Incidence, recurrence and mortality among Filipinos with differentiated thyroid cancer: A systematic review / Journal of the ASEAN Federation of Endocrine Societies

Background@#The majority of thyroid malignancies are differentiated thyroid carcinomas (DTCs). We examined the incidence, disease extent, recurrence and disease-specific mortality (DSM) of DTC among Filipinos residing in the Philippines and Filipino immigrants.@*Methodology@# In accordance with the 2020 PRISMA statement, we performed a systematic literature search in MEDLINE, Google Scholar, EBSCO, Cochrane and Clinicaltrials.gov for the period January 1, 1980 until January 27, 2022. Pooled incidence rate ratio and pooled proportions of disease extent, recurrence and DSM were determined.@*Results@#Literature search yielded 1,852 studies. Out of 26 articles retrieved, nine retrospective case controls and cohorts were included. Incidence of DTC was significantly higher in female Filipino immigrants compared with non-Hispanic whites (NHW). Distant metastases and recurrence were more common among Filipinos and Filipino immigrants compared with NHW. Limited data showed higher DSM in Filipino immigrants and NHW than Filipinos, which may be influenced by reporting bias.@*Conclusion@#This review supports the trend of increased incidence and recurrence of DTC among Filipinos, although case registries are essential to confirm these findings. In the setting of the newly released Philippine guidelines for DTC, prospective studies with active long-term follow-up will help detect any changes in the outcomes of DTC among Filipinos.

Nomogram-Based Prediction of Risk of Cervical Lymph Node Metastasis in Differentiated Thyroid Carcinoma / 中国医学科学院学报

Objective To establish a nomogram for predicting the risk of cervical lymph node metastasis in differentiated thyroid carcinoma (DTC). Methods The patients with complete clinical data of DTC and cervical lymph node ultrasound and diagnosed based on pathological evidence from January 2019 to December 2021 were assigned into a training group (n=444) and a validation group (n=125).Lasso regression was performed to screen the data with differences between groups,and multivariate Logistic regression to establish a prediction model with the factors screened out by Lasso regression.C-index and calibration chart were employed to evaluate the prediction performance of the established model. Results The predictive factors for establishing the model were lymph node short diameter≥0.5 cm,long-to-short-axis ratio<2,disappearance of lymph node hilum,cystic transformation,hyperechogenicity,calcification,and abnormal blood flow (all P<0.001).The established model demonstrated a good discriminative ability,with the C index of 0.938 (95%CI=0.926-0.961) in the training group. Conclusion The nomogram established based on the ultrasound image features of cervical lymph nodes in DTC can accurately predict the risk of cervical lymph node metastasis in DTC.

Analysis of the value of blood lipids and serum IL-6 and TSH detection in patients with differentiated thyroid cancer / 中华内分泌外科杂志

Objective:To explore the value of blood lipids, serum interleukin-6 (IL-6) and thyroid-stimulating hormone (TSH) detection in patients with differentiated thyroid cancer.Methods:From Mar. 2016 to Oct. 2021, 120 cases of DTC were admitted to the DTC group, 138 patients with benign thyroid nodules were included in the benign group, and 100 healthy people undergoing the physical examination in our hospital during the same period. were enrolled in the control group. Triglyceride (TG) , total cholesterol (TC) , high density liptein cholesterol (HDL-C) , low density lipoprotein (LDL-C) , IL-6, and TSH were compared between groups, and statistically significant indexes were included for multivariate analysis of the occurrence of DTC. The sensitivity, specificity and optimal cut-off value were analyzed, and their relationship with the clinicopathological characteristics of DTC patients was analyzed.Results:Serum TSH and IL-6 levels from high to low were malignant group, benign group and control group, and HDL-C levels from high to low were control group, benign group and malignant group ( P<0.05) . There was no significant difference in the levels of TC, TG or LDL-C ( P>0.05) . Multivariate Llogistics regression analysis indicated that TSH and IL-6 may be risk factors for the occurrence of differentiated thyroid cancer (all OR>1, P<0.05) . HDL-C may be a protective factor for the occurrence of differentiated thyroid cancer ( OR<1, P<0.05) . The ROC curve was drawn to determine the optimal cut-off value of TSH for the diagnosis of differentiated thyroid cancer, AUC: 0.985, sensitivity was 93.25%, specificity was 96.34%, 95% CI: 0.949-1.000 ( P<0.001) ; the best cut-off value of IL-6 for the diagnosis of differentiated thyroid cancer was 48.96 ng/L, AUC: 0.980, sensitivity was 96.98%, the specificity was 91.53%, 95%CI: 0.956-1.000 ( P<0.05) ; the best cut-off value of HDL-C for the diagnosis of differentiated thyroid cancer was 1.441 mmol/L, AUC: 0.0.691, the sensitivity was 85.10%, the specificity was 48.06%, 95%CI: 0.563-0.812 ( P<0.05) . The serum levels of TSH and IL-6 in patients with lymph node metastasis were significantly higher than those in patients without lymph node metastasis, and the level of HDL-C was significantly lower than those in patients without lymph node metastasis ( P<0.05) . TNM staging The serum levels of TSH and IL-6 in patients with stage III and IV were significantly higher than those in patients with stage I and II, and HDL-C was significantly lower than that in patients with stage I and II ( P<0.05) . Conclusions:Serum IL-6, TSH and HDL-C are closely related to the occurrence of differentiated thyroid cancer. The detection of serum IL-6, TSH and HDL-C is helpful for the differentiation of benign and malignant thyroid nodules. The presence or absence of lymph node metastasis in patients with differentiated thyroid cancer is related to TNM staging, and the detection value is high.

