Serum Thyroglobulin Research Articles

Improvement in neck ultrasound report quality following the implementation of European Thyroid Association guidelines for postoperative cervical ultrasound for thyroid cancer follow-up, a prospective population study.

The aim of this study was to prospectively evaluate the quality of postoperative neck ultrasound (POU) for thyroid cancer patients after implementing European Thyroid Association (ETA) guideline-based POU assessment. Our analysis involved 672 differentiated thyroid cancer patients. POU report quality was compared between the implementation radiology group (IRG), which implemented ETA guideline-based assessment in 2018, and all non-implementation radiology groups (NIRG). Differences in POU quality were evaluated before and after the implementation of guideline-based assessment. Additionally, we evaluated the ability of serum thyroglobulin (Tg) level <0.2 ng/mL or between 0.21 and 0.99 ng/mL and normal POU lesion status at 1-year follow-up to predict the absence of persistent disease or relapse at 3-year follow-up. IRG had significantly higher mean utility scores for POU reports of abnormal thyroid bed nodules compared to NIRG (P < 0.001). IRG's POU reports for suspicious nodules and lymph nodes were considered sufficient in 94% and 85% of cases, respectively, compared to 45% and 68% for NIRG. For patients with normal US lesion status and Tg <0.2 ng/mL or Tg 0.21-0.99 ng/mL at 1-year follow-up, the negative predictive values were 96% for both. Implementation of 2013 ETA POU-reporting guidelines allowed for the provision of high-quality POU reports, which may lead to increased accuracy in assessing the response to treatment and in estimating the risk of recurrence of thyroid cancer and likely reduce unnecessary repeat POU or FNA.

Significance of Thyroglobulin Autoantibodies in Patients With Thyroid Cancer Treated With Lenvatinib

Abstract Context Serum thyroglobulin (Tg) is a highly sensitive and specific tumor marker, employed in post-operative management of patients with differentiated thyroid carcinomas. Tumor shrinkage of radioiodine-refractory thyroid cancer (RAIR-DTC) treated with multitarget kinase inhibitors as lenvatinib, expressed according to the Response Evaluation Criteria in Solid Tumors (RECIST), is also associated with a drastic reduction of Tg levels. However, interference caused by circulating thyroglobulin autoantibodies (TgAb) represents the main limitation in the clinical use of Tg. Objective To evaluate if in RAIR-DTC TgAb could be considered a surrogate marker of Tg in monitoring response to treatment with lenvatinib. Design We retrospectively evaluated patients who had started lenvatinib and correlated serum Tg and TgAb with the radiological response across visits. Setting University of Pisa, Italy. Patients We selected 9/97 RAIR-DTC patients with detectable TgAb. Intervention None. Main Outcome Measure(s) None. Results Tg values correlated neither with TgAb title nor with radiological response across visits. Greater decreases in TgAb titer correlated with favorable radiological response to lenvatinib after 1 month (Spearman's correlation = 0.74, P = .021) and 6 months (correlation = 0.61, P = .079). According to RECIST, patients with partial response showed a ∼10-fold greater decrease in TgAb compared to those with stable disease at 1 month (median TgAb decrease: −142 vs −14 IU/mL, P = .01) and those with progressive disease at 6 months (median TgAb decrease: −264 vs−24 IU/mL, P = .04). Conclusion TgAb evaluation may represent a reliable surrogate marker for Tg trend in evaluating response of RAIR-DTC to treatment with lenvatinib. A multicentric study would be useful to confirm our results.

Predicting clinical outcomes of patients with serum thyroglobulin antibodies after thyroidectomy for differentiated thyroid cancer: a retrospective study from a UK regional center.

