1 ng/mL.

PSAT373 Metformin Decreases Serum Thyroglobulin Concentration in Non-Medullary Thyroid Carcinoma

Abstract Background The conventional treatment of non-medullary thyroid carcinoma (NMTC) includes surgical resection, TSH suppression and 131-iodine. Although highly successful, some patients develop persistent/recurrent NMTC requiring alternative therapies, including external radiation and multikinase inhibitors, which may have clinically significant adverse side effects. In vitro studies, in vivo studies in animals, and association studies in humans suggest that metformin, an inexpensive medication with a modest side effect profile, may help prevent or treat NMTC. No interventional metformin trials have been performed in humans. Hypothesis We performed a proof-of-concept intervention trial to test the hypothesis that metformin will decrease serum thyroglobulin concentration (Tg), a surrogate marker for NMTC, in humans with persistent/recurrent NMTC burden. Methods In this IRB approved study, we administered metformin to patients with persistent/recurrent NMTC and analyzed the change in Tg. When available and possible, tumor burden was evaluated by CT imaging. Ten patients with persistent/recurrent well-differentiated NMTC (6 classic papillary thyroid cancer, 1 tall cell variant of papillary thyroid cancer, 2 follicular thyroid cancer, and 1 hurthle cell thyroid cancer) were included. All had exhausted conventional therapies including total thyroidectomy and 131-iodine. All had biochemical evidence of NMTC with Tg > 2 ng/mL, and with non-detectable serum thyroglobulin antibody concentrations. Six had microscopic NMTC not detectable by conventional imaging, and four had NMTC detectable on CT imaging. Five patients elected to be treated with metformin (500 to 2000 mg/d) for two to five months. The remaining five served as untreated controls. Since the Tg variances in the two groups were not equal, the nonparametric Mann-Whitney test was used to determine if the change in Tg was different in the metformin treated and untreated groups. Results Tg decreased in all five patients receiving metformin and increased in all five controls. The mean Tg decrease with metformin therapy was 21.7 ± 8.4%, and the mean Tg increase in the control group was 16.6 ± 12.1%; p < 0.02. TSH was suppressed to < 0.1 mIU/L in both groups at baseline and did not change significantly during the study. Two of the five patients receiving metformin elected to continue the metformin for longer, and the CT imaging studies were evaluable by RECIST criteria. There was no decrease in tumor size in either patient. The progression-free survival was 6 months in one patient and 10 months in the other, which may be longer than that reported for similar historical controls that range from 3.6 to 5.8 months. Summary In summary, metformin caused a TSH-independent decrease of Tg in patients with persistent/recurrent NMTC, but no decrease in tumor size in two evaluable patients. More extensive studies are necessary to determine if metformin slows NMTC progression. Conclusion Metformin decreases Tg in NMTC. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Thyroglobulin is a poor predictor of differentiated thyroid cancer in patients who undergo surgery for thyroid nodular diseases.

Thyroglobulin, produced exclusively by thyroid follicular cells, serves as a specific tumor marker for the follow-up of differentiated thyroid cancer (DTC) patients after thyroidectomy. However, its role as a predictor of malignancy in patients with thyroid nodules is controversial. We assessed the potential role of preoperative serum thyroglobulin concentration to predict DTC in patients without a preoperative diagnosis of malignancy who underwent partial or total thyroidectomy. This retrospective study included patients with a preoperative diagnosis of benign multinodular goiter (MNG) or a thyroid nodule with indeterminate cytology (INC) (Bethesda system categories III/IV) who underwent partial or total thyroidectomy between January 2014 and May 2019. We compared the patients' demographic, clinical, imaging, and biochemical data according to their final diagnosis: DTC or benign thyroid nodular disease. Further statistical analysis included odds ratio calculation and receiver operating characteristic (ROC) curve analysis. Of 131 patients who met inclusion and exclusion criteria, the indication for surgery was benign MNG in 69 patients and a thyroid nodule with INC in 62 patients. A final diagnosis of DTC was reported in 18 of the 69 benign MNG patients (26%) and in 30 of the 62 thyroid nodule with INC patients (48%). The preoperative measurements of nodule diameter and serum thyroid-stimulating hormone and thyroglobulin concentrations did not significantly differ between patients with a final diagnosis of DTC and those with benign histology. Preoperative serum thyroglobulin alone is insufficient to differentiate between malignant and benign thyroid nodular disease.