Ferroptosis-related gene and its relationship with prognosis of differentiated thyroid carcinoma patients / 中华内分泌外科杂志

Objective:To analyze the marker of ferroptosis-related genes in differentiated thyroid carcinoma (DTC) based on TCGA database.Methods:The mRNA expression profiles and survival information of thyroid cancer patients and normal thyroid samples were downloaded from the TCGA database. The genetic difference analysis added 653 normal thyroid samples from the GETx database. Twenty-two ferroptosis-related genes were selected for univariate Cox regression analysis. Genes associated with prognostic in the TCGA cohort were further screened and prognostic models using LASSO regression was constructed. Adjusted P<0.05 and | log2FC>1" as the threshold, 22 differentially expressed genes were selected. The genes were screened by multivariate Cox regression analysis for prognosis-related genes and displayed in a line diagram. Results:22 of the 24 ferroptosis-related genes were differentially expressed between the tumor and normal tissues, with13 high expression, 9 low expression, 1 gene expression without difference and 1 gene not expressed in half of the samples. Univariate Cox regression analysis found that DPP4 and TFRC were associated with the degree of disease risk (HR was<1 and>1, respectively) . When integrating GPX4, TFRC and DPP4 into the LASSO model screening, it was found to be related to prognosis after dividing the patients into risk groups according to lambda. min=0.0027, Riskscore= (0.7316) * TFRC+ (-0.2539) *DPP4 (Log rank P=0.00635. Multivariate Cox regression analysis found that DPP4 and TFRC were related to the degree of disease risk (HR were<1 and>1, respectively) . Conclusion:The model of TFRC and DPP4 constructed by ferroptosis-related differential expression genes may be potential predictive markers of DTC patients, which still needs further verification and will provide theoretical basis for further clinical treatment.

Effect of Helicobacter pylori infection on standard dose of postoperative thyrotropin suppression therapy for differentiated thyroid cancer / 中华内分泌外科杂志

Objective:To study the effect of Helicobacter pylori (HP) infection on the standardized dose of postoperative thyrotropin suppression of differentiated thyroid carcinoma.Methods:A total of 82 patients diagnosed with differentiated thyroid carcinoma and receiving total thyroidectomy in Beijing Rehabilitation Hospital affiliated to Capital Medical University from Jan. 2019 to Jun. 2020 were enrolled in this study prospectively.19 patients with higher standardized dose of the thyrotropin suppression (>2.5 μg·kg -1·d -1) were selected as the experimental group, and 63 patients with the lower standardized dose of the thyrotropin suppression (≤2.5 μg·kg -1·d -1) were selected as the control group. The presence of HP infection was measured by C13 method, and the HP infection rate was compared between the two groups. The patients with HP infection in the experimental group received standard quadruple therapy to eradicate Helicobacter pylori. The standardized dose before and after treatment were observed and compared. Results:The HP infection rate in the experimental group (73.7%, 14/19) were significantly higher ( P<0.05) than those in the control group (31.7%, 20/63). In the experimental group, 14 patients with HP infection in the experimental group received standard quadruple therapy to eradicate HP. HP was successfully eradicated in 11 patients after the treatment (one patient quit the treatment before completion, the actual eradication rate was 84.6%) ; Eight weeks after the treatment, the dose adjustment of thyrotropin suppression reached steady-state in 13 patients completed the therapy. The average standardized dose was (2.15±0.25) μg·kg -1·d -1, significantly lower than that before treatment [ (2.89±0.21) μg·kg -1·d -1] ( P<0.05) . Conclusions:HP infection may be an important factor affecting the standardized dose of thyrotropin suppression in postoperative patients with thyroid cancer. For those patients with HP infection, eradication treatment of HP can significantly reduce the standardized dose and treatment-related complications.