Twenty-twenty-five percent of patients with differentiated thyroid cancer (DTC) can have elevated thyroglobulin antibodies (TgAb). The study aimed to find any prognostic significance of elevated TgAb during follow-up. Ten-year retrospective study from a tertiary center including 79 patients with raised TgAb after total/staged thyroidectomy for DTC. We identified patients with stable (7.6%), increasing (15%) and decreasing levels of TgAb (77.2%); groups 1, 2 and 3 respectively. During follow-up we analyzed TgAb in subcategories by TgAb trend (>50% rise, <50% rise, >50% decline, <50% decline, positive to negative/normalization, negative to positive and stable levels), gender, age, surgery, autoimmune disease, histology, RAI uptake, distant metastases, and recurrence. The incidence of raised TgAb levels was 33.2%, with female predominance. No connection was identified regarding other parameters. 11.4% had distant metastases. The highest mean maximum levels of TgAb was in group 2 (1918.75 IU/mL) and the lowest in group 3 (412.70 IU/mL). The recurrence rate changed significantly between the 3 groups: 50% in group 1, 75% in group 2, and 25% in group 3 (P=0.002). Recurrence rates decreased to 15% in the subcategory where TgAb became negative/normal from positive (P=0.0001). In patients with a negative to positive TgAb level trend or >50% rise, recurrence rates were 100% (P=0.041) and 70% (P=0.012) respectively. Patients with increasing TgAb levels during follow-up have a higher rate of recurrence, distinctly for those with negative to positive trend and >50% rise in TgAb. These patients need closer follow-up, and TgAb may be used as a dynamic follow-up marker.

Does Iodine Intake Modify the Effect of Maternal Dysglycemia on Birth Weight in Mild-to-Moderate Iodine-Deficient Populations? A Mother-Newborn Prospective Cohort Study.

It is unclear how maternal glycemic status and maternal iodine status influence birth weight among individuals with mild-to-moderate iodine deficiency (ID). We studied the association between birth weight and both maternal glucose levels and iodine intake among pregnant women with mild-to-moderate ID. Glucose values were assessed using a glucose challenge test (GCT) and non-fasting glucose levels that were determined before delivery; individuals' iodine statuses were assessed using an iodine food frequency questionnaire; and serum thyroglobulin (Tg) and urinary iodine concentrations (UIC) were used to assess each group's iodine status. Thyroid antibodies and free thyroxine (FT4) levels were measured. Obstetric and anthropometric data were also collected. Large-for-gestational age (LGA) status was predicted using a Cox proportional hazards model with multiple confounders. Tg > 13 g/L was independently associated with LGA (adjusted hazard ratio = 3.4, 95% CI: 1.4-10.2, p = 0.001). Estimated iodine intake correlated with FT4 among participants who reported consuming iodine-containing supplements (ICS) after adjusting for confounders (β = 0.4, 95% CI: 0.0002-0.0008, p = 0.001). Newborn weight percentiles were inversely correlated with maternal FT4 values (β = -0.2 95% CI:-0.08--56.49, p = 0.049). We conclude that in mild-to-moderate ID regions, insufficient maternal iodine status may increase LGA risk. Iodine status and ICS intake may modify the effect that maternal dysglycemia has on offspring weight.

Early Post-operative Stimulated Serum Thyroglobulin: Role in Preventing Unnecessary Radioactive Iodine Treatment in Low to Intermediate Risk Papillary Thyroid Cancer.

The aims of the study are to evaluate the predictive value of early post-operative stimulated thyroglobulin (sTg) analysis on the recurrence risk, and to define a cut-off value that is related to recurrence risk in low to intermediate risk papillary thyroid cancer (PTC). This retrospective cohort study included individuals who were diagnosed with PTC aged 18 years or older and had been operated by experienced surgeons of a tertiary university hospital between the years 2011 and 2021. The American Thyroid Association thyroid cancer guidelines version 2015 was used as the risk stratification system. Early sTg measurement obtained at 3-4 weeks after surgery when TSH >30 µIU/mL. Data was collected from the hospital database. A total of 328 patients who had post-operative early sTg values with negative anti-Tg antibodies were included. The median age was 44 years. Of the 328 patients, 223 (68%) were women. The median tumor diameter was 11mm. One hundred ninety-one patients (58.2%) had low risk and 137 (41.8%) had intermediate risk for recurrent disease. Of the 328 patients, 4.0% had recurrent disease. In multivariate Cox regression, post-operative early sTg value [OR: 1.070 (1.038-1.116), P = .000], and the pre-operative malign cytology [OR: 1.483 (1.080-2.245), P = .042] were independent risk factors for recurrence. On the ROC curve analysis, the cut-off value of early sTg was 4.1ng/mL for those with recurrent disease. This study demonstrated that early sTg could predict recurrent disease in patients with low to intermediate risk PTC. A cut-off of 4.1ng/mL was identified with a high negative predictive value.