Metformin Decreases Serum Thyroglobulin Concentration in Nonmedullary Thyroid Carcinoma.

ContextThe conventional treatment of nonmedullary thyroid carcinoma (NMTC) includes surgical resection, thyrotropin (TSH) suppression, and 131-iodine. Some patients develop persistent/recurrent metastatic disease requiring expensive alternative therapies, such as external radiation and multikinase inhibitors, which may have clinically significant side effects. Recent in vitro studies, in vivo studies in animals, and association studies in humans suggest that metformin, an inexpensive medication with a modest side effect profile, may help prevent or treat NMTC. No interventional trials analyzing the effect of metformin have been performed in humans.ObjectiveWe hypothesize that metformin administration will decrease serum thyroglobulin concentration (Tg), a surrogate marker for NMTC burden.MethodsThis retrospective institutional review board–approved study included 10 patients with persistent/recurrent NMTC who had exhausted conventional therapies including total thyroidectomy and 131-iodine. Five had detectable disease on computed tomography imaging. All had biochemical evidence of NMTC with Tg > 2.0 ng/mL with nondetectable serum thyroglobulin antibody concentrations. Five elected to have metformin treatment at doses varying from 500 to 2000 mg/day for 2 to 5 months. The remaining 5 served as untreated controls. Statistical significance was determined by the Mann–Whitney test.ResultsTg decreased (mean decrease = 21.7 ± 8.4%) in all 5 patients receiving metformin and increased (mean increase = 16.6 ± 12.1%) in all 5 controls (P < .01). TSH did not change significantly in either group.ConclusionIn summary, metformin caused a TSH-independent Tg decrease in patients with persistent/recurrent NMTC. More extensive studies are required to determine if metformin slows NMTC progression

Randomised comparison of 1.1 GBq and 3.7 GBq radioiodine to ablate the thyroid in the treatment of low-risk thyroid cancer: a 13-year follow-up

Purpose: The optimal activity of radioiodine (I-131) administered for ablation therapy in papillary and follicular thyroid cancer after thyroidectomy remains unknown in a long-term (> 10 year) follow-up. Some, shorter follow-up studies suggest that activities 1.1 GBq and 3.7 GBq are equally effective. We evaluated the long-term outcomes after radioiodine treatment to extend current knowledge about the optimal ablative dose of I-131.Methods: One hundred and sixty consecutive adult patients (129 females, 31 males; mean age 46 ± 14 y, range 18–89 y) diagnosed with histologically confirmed differentiated thyroid cancer, were randomised in a prospective, phase III, open-label, single-centre study, to receive either 1.1 GBq or 3.7 GBq of I-131 after thyroidectomy. At randomisation, patients were stratified according to the histologically verified cervical lymph node status and were prepared for ablation using thyroid hormone withdrawal. No uptake in the whole-body scan with I-131 and serum thyroglobulin concentration less than 1 ng/mL at 4–8 months after treatment was considered successful ablation.Results: Median follow-up time was 13.0 years (mean 11.0 ± 4.8 y; range 0.3–17.1 y). Altogether 81 patients received 1.1 GBq with successful ablation in 45 (56%) patients. In the original study, thirty-six patients (44%) needed one or more extra administrations to replete the ablation. Of these, 4 (8.9%) and 5 (14%) patients relapsed during the follow-up, respectively. Of the 79 patients treated with 3.7 GBq 45 (57%) had successful ablation after one administration of radioiodine and 34 (43%) needed several treatments. Of these, 2 (4.4%) and 9 (26.5%) patients relapsed, respectively. The groups did not differ in the proportion of patients relapsing (p = .591).Conclusion: During follow-up of median 13 years, 3.7 GBq is not superior to 1.1 GBq in the radioiodine treatment after thyroidectomy in papillary and follicular thyroid cancer.