Cost-effectiveness analysis of well-differentiated thyroid carcinoma surveillance using nuclear medicine procedures

Introduction@#Well-differentiated thyroid carcinoma (WDTC) is the most common type of thyroid cancer with a notable increasing incidence worldwide. It is prevalent among Filipino descent as compared to other nationalities. Its good prognosis and high survival rate predispose patients to lifetime surveillance with incomplete response, instead of death, as outcome measure. This eventually leads to increase in cost of care, utilization, and allocation of medical resources for the survivors of the disease. Thyroglobulin immunoradiometric assay (Tg IRMA) and I-131 diagnostic whole-body scan (dWBS) are two nuclear medicine procedures that are part of WDTC surveillance. Due to their varied availability in Asia-Pacific, most clinicians measure thyroglobulin (Tg) alone due to perceived cost-effectiveness. @*Objective@#This study aims to analyze the cost-effectiveness of two nuclear medicine procedures used in WDTC surveillance, namely thyroglobulin immunoradiometric assay and I-131 diagnostic whole-body scan, in detecting incomplete response. @*Methodology@#Three clinical guidelines on WDTC management were reviewed to identify frequency, total number and expenditure for surveillance, namely from the University of the Philippines-Philippine General Hospital in 2008 (PGH 2008), American Thyroid Association in 2015 (ATA 2015), and the Department of Health (DOH 2021). A Markov model was constructed to simulate a 36-month surveillance with complete and incomplete response to treatment as disease states. Parameter values like rate of incomplete response in WDTC patients, prognostic values per each surveillance test, and other relevant data were collected from literature search and established data. The cost of surveillance was based on the rates offered by Philippine General Hospital (PGH) Radioisotope Laboratory as of November 2022. One-way sensitivity was done to check robustness of results. @*Results@#ATA 2015 incurs the most expenses, amounting to PHP 14,600.00 to 20,450.00 ($ 254.19 – 356.04) for three years of surveillance, followed by DOH 2021 (PHP 11,700.00 – 15,600.00 or $ 203.74 – 271.65), and PGH 2008 (PHP 3,900.00 – 6,825.00 or $ 67.91 – 118.85). The thyroglobulin IRMA arm costs lower (PHP 17,784.00 or $ 309.74) than I-131 dWBS (PHP 271,875.00 or $ 4,735.13) in detecting incomplete response. I-131 dWBS should cost around PHP 570.00 (or $ 9.92) to be as cost-effective as the thyroglobulin IRMA.@*Conclusion@#This study has identified that thyroglobulin IRMA is more cost-effective than I-131 diagnostic whole-body scan in detecting incomplete response in WDTC patients. This supports the perceived cost-effectiveness of thyroglobulin measurement in surveillance, even without diagnostic whole body-scans. This study also identified that the new DOH 2021 guidelines will incur lesser expenditure in using nuclear medicine procedures for surveillance as compared to ATA 2015 guidelines. Local clinicians may also find it easier to follow as it is more suitable to the Philippine setting.

Clinical features and prognostic factors of extrathyroidal extension in differentiated thyroid carcinoma / 中华内分泌外科杂志

Objective:To investigate the risk factors related to extrathyroidal extension (ETE) of differentiated thyroid carcinoma (DTC) and the specific effects on the prognosis.Methods:The clinical data of 592 patients with newly diagnosed DTC admitted to our hospital from Jun. 2015 to Jun. 2016 were retrospectively analyzed. The data including the maximum tumor diameter and lymph node metastasis were collected, and the survival data were followed up. Chi-square test and Logistic regression were used to analyze the risk factors associated with ETE. Kaplan-Meier method and Cox proportional risk model were used to analyze the effect of ETE on disease-free survival.Results:There were 100 ETE of 592 DTC patients (16.9%) . Univariate analysis showed that the risk factors for ETE were the largest tumor diameter ≥2 cm, multiple lesions, and lymph node metastasis in the lateral cervical region ( P<0.01) . The follow-up time was 29 to 64 months, and the median follow-up time was 60 months. The 3-year and 5-year DFS rates of patients with DTC and ETE were 86.9% and 83.2% respectively, which were significantly lower than those of patients without ETE ( P<0.001) . Univariate analysis showed that ETE ( P<0.001) was a risk factor for postoperative recurrence in patients with DTC. Cox multivariate regression showed that ETE (HR: 10.564, 95% CI 3.712-30.063, P<0.001) was an independent risk factor for postoperative recurrence in patients with DTC. Conclusions:DTC accompanied by ETE is associated with risk factors such as large tumor diameter and multiple lesions, which has a lower 5-year DFS. Patients with the above characteristics should consider the possibility of ETE before surgery, and focus on long-term follow-up after surgery.

Patterns of radioiodine use for differentiated thyroid carcinoma in Brazil: insights and a call for action from a 20-year database

ABSTRACT Objective: This study aimed to explore the patterns of radioactive iodine (RAI) use for differentiated thyroid cancer (DTC) in Brazil over the past 20 years. Materials and methods: A retrospective analysis of the DTC-related RAI prescriptions, from 2000 to 2018, retrieved from the Department of Informatics of the Unified Health System (Datasus) and National Supplementary Health Agency (ANS) database was performed. RAI activities prescriptions were re-classified as low (30-50 mCi), intermediate (100 mCi), or high activities (>100 mCi). Results: The number of DTC-related RAI prescriptions increased from 0.45 to 2.28/100,000 inhabitants from 2000 to 2015, declining onwards, closing 2018 at 1.87/100,000. In 2018, population-adjusted RAI prescriptions by state ranged from 0.07 to 4.74/100,000 inhabitants. Regarding RAI activities, in the 2000 to 2008 period, the proportion of high-activities among all RAI prescriptions increased from 51.2% to 74.1%. From 2009 onwards, there was a progressive reduction in high-activity prescriptions in the country, closing 2018 at 50.1%. In 2018, the practice of requesting high-activities varied from 16% to 82% between Brazilian states. Interestingly, variability of RAI use do not seem to be related to RAI referral center volume nor state socio-economic indicators. Conclusion: In recent years, there has been a trend towards the lower prescription of RAI, and a reduction of high-activity RAI prescriptions for DTC in Brazil. Also, significative inter-state and inter-institutional variability on RAI use was documented. These results suggest that actions to advance DTC healthcare quality surveillance should be prioritized.

Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort

ABSTRACT Objective: The 8th TNM system edition (TNM-8) released in 2018 presents significant changes when compared to the 7th edition (TNM-7). The aim of this study was to assess the impact of changing the TNM staging criteria on the outcomes in a Brazilian cohort of differentiated thyroid carcinoma (DTC). Subjects and methods: DTC patients, attending a tertiary, University-based hospital, were classified by TNM-7 and TNM-8. Prediction of disease outcomes status of the two systems was compared in a retrospective cohort study design. Results: Four hundred and nineteen DTC patients were evaluated, comprised by 82% (345/419) women, with mean age at diagnosis of 46.4 ± 15.6 years, 89% (372/419) papillary thyroid carcinoma, with a median tumor size of 2.3 cm (P25-P75, 1.3-3.5). One hundred and sixty patients (38%) had lymph node metastases and 47 (11%) distant metastases at diagnosis. Using the TNM-7 criteria, 236 (56%) patients were classified as Stage I, 50 (12%) as Stage II, 75 (18%) as Stage III and 58 (14%) as Stage IV. When evaluated by the TNM-8, 339 (81%) patients were classified as Stage I, 64 (15%) as Stage II, 2 (0.5%) as Stage III and 14(3%) as Stage IV. After a median follow-up of 4.4years (P25-P75 2.6-6.6), the rate of incomplete biochemical and/or structural response was 54% vs. 92% (P = 0.004) and incomplete structural response was 42% vs. 86% (P = 0.009) for patients classified as stage IV by TNM-7 vs TNM-8, respectively. Only 4 (1%) disease-related deaths were recorded. Conclusions: In our cohort, 37% of DTC patients were down staged with the application of TNM-8 (vs. TNM-7). Additionally, TNM-8 seems to better stratify the risk of structural incomplete response at follow-up.

(99m)Tc-Pertechnetate Scintigraphy Predicts Successful Postoperative Ablation in Differentiated Thyroid Carcinoma Patients Treated with Low Radioiodine Activities

BACKGROUND: Postoperative routine radioiodine (RAI) treatment is currently debated for patients with low-risk differentiated thyroid carcinoma (DTC) patients. If performed, a low 131I activity (i.e., 1 to 2 GBq) is recommended with the aim to ablate thyroid remnant and facilitate subsequent follow-up by thyroglobulin measurement. The purpose of this study was to evaluate the relationship between postsurgical technetium-99m (99mTc)-pertechnetate scintigraphy and the rate of successful remnant ablation after low activity radioiodine ablation in patients with DTC. METHODS: Enrolled were 193 patients with low risk DTC who underwent total thyroidectomy and RAI ablation with a fixed 1.1 GBq activity of 131I. 99mTc-pertechnetate scans were done and thyrotropin stimulated thyroglobulin (sTg) levels measured just before ablation. Ablation effectiveness was assessed 6 to 12 months later by sTg measurement, neck ultrasound and diagnostic whole body scan. RESULTS: A negative 99mTc-perthecnetate scans was the best predictor of successful ablation (P<0.001) followed by preablative sTg levels <0.8 ng/mL (P=0.008) and 99mTc-pertechnetate uptake rate values <0.9% (P=0.065). Neither sex nor age of the patient at the time of ablation or tumor histology and size showed a significant association with the rate of successful ablation. CONCLUSION: The 99mTc-pertechnetate scintigraphy is a simple and feasible tool to predict effectiveness of low activity 131I thyroid to ablate thyroid remnants in patients with DTC.

Correlation between KRAS genemutationandDTC resistance to 131I radiotherapy and prognosis / 中国肿瘤生物治疗杂志