Clinical value of 125I radioactive seed implantation in the treatment of lymph node metastasis of 131I refractory differentiated thyroid cancer

PurposeTo evaluate the clinical value of 1251 seed implantation in the treatment of lymph node metastasis of 111 cases of refractory differentiated thyroid cancer (RAIR-DTC). Methods and materialsFrom January 2015 to June 2016, 42 patients with RAIR-DTC with lymph node metastasis (14 males and 28 females, median age 49 years) were analyzed retrospectively. After CT-guided 1251 seed implantation, CT was reexamined 2,4,6 months after operation, and the changes of metastatic lymph node size, serum thyroglobulin (Tg) level and complications were compared before or after treatment. Paired-Samples T Test, Methods repetitive measure analysis of variance, Spearman correlation coefficient analysis were used to analyze the data. ResultsAmong the 42 patients, 2 had complete remission (4.76%), 9 had partial remission (21.43%), 29 had no change (69.05%), and 2 had disease progression (4.76%), with an overall effective rate of 95.24% (40/42). The diameter of lymph node metastasis was (1.39 ± 0.75) cm after treatment and (1.99 ± 0.38) cm before treatment; the diameter of lymph node metastasis was significantly reduced after treatment compared with that before metastasis (t = 5.557, P< 0.01); the serum Tg at 2, 4 and 6 months after treatment were (53.34 ± 14.05) ug/L, (33.17 + 7.61)ug/L and (25.93 ± 10.91)ug/L, respectively, compared with (57.72 ± 15.23)ug/L before treatment, and the differences between serum Tg after treatment and before treatment were all statistically significant (F = 23.612,P<0.05). Except for the diameter of lymph node metastasis (χ2 = 4.524, P<0.05), the patients' age, gender, metastasis site and the number of implanted particles per lesion were not influential factors in the efficacy (χ2 = 0.569–15.884, rs = 0.277, all P>0.05). Conclusion125I RSIT can significantly alleviate the clinical symptoms of RAIR-DTC patients with LNM, and the LNM lesions size has relevance for the treatment effect. The clinical follow-up time of serum Tg level can be extended to 6 months or even longer.

Comparison of Radioactive Iodine Activities in Terms of Short- and Long-term Results in Ablation Therapy in Patients with Low-risk Differentiated Thyroid Cancer.

The aim of this study was to compare the treatment responses after ablation with 30-50 mCi radioactive iodine (RAI) and 100 mCi RAI in patients with differentiated thyroid cancer (DTC) who were in the low-risk group according to 2015 American Thyroid Associations Classification (ATA 2015) criteria. Between February 2016 and August 2018, 100 patients who received RAI treatment in our clinic after total thyroidectomy and who were in the low-risk group DTC were included in this retrospective study. These patients were divided into 2 groups: low-activity (30-50 mCi) (group 1) and high-activity (100 mCi) (group 2). While 54 patients were treated with low activity, 46 patients received high activity RAI. The 2 groups were compared according to the 1st- and 3rd-year treatment response status. According to the first-year follow-up, 15 patients were accepted as indeterminate response and 85 patients as excellent response. Three (5.5%) of the patients who were accepted as indeterminate response were in group 1 and 12 (26%) were in group 2. According to the third year follow-up, 1 patient in group 1 and 3 patients in group 2 were accepted as indeterminate response. No biochemical incomplete response or recurrent disease was detected. In the chi-square analysis performed to investigate the relationship between the first-year treatment response and RAI activities, a significant relationship was found (p=0.004). In the Mann-Whitney U test performed to investigate the parameters that may be effective in the treatment response, only the preablative serum thyroglobulin value was shown to have a significant difference between the two groups (p=0.01). In the long-term follow-up of the patients, based on the third year treatment response data, chi-square analysis was performed to evaluate the two groups in terms of treatment responses, and no statistically significant relationship was found (p=0.73). Ablation with 30-50 mCi can be safely applied in DTC patients who are in the ATA 2015 low-risk group and are planned for RAI ablation treatment.