Heterophile antibody interference associated with natural killer cell therapy.

The adoptive transfer of ex vivo-expanded natural killer (NK) cells has recently been employed as an alternative cancer treatment in certain institutions. However, the safety profiles of this strategy remain uncharacterized. We evaluated three patients who exhibited elevated serum parathyroid hormone (PTH) levels without the relevant clinical manifestations and had a history of autologous NK cell therapy. The serum PTH concentration was measured using a second-generation PTH assay, and the serum thyroglobulin concentration was measured using a second-generation thyroglobulin assay. Subsequently, the PTH or thyroglobulin concentration obtained using heterophile-blocking tube (HBT) for a secondary confirmation assay was measured and compared with the result of the initial assay. The three patients had falsely elevated serum PTH and thyroglobulin levels owing to heterophile antibody interference associated with NK cell therapy that persisted for at least up to 12 months after the treatment and was confirmed by normalization of hormone levels after HBT treatment. We propose that certain types of mouse monoclonal antibodies used to stimulate NK cells can induce heterophile antibodies. Abnormal laboratory test results in individuals administered NK cell therapy without the relevant clinical manifestations must be examined in the context of heterophile antibody interference to avoid misdiagnosis and unnecessary testing.

Preoperative significance of thyroglobulin, thyroid stimulating hormone and thyroglobulin antibody in differentiated papillary thyroid carcinoma

Background: The objective of the study was to compare the levels of preoperative thyroglobulin (TG), thyroid stimulating hormone level (TSH), FT3, FT4 and TG Ab among 50 malignant and 50 benign thyroid swellings. Papillary thyroid cancer (PTC) is the most common malignancy in thyroid gland. TG antibodies (Ab) occur in around 20% of patients with papillary thyroid cancer (PTC), and the presence of TG Ab complicates the follow-up of these patients because TG-Ab interferes with the assay of serum TG7.Methods: A prospective and retrospective study conducted on 100 patients with thyroid nodule diagnosed by neck ultrasound and confirmed by histopathological evaluation in Faculty of Medicine, Menoufia University Hospital, Egypt, during January 2017 to July 2019. History taking, levels of TG, TSH free T3, free T4 and TG Ab, neck ultrasound or CT and pathological evaluation were done.Results: There were statistically significant differences between malignant and benign thyroid swellings regarding, TG level, TSH and T4 level. Also, there was statistically significant difference between the level of TG and tumor recurrence (p=0.01). While, there was no statistical significance between focality, staging, lymph node status, capsular invasion, lymphovascular embolization, and evidence of hashimoto thyroiditis and the level of TG.Conclusions: Preoperative serum TG concentration is a useful marker for predicting the presence of initial distant metastasis of PTC and tumor recurrence. TSH level considered an important prognostic factor for papillary thyroid cancer patients.

Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders.

Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders.

Preoperative Serum Thyroglobulin Level as a Useful Predictive Marker to Differentiate Thyroid Cancer

Introduction: Thyroid cancer is the most common endocrine system cancer. Although fine-needle aspiration biopsy is the most commonly used method for diagnosis, it is not always sufficient. The aim of this study was to investigate the influence of preoperative serum thyroglobulin (Tg) concentration on differentiated thyroid cancer risk. Material and Methods: A total of 133 patients who underwent total thyroidectomy due to various indications at the Ear-Nose-Throat Department, Ataturk University Medical School, between April 2015 and December 2015, were included in this prospective study. Histopathological diagnosis and preoperative Tg levels were compared. Receiver operating characteristic (ROC) analysis was used for detection of the cut-off to discriminate malignant from benign thyroid masses using preoperative Tg as a variable. Results: Malignant pathology (differentiated thyroid carcinoma) was detected in 59 out of 133 patients (44.4%) and benign pathology in 74 (55.6%). A statistically significant difference in preoperative Tg value was detected between malignant and benign cases (p < 0.05). Conclusion: The prevalence of differentiated thyroid carcinoma was higher among patients with a preoperative serum Tg value > 188.5 ng/mL, and this may thus be used as a marker for the diagnosis of this malignancy.