@# Objective: To investigate the correlation between KRAS gene mutation and differentiated thyroid carcinoma (DTC) treatment effect and prognosis, and to explore the mechanism. Methods: Clinical tissue samples from DTC patients undergoing 131I Radiotherapy were collected. Then single strand conformation polymorphism analysis of polymerase chain reaction products (PCRC-SSCP) was used to detect KRAS mutation rate in thyroid cancer patients of different TNM stages; p21 protein expression level was detected by real-time quantitative polymerase chain reaction (qPCR) and western blotting. DTC cells were treated by sub-lethal dose of 131I Radiotherapy, and then CCK-8 assay, transwell assay and flow cytometry (FCM) were used to evaluate the changes of cells viability. Animal models were then constructed for verification. Results: The results showed that KRAS gene mutants were increased in 131I-resistant DTC patients; KRAS gene mutation suppressed p21 protein expression and was associated with clinical stage and poor prognosis. In vivo and in vitro experiments proved that sub-lethal dose of 131I increased KRAS gene mutation rate, suppressed p21 expression level, and caused 131I radiotherapy resistance. Reversely, over-expression of KRAS gene could significantly increase p21 expression, and inhibit tumor proliferation and metastasis. Conclusion: KRAS gene mutations were associated with DTC TNM stages and 131I resistance in DTC patients. Sub-lethal dose of 131I treatment could improve 131I resistance in DTC cells line, inversely, over-expressed KRAS gene could increase the sensitivity to 131I radiotherapy in DTC patients.

Prognostic factors of differentiated thyroid carcinoma in children under 14 years old / 中华内分泌外科杂志

Objective To investigate the clinical prognostic features of pediatric differentiated thyroid carcinoma (DTC).Methods A retrospective analysis of clinical data of 56 cases of pediatric differentiated thyroid carcinoma under 14 years old admitted in our hospital from Aug.2009 to Oct.2018 was performed.KaplanMeier method and COX proportional hazards model were used to analyze the factors affecting the disease-free survival of patients.Results The follow-up period was from 6 months to 82 months,and the median follow-up time was 28 months.Recurrence occurred in 15 patients,with a survival rate of 100％.The 3-and 5-year disease-free survival rate was 67.4％ and 63.5％.Univariate analysis showed that tumor diameter ＞2 cm (P=0.046),multiple lesions (P＜0.001),cervical lymph node metastasis (P=0.008),and extra thyroidal extension (ETE) (P=0.035) were related factors affecting postoperative recurrence,while gender,age,Hashimoto's thyroiditis,tumor TNM stage,central lymph node metastasis and surgical approach were not related to postoperative recurrence.COX multivariate analysis showed that multiple lesions (HR:8.815,P=0.010) was the independent factor influencing the prognosis of pediatric differentiated thyroid carcinoma.Conclusions Multiple lesion is an independent influencing factor for the recurrence of pediatric differentiated thyroid carcinoma patients after surgery.Meanwhile,total thyroidectomy and long-term follow-up should be followed.Although the metastasis rate of lymph node and distant organ are high,overall prognosis is good in pediatric DTC.

Semi-quantitative analysis of the effect of 131I on residual thyroid tissue in patients with differentiated thyroid cancer / 中华地方病学杂志

Objective To evaluate the effect of postoperative thyroid residual tissue on 131I treatment of differentiated thyroid carcinoma (DTC) metastases in patients with DTC.Methods Patients with thyroid residual tissue and lymph node metastases or distant organ metastases were confirmed by 131I whole body scan after 131I treatment of DTC from January 2004 to January 2013 in Dalian.The clinical data were divided into the cured group and the non-cured group according to the final results of mI treatment.The per unit area count value (Kc/cm2) of residual thyroid remnant (NTR),lymph node metastases (LNM) and distant metastases (DM) were measured and performed semi-quantitative analysis.The thresholds of the analysis results were calculated by the Bootstrap method.Results A total of 114 patients were studied,aged from 14 to 80 years old,including 47 males and 67 females;the ratio of males to females was 1.0:1.4.There were significant differences in NTR unit area counts (0.25 vs 1.29 Kc/cm2) between the cured group and the non-cured group (72 in the cured group and 42 in the non-cured group,U =0.001,P ＜ 0.05);there was no significant difference in LNM unit area counts (0.21 vs 0.41 Kc/cm2) between the cured group and the non-cured group (U =0.052,P ＞ 0.05).Those with the ratio of residual area to lymph node metastases (N/L) and the ratio of residual area to distant metastases(N/D) less than 1.7 had a better 131I treatment;unit area N/L greater than 4.9 and unit area N/D greater than 8.0 had a poor therapeutic effect.Conclusion Excessive residual tissue after surgery results in poor efficacy of 131I treatment;semi-quantitative analysis for whole body scan after 131I treatment can predict the efficacy of 131I treatment.

Clinical analysis of differentiated thyroid carcinoma in children and adolescent: 75 cases / 中华内分泌外科杂志

Objective To investigate the clinical characters and treatment strategies of differentiated thyroid carcinoma in children and adolescent.Methods The clinical data of 75 cases of thyroid carcinoma in children and adolescents(≤ 18 years old)from Jan.2004 to Mar.2017 in the First Hospital of China Medical University were retrospectively analyzed.Clinical pathology characters and prognosis between patients ＜13 years old (group A) and those ≥ 13 years old (group B) were compared.Results There were 74 cases with papillary carcinoma and 1 with follicular carcinoma.The rate of lateral neck lymph node metastasis(100％ vs 54.5％,x2=6.818,P=0.025) and bilateral location (55.6％ vs 18.2％,x2=6.311,P=0.037) in group A were higher than in group B.There were no significant differences in central lymph nodes metastasis (88.9％ vs 69.7％,x2=1.758,P=0.420),gender composition ratio (22.2％ vs 31.8％,x2=0.343,P=0.841),extra-thyroid extension (33.3％ vs 18.2％,x2=1.136,P=0.534),distant metastasis(11.1％ vs 1.5％,x2=2.810,P=0.566) and recurrent disease(25％ vs 7.8％,x2=1.141,P=0.183) between the two groups.Conclusions Papillary carcinoma is the most common pathology type in children and adolescent thyroid carcinoma.Patients＜13 years old are more likely to present lateral neck lymph node metastasis and bilateral location.