Predictive Role of Serum Thyroglobulin after Surgery and before Radioactive Iodine Therapy in Patients with Thyroid Carcinoma.

Thyroidectomy followed by radioactive iodine therapy (RAI) is the treatment of choice for differentiated thyroid carcinoma (DTC). Serum thyroglobulin (Tg) measurement has proved to be useful for predicting persistent and/or recurrent disease during follow-up of DTC patients. In our study, we evaluated the risk of disease recurrence in patients with papillary thyroid carcinoma (PTC), who were treated with thyroidectomy and RAI, by measuring serum Tg at different time-points: at least 40 days after surgery, in euthyroidism with TSH < 1.5 and usually 30 days before RAI (Tg-30), on the day of RAI (Tg0), and seven days after RAI (Tg+7). One hundred and twenty-nine patients with PTC were enrolled in this retrospective study. All patients were treated with 131I for thyroid remnant ablation. Disease relapse (nodal disease or distant disease) during at least 36 months follow-up was evaluated by serum measurements of Tg, TSH, AbTg at different time points and by imaging techniques (neck ultrasonography, 131I-whole body scan (WBS) after Thyrogen® stimulation). Typically, patients were assessed at 3, 6, 12, 18, 24, and 36 months after RAI. We classified patients in five groups: (i) those who developed nodal disease (ND), (ii) those who developed distant disease (DD), (iii) those with biochemical indeterminate response and minimal residual thyroid tissue (R), (iv) those with no evidence of structural or biochemical disease + intermediate ATA risk (NED-I), and (v) those with no evidence of structural or biochemical disease + low ATA risk (NED-L). ROC curves for Tg were generated to find potential discriminating cutoffs of Tg values in all patients' groups. A total of 15 out of 129 patients (11.63%) developed nodal disease and 5 (3.88%) distant metastases, during the follow-up. We found that Tg-30 (with suppressed TSH) has the same sensitivity and specificity than Tg0 (with stimulated TSH), and it is slightly better than Tg+7, which can be influenced by the size of the residual thyroid tissue. Serum Tg-30 value, measured in euthyroidism 30 days before RAI, is a reliable prognostic factor to predict future nodal or distant disease, thus allowing to plan the most appropriate therapy and follow-up.

The determinants of thyroid function among vegetable farmers with primary exposure to chlorpyrifos: A cross-sectional study in Central Java, Indonesia

ObjectivesOccupational pesticide exposure, chlorpyrifos (CPF) in particular, may adversely affect the thyroid. The purpose of this study was to evaluate the determinants of thyroid function as indicated by the serum concentration of thyroid-stimulating hormone (TSH) among Indonesian vegetable farmers with primary exposure to CPF. MethodsA total of 151 vegetable farmers participated in this study. The sociodemographic and occupational characteristics of the participants were obtained using a structured interviewer-administered questionnaire. A validated quantitative method was used to estimate the cumulative exposure level (CEL). Serum TSH, thyroglobulin (Tg), free thyroxine (FT4), and urinary iodine excretion (UIE) were measured in the laboratory. The difference in TSH concentrations according to CEL and other characteristics were analysed using the Mann-Whitney U test. A multiple linear regression model was used to evaluate the potential determinants of TSH. ResultsThe mean age was 50 (SD 9.4) years. The median concentrations of TSH, FT4, and Tg/FT4 ratio were 1.46 mIU/L, 1.17 ng/dL, and 6.23 × 102, respectively. We observed that higher TSH concentrations were found among those with a higher Tg/FT4 ratio, were classified as high CEL, and had lower UIE or FT4. ConclusionsOur findings show that Tg/FT4 ratio, CEL, FT4, UIE concentrations, and post-spraying days were determinants of TSH concentrations among farmers with primary exposure to CPF. These results indicate that farmers are exposed to agents with thyroid-disrupting properties, thus supporting previous evidence showing the potential for thyroid disorders in agricultural populations exposed to pesticides.