Outcome after ablation in patients with low-risk thyroid cancer (ESTIMABL1): 5-year follow-up results of a randomised, phase 3, equivalence trial

In ESTIMABL1, a randomised phase 3 trial of radioactive iodine (131I) administration after complete surgical resection in patients with low-risk thyroid cancer, 92% of patients had complete thyroid ablation at 6-10 months, defined as a recombinant human thyroid-stimulating hormone (rhTSH)-stimulated serum thyroglobulin concentration of 1 ng/mL or less and normal findings on neck ultrasonography. Equivalence was shown between low-activity (1·1 GBq) and high-activity (3·7 GBq) radioactive iodine and also between the use of rhTSH injections and thyroid hormone withdrawal. Here, we report outcomes after 5 years of follow-up. This multicentre, randomised, open-label, equivalence trial was done at 24 centres in France. Between March 28, 2007, and Feb 25, 2010, we randomly assigned (1:1:1:1) adults with low-risk differentiated thyroid carcinoma who had undergone total thyroidectomy to one of four strategies, each combining one of two methods of thyrotropin stimulation (rhTSH or thyroid hormone withdrawal) and one of two radioactive iodine activities (1·1 GBq or 3·7 GBq). Randomisation was by computer-generated sequence, with variable block size. Follow-up consisted of a yearly serum thyroglobulin measurement on levothyroxine treatment. Measurement of rhTSH-stimulated thyroglobulin and neck ultrasonography were done at the discretion of the treating physician. No evidence of disease was defined as serum thyroglobulin of 1 ng/mL or less on levothyroxine treatment and normal results on neck ultrasonography, when performed. This study was registered with ClinicalTrials.gov, number NCT00435851. 726 patients (97% of the 752 patients originally randomised) were followed up. At a median follow-up since randomisation of 5·4 years (range 0·5-9·2), 715 (98%) had no evidence of disease. The other 11 had either structural disease (n=4), raised serum thyroglobulin concentration (n=5), or indeterminate findings on neck ultrasonography (n=2). At ablation, six of these patients had received 1·1 GBq radioactive iodine (five after rhTSH and one after withdrawal) and five had received 3·7 GBq (two after rhTSH and three after withdrawal). TSH-stimulated (either after rhTSH injections or thyroid hormone withdrawal according to the treatment group) thyroglobulin concentration measured at the time of ablation was prognostic for structural disease status at ablation, ablation status at 6-10 months, and the final outcome. Our findings suggest that disease recurrence was not related to the strategy used for ablation. These data validate the use of 1·1 GBq radioactive iodine after rhTSH for postoperative ablation in patients with low-risk thyroid cancer. French National Cancer Institute (INCa), French Ministry of Health, and Sanofi Genzyme.

The Association between Ocular Problems and Serum Testosterone, Prolactin and Thyroglobulin Concentrations in Delayed Phase of Sulfur Mustard Exposure

Aside from direct toxic effects, Sulfur Mustard (SM) induced serum hormone abnormalities may aggravate ocular complaints, including Ocular Surface Discomfort (OSD) (burning, itching, and redness), dry eye sensation, photophobia, blurred vision, foreign body sensation, and pain. The aim of the current study was to investigate the possible association of ocular complaints with serum hormone concentrations in chronic phase of Sulfur Mustard (SM) exposure. As a part of Sardasht Iran Cohort Study (SICS), 372 SM-exposed patients and 128 non-exposed participants were enrolled. Ocular complaints and ocular surface biomicroscopic conditions and serum hormones were compared. The exposed with tearing group had significantly higher mean serum levels of testosterone and prolactin (ng/mL) than controls (5.75 vs. 4.75, P=0.031; 11.71 vs. 8.42, P=0.009). The exposed with OSD group had significantly higher mean serum levels of prolactin than controls (12.48 vs. 6.90, P=0.002). The exposed with photophobia group had significantly higher mean serum levels of testosterone than the matched exposed (6.25 vs. 5.65, P=0.013). The exposed with blurred vision group had significantly higher mean serum levels of Thyroglobulin (Tg) (ng/mL) than the matched exposed (65.73 vs. 32.6, P=0.003). Higher mean serum levels of testosterone (in exposed with tearing and photophobia) and prolactin (in exposed with tearing and OSD) may play protective roles against SM effects. Higher mean serum levels of Tg may deteriorate the tear film integrity and optical surface, which causes blurred vision. In the chronic phase of SM toxicity, some ocular surface problems are associated with alterations in the serum concentrations of testosterone, prolactin, and Tg.