Correlation between the 131 iodine stimulated thyroglobulin before treatment and 131 iodine treatment in patients with high-risk differentiated thyroid carcinoma / 西安交通大学学报(医学版)

Objective: To explore the correlation between the treatment of precurative stimulated thyroglobulin (sTg) level and 131 iodine treatment in patients with high-risk differentiated thyroid carcinoma (DTC). Methods: After 131 iodine therapy in The First Affiliated Hospital of Xian Jiaotong University from March to June 2016, the patients with high-risk DTC were followed up. We compared the clinical characteristics and pre-treatment sTg level, ROC curve and the evaluation of the best diagnostic boundary value point sTg predictive value of iodine ER after treatment in satisfaction (excellent response, ER), (acceptable response, AR), and (incomplete response, IR) groups by means of chi square test and One-way ANOVA. Results: There were 91 high-risk DTC patients treated with iodine-131, including 23 males and 68 females, with an average age of 45.62±11.84 years, with an average of 131 iodine doses of (121.4±17.3)mCi. We analyzed retrospectively the follow-up results of 78 patients (46 cases of ER, 14 cases of AR, and 18 cases of IR). The three groups did not differ significantly in age, gender, or invasion outside the thyroid gland (P=0.300, 0.299, 0.274). however, they differed significantly in primary lesion diameter, neck lymph node metastasis, 131 iodine treatment dose, and postoperative sTg level (P=0.018,0.003, 0.000, 0.000). The levels of sTg and 131 iodine treatment dose were significantly higher in IR group than in non-IR groups (P=0.008), but they had no significant difference between AR and IR groups (P=0.786). In IR group the sTg boundary value point was 9.69 ng/mL (sensitivity 66.7%, specificity 86.9%), ROC curve was 0.897, and 95% CI was 0.826-0.968. Conclusion: The level of sTg in patients with moderate- and high-risk DTC is predictive of clinical outcome after 131 iodine treatment. The level of sTg after operation is higher than 9.69 ng/mL, which can be used as the cut-off point to indicate the poor curative effect.

Diagnóstico clínico, ultrasonográfico y citohistológico del carcinoma diferenciado del tiroides / Clinical, ultrasonographic and cytohistological diagnosis of differentiated thyroid carcinoma

Introducción: el carcinoma diferenciado del tiroides representa la neoplasia maligna más frecuente en Endocrinología. Su presentación clínica y su diagnóstico se han modificado gracias a la disponibilidad de herramientas diagnósticas, tales como, el ultrasonido tiroideo y la biopsia aspirativa con aguja fina. Objetivos: describir las características clínicas, ultrasonográficas y citohistológicas de los pacientes intervenidos quirúrgicamente por enfermedad tiroidea maligna, y evaluar en ellos la prevalencia de hipocalcemia crónica y el valor de la hormona estimulante del tiroides. Métodos: se realizó un estudio descriptivo retrospectivo, en el cual se revisaron los informes consecutivos de Anatomía Patológica de todos los pacientes intervenidos quirúrgicamente por enfermedad tiroidea nodular en el Hospital General Provincial Camilo Cienfuegos en el periodo comprendido de enero de 2012 a diciembre 2014. La muestra estuvo conformada por 118 historias clínicas de pacientes operados por enfermedad tiroidea nodular que reunieron los criterios siguientes: datos clínicos, resultados según los criterios de Bethesda de la punción aspirativa con aguja fina, del ultrasonido del tiroides y la biopsia. A estos pacientes se les citó para una evaluación clínica y se les determinó en ayunas, la hormona estimulante del tiroides y en 2 días diferentes, la calcemia. Los pacientes fueron clasificados en portadores de: enfermedad tiroidea maligna (n= 39) y enfermedad tiroidea benigna (n= 79). Resultados: clínicamente solo el 15,4 por ciento de los pacientes con enfermedad tiroidea maligna presentaron dolor o molestia espontánea y/o a la palpación de la glándula del tiroides. La enfermedad tiroidea maligna se diagnosticó en todas las categorías del citodiagnóstico: I: 1/1 (100 por ciento), II: 8/83 (9,6 pòr ciento), III: 4/6 (66,7 por ciento), IV: 2/2 (100 por ciento), V: 18/20 (90 por ciento), VI: 6/6 (100 por ciento). El carcinoma papilar representó la neoplasia más frecuentemente diagnosticada (37/39 pacientes), el 33,3 por ciento de estos enfermos mostraron cifras de hormona estimulante del tiroides por encima de 2,0 mU/L, y hubo un 46,15 por ciento de hipocalcemia crónica. Conclusiones: el carcinoma papilar fue la neoplasia más frecuentemente diagnosticada en los pacientes operados por enfermedad tiroidea maligna. La mayoría de estos pacientes tuvieron un comportamiento subclínico, un tercio de valores no óptimos de la hormona estimulante del tiroides y una prevalencia alta de hipocalcemia crónica(AU)