Long-term results of radiofrequency ablation for locally recurrent papillary thyroid carcinoma

Objective To evaluate the long-term efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) for treating locally recurrent papillary thyroid cancer (PTC). Methods This retrospective study involved 32 patients with pathologically confirmed locally recurrent PTC. The ablation zone was assessed by contrast-enhanced ultrasound (CEUS) after RFA. At baseline, 6 and 12 months and every 6 months or 12 months thereafter, the following results were recorded: recurrence rate, largest diameter, volume, volume reduction rate (VRR) of recurrent lesions, serum thyroglobulin (Tg) level and complications. Results 58 recurrent lesions in 32 patients were successfully ablated with RFA. The mean follow-up time was 73.19 ± 12.68 months (range, 60 to 98 months). At the last follow-up, almost all ablated lesions disappeared completely, and only one lesion showed scar-like changes. Nine (28.13%) patients developed new locally recurrent tumors; they were successfully treated with repeat RFA sessions. No new recurrent lesions were found during the follow-up. The largest diameter and volume of recurrent lesions decreased from 13.71 ± 6.48 mm and 520.43 ± 627.85 mm3 to 0 each at the end of observation period (p < .001). The average VRRs at 6, 12, 24, 36, 48, 60 months and last follow-up after RFA were 54.17%, 72.90%, 82.28%, 89.30%, 92.57%, 96.60%, 96.88%, 98.14% and 100% respectively. The median of serum Tg level was decreased from 1.48 ng/mL to 0.00 ng/mL (p < .05). No complications were reported during the follow-up. Conclusions US-guided RFA is an effective and safe option for treating locally recurrent PTC in selected patients, with favorable long-term outcomes.

Comparison of surgical completeness in patients operated on conventional open total thyroidectomy (OT) or trans-axillary robot-assisted total thyroidectomy (RATT) by a single axillary approach.

Trans-axillary robot-assisted total thyroidectomy (RATT) is nowadays worldwide accepted but the completeness obtained by RATT is still debated. The Aim of this study was to compare the completeness and safety of RATT with conventional open thyroidectomy (OT). We enrolled patients with nontoxic multinodular goiter, cytologically indeterminate nodules and well differentiated thyroid cancer without local and/or distant metastasis. In all cases the biggest nodule should be < 6cm. The surgical completeness was evaluated by means of serum thyroglobulin (hs-Tg) and neck ultrasound (nUS) performed three months postoperatively. 100 patients underwent either RATT or OT. The type of surgical procedure was chosen by patients. They were then divided in two subgroups based on benign or malignant histology. There were no significant differences in the postoperatively values of hs-Tg in patients operated with RATT or OT, both in benign and malignant subgroups. The post-operative thyroid remnant volume estimated by nUS was not significantly different between the two groups, both in benign and malignant subgroups. We also analyzed the difference of the volume of the thyroid remnant ipsilateral to the axillary access vs that of the remnant on the contralateral side and there was not significantly difference in both subgroups. RATT was demonstrated to determine a comparable surgical completeness as OT, both in benign and malignant thyroid diseases, with no differences in the prevalence of surgical complications. In our hands the surgical completeness of RATT by a single trans-axillary was satisfying.

The iodine study in pregnancy: no correlation between serum thyroglobulin and urinary iodine concentration

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Correlation between metabolic uptake of F-18-FDG-PET/computed tomography and thyroglobulin level in differentiated thyroid cancer patients with suspected recurrence.