Overwhelming rapid metabolic and structural response to apatinib in radioiodine refractory differentiated thyroid cancer.

Currently, patients with radioiodine refractory differentiated thyroid cancer (RAIR-DTC) have limited treatment options. In this study, we aimed to assess the short-term efficacy and safety of apatinib in RAIR-DTC. Ten adult patients were prospectively enrolled to receive oral apatinib (750 mg q.d). The primary endpoints were change in serum thyroglobulin (Tg) concentration, disease control rate (DCR) and objective response rate (ORR) based on RECIST 1.1 criteria. The secondary endpoints included change in glucose metabolism, evaluated by maximum standard uptake value (SUVmax), and safety. As early as 2 weeks after apatinib treatment, the serum Tg concentration decreased by 21.0% in 8 patients available for detection without interference, and a further sharp decline by 81.4% compared with the baseline level occurred at 8 weeks post-treatment. The DCR and ORR were 100% (10/10) and 90% (9/10), respectively. The sum of tumor diameter shrank to 22.8±8.1 mm from 38.8±15.7 mm (P=0.001). Moreover, a significant decrease in SUVmax was observed from 6.53±5.14 to 2.56±1.67 and 2.45±1.48 at 4-week and 8-week time-points after treatment (P=0.032 and 0.020), respectively. The common grade 3 adverse events (AEs) included hand-foot-skin reaction (50%), hypertension (30%), and hypocalcemia (20%). No severe AE related to apatinib was observed during treatment. Hence, apatinib seems to be a promising therapeutic option for RAIR-DTC patients. Apart from RECIST 1.1 criteria, the biochemical marker (Tg) and glucose metabolism index (SUVmax) could be adopted in assessing the early response to TKI in RAIR-DTC.

Serum Thyroglobulin Concentration Is a Weak Marker of Iodine Status in a Pregnant Population with Iodine Deficiency

Objective: To assess the reliability of thyroglobulin (Tg) as a marker of iodine status during pregnancy. Design: 299 women aged 30.5 ± 4.8 years (mean ± SD) were studied. Methods: In every subject, we measured urinary iodine concentration (UIC), serum thyrotropin (TSH), Tg, free thyroxine (fT₄), Tg autoantibodies (TgAbs) and human chorionic gonadotropin (hCG) levels. We excluded samples with increased TgAbs from the analysis. Results: According to WHO criteria, the study population was iodine deficient in every trimester. Serum Tg levels did not differ during the three trimesters of pregnancy. Serum hCG levels fell significantly as pregnancies advanced. A weak, significantly negative correlation (limited to the 3rd trimester) was found between Tg and UIC (ρ = -0.187, p = 0.039). Serum fT₄ decreased as pregnancies advanced and TSH increased. Serum fT₄ was negatively correlated with TSH (ρ = -0.161, p = 0.006) and positively with hCG (ρ = +0.165, p = 0.005). The multiple regression equation of Tg based on hCG, TSH, UIC and trimester of pregnancy was significant but weak (F = 4.057, p = 0.003; R² = 0.055), with hCG as a significant predictor Tg (p for log hCG = 0.041). Conclusions: Tg cannot be considered as a valid marker of iodine deficiency in pregnancy, at least in a mildly iodine-deficient environment. Further studies in a larger patient cohort with differences in iodine status, as well as studies on Tg changes after improving iodine status in pregnant women, are needed in order to corroborate these results.