ntroduction: differentiated thyroid carcinoma represents the most frequent malignant neoplasia in Endocrinology. Its clinical presentation and diagnosis have been modified thanks to the availability of diagnostic tools, such as thyroid ultrasound and fine needle aspiration biopsy. Objectives: to describe the clinical, ultrasonographic and cytohistological characteristics of patients undergoing surgery for malignant thyroid disease, and to evaluate in them the prevalence of chronic hypocalcemia and the value of the thyroid´s stimulating hormone. Methods: a retrospective descriptive study was carried out, in which consecutive reports of Pathological Anatomy of all patients surgically treated for nodular thyroid disease at Camilo Cienfuegos Provincial General Hospital in the period from January 2012 to December 2014 were reviewed. The sample consisted of 118 medical records of patients operated on for nodular-thyroid disease that met the following criteria: clinical data, results according to the Bethesda criteria of fine needle aspiration, thyroid ultrasound and biopsy. These patients were called for a clinical evaluation and they were indicated to be fasting. The patients were classified into carriers of: ETM (n=. 39) and benign thyroid disease (n= 79). Results: in clinical terms, only 15.4 percent of the patients with malignant thyroid disease presented spontaneous pain or discomfort, and / or during palpation of the thyroid glands. Malignant thyroid disease was diagnosed in all categories of cytodiagnosis: I: 1/1 (100 percent), II: 8/83 (9.6 percent), III: 4/6 (66.7 percent), IV: 2/2 (100 percent), V: 18/20 (90 percent), VI: 6/6 (100 percent). Papillary carcinoma represented the most frequently diagnosed neoplasm (37/39 patients); 33.3 percent of these patients showed thyroid stimulating hormone levels above 2.0 mU / L, and there was 46.15 percent of chronic hypocalcemia. Conclusions: papillary carcinoma was the most frequently diagnosed neoplasm in patients operated of malignant thyroid disease. The majority of these patients had a subclinical behavior, a third of non-optimal values of the thyroid stimulating hormone and a high prevalence of chronic hypocalcemia(AU)

Response Prediction of Altered Thyroglobulin Levels After Radioactive Iodine Therapy Aided by Recombinant Human Thyrotropin in Patients with Differentiated Thyroid Cancer / 대한핵의학회잡지

PURPOSE: Thyroglobulin (Tg) may be released from damaged residual thyroid tissues after radioactive iodine (RAI) therapy in patients with differentiated thyroid carcinoma (DTC). We investigated whether altered levels of serum Tg after recombinant human thyrotropin (rhTSH)-aided RAI therapy could be a prognostic marker in patients with DTC.METHODS: We evaluated 68 patients who underwent RAI therapy after total thyroidectomy. Serum Tg levels were measured just before RAI administration (D0Tg) and 7 days after RAI therapy (D7Tg). Patients with a D0Tg level greater than 2.0 ng/mL were excluded to more precisely evaluate the injury effect of RAI in small remnant tissues. The ratioTg was defined as the D7Tg level divided by that on D0Tg. The therapeutic responses were classified as acceptable or non-acceptable. Finally, we investigated which clinicopathologic parameters were associated with therapeutic response.RESULTS: At the follow-up examination, an acceptable response was observed in 50 patients (73.5%). Univariate analysis revealed significant differences in N stage (P = 0.003) and ratioTg (acceptable vs. non-acceptable responses, 21.9 ± 33.6 vs. 3.8 ± 6.5; P = 0.006). In multivariate analysis, only ratioTg significantly predicted an acceptable response (odds ratio 1.104; 95% confidence interval 1.005–1.213; P = 0.040). A ratioTg above 3.5 predicted an acceptable response with a sensitivity of 66.0%, specificity of 83.3%, and accuracy of 70.6% (area under the curve = 0.718; P = 0.006).CONCLUSIONS: Altered levels of serum Tg after RAI therapy, calculated as the ratioTg (D7Tg/D0Tg), significantly predicted an acceptable response in patients with DTC.