Our objective is to determine if there is correlation between serum thyroglobulin and SUVmax of the main lesion detected in F18-FDG-PET/CT scan, in differentiated thyroid cancer (DTC) patients with suspected recurrence. All DTC patients enrolled in this prospective study, received at least one dose of radioactive iodine. During follow-up, they are suspected to have a recurrence due to elevated tumor markers although negative iodine whole-body scans. For all patients, F18-FDG-PET/CT scanning was performed. A 3D volume of interest was generated over the liver and main lesion to obtain maximum standardized uptake value (SUVmax). We calculated the lesion/liver ratio. Follow-up and/or histopathological examination were the gold standard. Pearson's correlation coefficient was calculated between thyroglobulin and SUVmax of the main lesion. Sixty-eight patients were recruited in this study. F18-FDG-PET/CT identified suspicious malignant lesions in 42 patients, equivocal in 18 patients, while 8 patients showed no abnormal findings. Fifty-two, 6, 8, and 2 patients were true positive, true negative, false positive, and false negative respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 72%, 57% 87%, 35%, and 69% respectively. The median SUVmax and lesion/liver ratio were significantly higher in the malignant lesions than that of benign lesions (3.9 vs. 1.3 and 1.45 vs. 0.54 respectively). We found that the main lesion SUVmax and lesion/liver ratio have a positive moderate correlation with thyroglobulin (0.338 and 0.325 respectively). In DTC patients with suspected recurrence, SUVmax of F18-FDG-PET/CT lesion showed a moderate positive correlation with serum thyroglobulin.

Sellar-Parasellar and Petrous Bone Metastasis from Differentiated Thyroid Carcinoma: Imaging Characteristics and Follow-Up Profile Post Radioiodine Therapy.

Sella turcica and petrous bone metastasis from differentiated thyroid carcinoma are rare clinical entities, with only a few limited cases reported to date. Two cases, one of sella turcica metastasis and the other of petrous bone metastasis from carcinoma of the thyroid gland, are presented. The cases diagnosed to have arisen from poorly differentiated thyroid carcinoma and follicular carcinoma of thyroid, respectively, subsequently underwent total thyroidectomy, radioiodine (RAI) scans and RAI therapies with iodine-131, external radiotherapy, and levothyroxine suppression with follow-up. Their clinical symptoms gradually subsided, with reduction in serum thyroglobulin, and finally resulted in disease stabilization. With the multimodality therapeutic approach, both patients are alive to date, with 48- and 60-month survival post diagnosis, respectively.

ESTIMation of the ABiLity of prophylactic central compartment neck dissection to modify outcomes in low-risk differentiated thyroid cancer: a prospective randomized trial

BackgroundProphylactic central neck dissection in clinically low-risk cT1bT2N0 papillary thyroid carcinoma is controversial, due to a large number of conflicting retrospective studies, some showing an advantage in terms of locoregional recurrence, others showing no advantage. These previous studies all show high rates of excellent response. We aim to demonstrate the non-inferiority of thyroidectomy alone as compared to total thyroidectomy with prophylactic central neck dissection in conjunction with adjuvant RAI 30 mCi with rTSH stimulation in terms of excellent response at 1 year.Trial design and methodsProspective randomized open multicenter phase III trial including patients with 11–40-mm papillary thyroid carcinoma (Bethesda VI) or suspicious cytology (Bethesda V) confirmed malignant on intra-operative frozen section analysis, with no suspicious lymph nodes on a specialized preoperative ultrasound examination. Patients will be randomized 1:1 into two groups: the reference group total thyroidectomy with bilateral prophylactic central neck dissection, and the comparator group total thyroidectomy alone. All patients will receive an ablative dose of 30mCi of radioactive iodine (RAI) within 4 months of surgery. The primary outcome is to compare the rate of excellent response at 1 year after surgery between the groups, as defined by an unstimulated serum thyroglobulin (Tg) level ≤ 0.2 ng/mL with no anti-Tg antibodies, an normal neck ultrasound and no ectopic uptake on the post-RAI scintiscan. Non-inferiority will be demonstrated if the rate of patients with excellent response at 1 year after randomization does not differ by more than 5%. Setting the significance level at 0.025 (one-sided) and a power of 80% requires a sample size of 598 patients (299 per group). Secondary outcomes are to compare Tg levels at 8 +/− 2 postoperative weeks, before RAI ablation, the rate of excellent response at 3 and 5 years, the rate of other responses at 1, 3, and 5 years (biochemical incomplete, indeterminate, and structurally incomplete responses), complications, quality of life, and cost-utility.Discussion (potential implications)If non-inferiority is demonstrated with this high-level evidence, prophylactic neck dissection will have been shown to not be necessary in clinically low-risk papillary thyroid carcinoma.Trial registrationNCT 03570021. June 26,2018

Enlargement of a metastatic lymph node from differentiated thyroid cancer after COVID-19 vaccination.