A Case of Acute Suppurative Thyroiditis Accompanied by Transient Abducens Nerve Palsy

ABSTRACT Objective: This article reports the case of a 66-year-old female that developed right abducens nerve palsy 1 week after the onset of acute suppurative thyroiditis on her left side. Recurrent laryngeal nerve palsy has not been previously reported in a patient with acute suppurative thyroiditis and abducens nerve palsy. Methods: A medical examination of the patient revealed abnormal eye movements but no other abnormal neurological findings. Warmth, redness, and tenderness in the left anterior neck were noted along with right abducens nerve palsy. Laboratory data suggested a bacterial infection. Serum thyroid hormone and thyroglobulin concentrations were elevated. Computed tomography demonstrated unclear edematous changes together with the presence of air noted on the left side of the upper thyroid. Results: The patient was treated with an empiric broad-spectrum antibiotic and her suppurative thyroiditis improved. Two months after therapy, the right abducens nerve palsy improved without additional t...

Treatment Outcomes and Risk Factors for Recurrence After Definitive Surgery of Locally Invasive Well-Differentiated Papillary Thyroid Carcinoma

Papillary thyroid carcinoma (PTC) is generally an indolent tumor that has a favorable prognosis. However, locally invasive PTC can recur after treatment, and its optimal treatment is still controversial. This study aimed to evaluate treatment outcomes and identify risk factors for recurrence and survival in patients with locally invasive PTC. All consecutive patients who underwent definitive surgery and radioactive iodine therapy for non-distant metastatic invasive PTC were included. Clinical factors, operative and pathological findings, surgical morbidity, and recurrences were recorded. Univariate and multivariate Cox proportional hazard models served to identify factors associated with recurrence-free survival (RFS) and overall survival. Of the 96 patients, 74 (77%), 52 (55%), 4 (4%), and 14 (15%) had invasion to the recurrent laryngeal nerve (RLN), trachea, larynx, and esophagus, respectively; 39 (41%) had preoperative vocal cord paresis or paralysis; and 24 (25%) developed recurrence during follow-up (median 77 months). The patients with single and multiple organ invasion did not differ significantly in terms of recurrence-free or overall survival (p > 0.05). The patients with and without recurrences did not differ in terms of surgical extent and involving nerve preservation. Multivariate analysis showed that high (≥1 ng/mL) post-ablation stimulated serum thyroglobulin concentration was an independent predictor of poor RFS (p = 0.013). Disease extent, surgical extent, and involving nerve preservation did not associate with recurrence or overall survival outcomes. The post-ablation stimulated thyroglobulin level may be an independent predictor for recurrence. Careful follow-up of patients with this risk factor is recommended.

Serum Thyroglobulin Concentrations Are Sensitive to Moderate Increases in Dietary Iodine Intake

Clinical ThyroidologyVol. 27, No. 10 SummariesSerum Thyroglobulin Concentrations Are Sensitive to Moderate Increases in Dietary Iodine IntakeAlbert G. BurgerAlbert G. BurgerSearch for more papers by this authorPublished Online:8 Oct 2015https://doi.org/10.1089/ct.2015;27.287-288AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Serum Thyroglobulin Concentrations Are Sensitive to Moderate Increases in Dietary Iodine Intake." Clinical Thyroidology, 27(10), pp. 287–288FiguresReferencesRelatedDetails Volume 27Issue 10Oct 2015 InformationCopyright 2015 American Thyroid Association, Inc.To cite this article:Albert G. Burger.Serum Thyroglobulin Concentrations Are Sensitive to Moderate Increases in Dietary Iodine Intake.Clinical Thyroidology.Oct 2015.287-288.http://doi.org/10.1089/ct.2015;27.287-288Published in Volume: 27 Issue 10: October 8, 2015PDF download

Prognostic Value of Basal Serum Thyroglobulin Levels, but Not Basal Antithyroglobulin Antibody (TgAb) Levels, in Patients with Differentiated Thyroid Cancer.