The Predictive Values of Lesion Size, F-18 FDG Avidity and I-131 Avidity for the Clinical Outcome of I-131 Treatment in Patients with Metastatic Differentiated Thyroid Carcinoma Only in the Lung / 대한핵의학회잡지

PURPOSE: We aimed to evaluate the prognostic values of radiography, F-18 FDG PET, and I-131 whole body scans in patients with lung-only metastasis from differentiated thyroid carcinoma (DTC).METHODS: Between 1998 and 2013, we included 31 patients (F: 26, M: 5) with lung-only metastasis from DTC who had been treated with I-131 and underwent PET. Lung metastasis was categorized according to the size (macronodular ≥1.0 cm vs. micronodular <1.0 cm), FDG avidity (avid vs. non-avid), and I-131 avidity (avid vs. non-avid). Progression-free survival (PFS) was evaluated for each patient.RESULTS: Among 31 patients, seven (23%) had macronodular lung metastasis, 26 (84%) had FDG avid lung metastasis, and 16 (52%) had I-131 avid lung metastasis. During the median follow-up period of 9.4 y, median PFS was 6.1 y. Based on Kaplan-Meier analysis, macronodular lung metastasis (p = 0.017) and I-131 non-avid lung metastasis (p = 0.059) were significantly associated with worse outcomes, but FDG avid lung metastasis was not (p = 0.135). Patients with FDG non-avid lung metastasis did not experience disease progression during follow-up, while 11 of 26 patients (42%) experienced disease progression. Based on univariate analysis, the hazard ratio for a poor prognosis was 3.78 (p = 0.029) for macronodular lung metastasis and 3.29 (p = 0.079) for I-131 non-avid lung metastasis.CONCLUSIONS: Macronodular and I-131 non-avid lung metastasis were associated with a poor prognosis in lung-only metastasis from DTC. Although FDG avid lung metastasis may be associated with a poor prognosis, a larger-scale study is needed.

The significance of serum stimulating thyrogloblin level in monitoring and diagnosis of differeniated thyroid carcinoma metastasis / 中华放射医学与防护杂志

Objective To investigate the clinical significance of postoperative stimulated thyroglobulin ( ps-Tg) detection in the patients with differentiated thyroid carcinoma ( DTC) 131 I therapy. Methods Totally 73 cases with DTC who were hospitalized from March 2009 to March 2018 with complete treatment and follow-up data were selected as the study subjects. The cases were divided into three groups by 131I scanning image, no metastasis group (32 cases), lymph node metastasis group (31 cases), and distance metastasis group ( 10 cases ) . The levels of stimulated thyroglobulin ( s-Tg ) in serum were detected within one week before 131 I ablation for thyroid remnant and metastasis after surgical treatment. The 131I -whole body scan (131I -WBS) was performed at 3 to 5 days after 131I treatment and these cases were followed-up for 8-12 months. Results There was not statistically significant difference in ps-Tg between no metastasis group and lymph node metastasis group before 131I treatment(P>0.05). The ps-Tg in distance metastasis group was significantly higher than that in patients without metastasis and lymph node metastasis(Z= -3.810、 Z= -3.371, P<0.05). Before treatment with 131I ablation metastasis, there was not statistically difference in s-Tg among 3 groups(H=11.764, P<0.05). The area under the ROC curve of ps-Tg and s-TG diagnostic DTC distant metastasis rate before treatment of ablation for thyroid remnant was 0.903, and the accuracy were 90.48％. The area under the ROC curve of diagnosis of DTC distant metastasis and lymph node metastasis before ablation for thyroid metastasis was 0. 817 and 0.644, and the accuracy was 88.10％ and 65.08％, respectively. Conclusions The accuracy of diagnosing DTC distant metastasis of ps-Tg before 131 I ablation for thyroid remnant is superior to ps-Tg before ablation forthyroid metastasis. The level of s-Tg diagnosis of DTC lymph node before 131 I ablation metastasis precede ps-Tg before 131 I ablation for thyroid remnant

Clinical significance of tracing thyroglobulin in predicting metastasis of post-operative patients with differentiated thyroid carcinoma before its first pre-ablation with 131I / 中华内分泌代谢杂志

Objective To investigate the value of tracing thyroglobulin(Tg)in predicting metastasis of post-operative patients with differentiated thyroid carcinoma(DTC)before its first pre-ablation with 131I. Methods 106 cases with DTC, undergoing total thyroidectomy and lymphadenectomy, were assigned to 2 groups as M0 group (without metastasis)and M1 group(with metastasis). Clinical data including pre-ablation stimulated thyroglobulin (sTg)and pre-operative Tg were determined. sTg, pre-operative Tg, Tg variation(△Tg), and Tg variation rate (△Tg/pre-operative Tg)between 2 groups were compared. The ROC curve and the diagnostic critical point(DCP) were analyzed. Results sTg, Pre-operative Tg, Tg variation, and Tg variation rate were significantly higher than those of M0(all P<0.01). The corresponding areas under the ROC curve(AUC)to differentiate the two groups were 0.913,0.702,0.773,and 0.943,respectively. The best diagnostic value points(DCP)were 40.60 ng/ml and-72.5%. The sensitivity and specificity were 70. 21%, 100. 00%, and 89. 36%, 88. 13%, respectively. Conclusion The pre-ablation sTg seems to be a useful diagnostic marker for predicting metastasis before the first 131I ablation. The sTg value can be effectively corrected by the Tg variation rate,and the sensitivity and accuracy of sTg for metastasis in DTC patients can be improved,finally providing evidence for pre-ablative assessment as well as strategies of 131I therapy.