The massive vaccination campaign against COVID-19 has granted a high level of protection against the severe forms of the disease at the price of some mild adverse events. To underline that COVID-19 vaccination can induce a transient enlargement of lymph-node metastases in differentiated thyroid cancer patients. We describe the clinical, laboratory, and imaging features of a 60-year-old woman affected by paratracheal lymph-node relapse of Hurtle Cell Carcinoma who came to our attention after full COVID-19 vaccination because of neck swelling and pain. In April 2021, after 5 years of stable structural disease, the patient presented an enlargement of the metastatic lymph node, associated with a rise of serum thyroglobulin (from 4.6 to 14.7 pg/mL). Anti-inflammatory treatment was started and pain and swelling remitted after 15 days. At the subsequent evaluation, at neck ultrasound, the right paratracheal lesion was smaller and thyroglobulin dropped to 3.9 pg/mL. We report the case of an enlargement of metastatic lymph node from differentiated thyroid cancer after COVID-19 vaccination. We warn clinicians to identify features of inflammatory response due to COVID-19 vaccination in order to prevent unwarranted surgical treatment.

Serum thyroglobulin as a biomarker of iodine excess and thyroid disease occurrence in adults

BackgroundThyroglobulin (Tg) is considered a sensitive indicator of iodine deficiency. However, the usefulness of Tg as a biomarker of excess iodine is uncertain. The present study aimed to determine the influence of different iodine intake on serum Tg levels, evaluate the influence of thyroid diseases on the distribution of Tg, and identify the factors that may affect Tg levels. MethodsA cross-sectional survey with a total of 1208 adults was conducted in different water iodine areas in China. Urinary iodine concentration (UIC), water iodine concentration (WIC), serum Tg, thyroid-stimulating hormone (TSH), and thyroid antibodies were measured. The thyroid volumes and nodules were measured by B-scan ultrasound. ResultsBased on the WIC data, subjects were divided into three groups. Based on the median urinary iodine concentration (MUIC) data, the iodine levels were adequate, more than adequate, and excess for the WIC < 10 μg/L group, 10 μg/L ≤ WIC ≤ 100 μg/L g, and WIC > 100 μg/L groups, respectively. The median Tg was significantly higher in the excess iodine group than in the adequate iodine group and the more than adequate iodine group (14.6 μg/L vs.12.7 μg/L, P = 0.042; 14.6 μg/L vs.12.5 μg/L, P = 0.004). Multiple linear regression analysis showed that excess iodine intake, goitre, thyroid nodules, and hypothyroidism were significantly related to higher serum Tg levels. ConclusionSerum Tg level can be a promising biomarker of excessive iodine intake, but other factors, especially the presence of thyroid disease, should be considered when using this parameter.

The impact of vitamin D deficiency on some biochemical parameters and clinical outcome in Palestinian pregnant women during the first trimester.

Vitamin D deficiency is widespread worldwide and associated with negative effects on maternal and neonatal health. This study aimed to evaluate the relationship between vitamin D and thyroid and parathyroid hormone levels in the first trimester of pregnancy. This case control study included 200 participants aged (18-40) years divided into two groups; 100 pregnant females at the first trimester as case group, attending the main general clinical centers in Gaza strip, Palestine and 100 apparently healthy non-pregnant females as control group. Vitamin D, free thyroxine, free triiodothyronine, thyroid stimulating hormone, parathyroid, and the autoantibodies specific for thyroglobulin and thyroid peroxidase in serum were measured in all mothers and statistically analyzed using SPSS version 21 software. Serum vitamin D, TSH, anti-TPO, and anti-TG levels were significantly decrease while, parathyroid levels were non-significantly decreased in the first trimester of pregnancy compered to control group. The levels of fT4 were significantly increased and level of fT3 were non significantly increased among pregnant mothers compered to control group. Analyses using Pearson correlation coefficients showed positive correlations between vitamin D with fT4, fT3, Anti-TPO with P -value < 0.05 and negative correlations with mother age, TSH, PTH with P-value < 0.05 in early pregnancy. Vitamin D deficiency among pregnant women in the first-trimester can be associated with thyroid, parathyroid parameters and thyroid autoantibodies with potential adverse consequences for overall health, emphasizing a routine monitoring and vitamin D supplementation prevention strategies to optimize maternal and fetal outcomes.

A Comparison of Completeness and Complication of Total Thyroidectomy with or Without Neuromonitoring.

Total Thyroidectomy (TT) in true sense is not total as evidenced by remnant uptake in radio-iodine scans and serum thyroglobulin. The aim of this study is to assess the completeness of TT, operating time and recurrent laryngeal nerve injury with and without neuro-monitoring (IONM). Cross sectional analytical study using retrospective data of patients undergoing total thyroidectomy for benign and malignant goiters. Surgeries performed by single surgeon. Patients undergoing TT (2015-22) were grouped into Group A (n = 400) and Group B (n = 400) based on use of IONM. Subgroup of patients (Group A1&B1) who had differentiated thyroid cancer were compared for completeness of thyroidectomy with DxWBS and serum thyroglobulin (TG). Group A and B were compared for operating time and incidence of RLN palsy. Of the 800 RLN at risk transient RLN palsy was lower with IONM (p = 0.048). Mean operating time was significantly higher in Group-B(p = 0.0038). Subgroup A1 showed lower radio-active iodine uptake percentage, higher number of patients with negative scan, TG of < 1ng/mL indicating better completeness of TT. Our study shows better completeness of thyroidectomy, lower incidence of transient RLN palsy and shorter operating time with IONM.

Inflammatory biomarkers predict outcomes of patients with radioactive iodine refractory thyroid cancer treated with sorafenib.

The objective of this multicenter, retrospective cohort study was to evaluate the ability of inflammatory biomarkers representing the host immune system to predict outcomes in 70 patients with progressive radioactive iodine (RAI)-refractory thyroid cancer who were treated with sorafenib. Patients were divided into low and high inflammatory biomarker groups based on median values. Progression-free survival (PFS) and overall survival (OS) were assessed based on the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). The median LMR, NLR, and PLR values were 3.4, 2.2, and 140.1, respectively. No significant differences were observed in baseline characteristics of high and low LMR, NLR and PLR groups. Median PFS values were 6.6 and 19.5 months in the low and high LMR groups, respectively (P < 0.001). Compared with the high NLR and PLR groups, PFS was significantly prolonged in the low NLR and PLR groups (P = 0.003 and P = 0.041 respectively). In the multivariate analysis, low LMR and high NLR were associated with poor PFS after adjusting for multiple confounding factors including age, sex, pathology, disease-related symptoms, serum thyroglobulin level, lung-only metastasis, cumulative RAI dose, time from diagnosis, and longer diameter of the target lesion (hazard ratio, HR = 2.42; 95% confidence interval, CI 1.25-4.71; P = 0.009, and HR = 2.09; CI, 1.06-4.14; P = 0.033, respectively). High LMR, low NLR, and low PLR were significantly associated with prolonged OS (P = 0.011, P = 0.023, and P = 0.007, respectively). Patients with at least one risk factors for inflammatory biomarkers presented a significantly lower PFS (HR 2.29; CI, 1.36-3.84; P = 0.003) and OS (HR 2.95; CI, 1.49-5.81; P = 0.006) than patients without any risk factor. Baseline inflammatory biomarkers successfully predicted PFS and OS in patients with progressive RAI-refractory thyroid cancer treated with sorafenib. These prognostic biomarkers might help arrive at appropriate clinical decisions regarding the use of sorafenib.