Objective: The prognostic values of serum thyroglobulin (Tg) and antithyroglobulin antibody (TgAb) levels, measured immediately before I-131remnant ablation in patients with differentiated thyroid cancer (DTC), have been advocated by some researchers; however, it had controversial outcomes. This study was carried out to examine this dilemma and to check the clinical significance of basal serum Tg and TgAb levels and postablation iodine 131whole body scan(WBS) findings in DTC patients. Methods: In this retrospective study, the records of 500 patients with differentiated thyroid cancer, who had undergone treatment between 2003 and 2010, were assessed. Of those, 149 patients with results of basal serum thyroglobulin concentration and whole body scan using radioactive iodine were included. Age, sex, tumour histology, basal thyroglobulin (Tg), anti-thyroglobulin (TgAb) and TSH concentration, radioactive iodine doses in each hospitalization, numbers of hospitalization, and results of whole body scans were recorded. The relationship among basal Tg, TgAb, TSH, and whole body scan with hospitalization number and total radioactive iodine doses were assessed. Results: A total of 149 patients, including 123 (83%) females and 26 (17%) males, with a mean age of 40±15 years, took part in the study. The mean (SD) basal Tg, TgAb, and TSH were 91.7±169.2 ng/mL (0.1-1000 ng/mL), 250±893 U/mL (0-9000 U/m L), and 64.8±61.5 µU/mL (30-689 U/mLµ), respectively. A total of 52 (34.9%) cases had TgAb levels greater than 100 U/mL. The mean basal Tg in patients who were admitted three or more times was significantly greater than that of patients with one hospitalization (p=0.026). In addition, the mean of Tg in patients who received 7.4 GBq radioactive iodine or less was significantly lower than the others (p=0.003). The mean of TgAb and TSH were not different between these groups. In the results of the whole body scans, patients with metastasis had higher frequency of hospitalization (p=0.010) and received higher radioactive iodine levels (p<0.001). Conclusions: The findings of this study showed that, in differentiated thyroid cancer, lower basal serum Tg levels and absence of metastasis in radioiodine scan after ablation treatment were correlated with fewer hospitalizations and lower doses of radioactive iodine. Basal TgAb and TSH had no relation. Therefore, it seems that basal Tg could help us in determining which patients need aggressive treatment.

Clinical significance of thyroglobulin autoantibodies enhancement in patients with differentiated thyroid cancer after thyroidectomy and radioiodine therapy

Purpose: to evaluate the clinical utility of antithyroglobulin antibodies (TgAb) as a tumor marker in patients with differentiated thyroid cancer (DTC) after thyroidectomy and radioiodine ablation. Patients and methods. From 345 consecutive DTC patients after thyroidectomy and radioiodine ablation we select ed 148 patients with elevated TgAb level (with distant metastasis n = 93, without distant metastasis n = 55). Serum TgAb concentration was measured before radioiodine ablation and then every time before 131I treatment (RIT) or diagnostic 131I whole body scanning (WBS). Results were compared with serum thyroglobulin (Tg) concentration, neck echography, lung and bone roentgenography and 131I WBS findings. Results. TgAb level was elevated in 21% DTC patients before 131I ablation. The other 22% with initially normal TgAb displayed their rising during followup. In absence of distant metastasis TgAb declined after 1 st–2 nd cycle of RIT (an average 8.9 months after 131I ablation). Persistance or rising of TgAb in the longer term was associated with detectable thyroid remnant, residual tumor or metastatic lymph nodes. In case of negative TgAb status after sugery an increase of TgAb during first 3–6 months after ablation indicated mostly a response to the rise of Tg antigen secondary to 131I ablation. A rise TgAb in the longer term (after 3rd–5th cycles of RIT) indicated to residual or recurrent disease in 86% cases. In patients with distant metastasis there were no correlation between change in TgAb concentration and clinical sta tus, including the rate of regression of metastatic disease. But in case of low or undetectable Tg and permanent high TgAb level only TgAb indicated the presence of disease. Conclusion: persistence or rising TgAb in longer term after 131I ablation can serve as surrogate tumor marker of per sistent or recurrent disease. It is critical to measure TgAb concentration, especially in patients with low or unde tectable Tg, because in these cases TgAb appears to be the only serum DTC tumor marker.

Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders

Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders