Comparison of 8th and 7th editions of TNM staging in terms of mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer.

OBJECTIVE: To compare the eighth and seventh editions of TNM staging (TNM-8 and TNM-7) on disease-related mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer (DTC). METHODS AND MATERIALS: We studied 400 patients (79% female) with DTC with a mean age of 40.93±14.11 years. TNM staging was recorded according to the 7th and 8th editions and patients were followed for at least 1 year and response to therapy was recorded according to ATA response categorization. RESULTS: The mean follow up time was 42.5±15.24 months. Overall, 108 patients (27%) were down-staged using the TNM-8, mainly due to the changes in the age cut-off (14.5%), N (9.25%), and T categorization (3.25%). All patients in stage III and 82.8% in stage IV were down-staged. The mean Tg levels were significantly higher in stages III and IV in TNM-8 compared to TNM-7. Four disease-related death were recorded during follow up, all in stage IV according to TNM-7, while one was in stage II according to TNM-8. One year after treatment, persistent disease was detected in 12% and 77% of patients in stage III according to the 7th and 8th editions, respectively (P= 0.04). Similarly, biochemical incomplete response one year after treatment was seen in 7.3% and 87% in stage III disease using 7th and 8th editions (P = 0.006) that fell to 2.4% and 22% in the last visit respectively (P = 0.04). CONCLUSION: Persistent disease and incomplete response to therapy were more common in stages III and IV in TNM-8 compared to TNM-7. The eighth edition was a better predictor of persistent disease in stages III and IV disease.

Longer Time to Reach Excellent Response to Treatment in Familial Versus Sporadic Non-medullary Thyroid Cancer (NMTC): A Matched Case-Control Study.

BACKGROUND: Familial non-medullary thyroid cancer (NMTC) are supposed to be more aggressive and require more frequent treatment compared to non-familial thyroid cancer. OBJECTIVES: This matched case-control study aimed to compare the response to treatment between the matched case-control groups of familial and sporadic NMTC. METHODS: This is a retrospective study in patients with familial NMTC (at least one other first-degree relative involved) who were treated with surgery, followed by radio-iodine therapy (RIT) without consideration of its familial origin. Response to treatment was compared between familial NMTC and age, sex, and TNM stage-matched non-familial NMTC (control group). Response to treatment was assessed one and two years after RIT, and time to excellent response was identified. RESULTS: Out of 2,944 NMTC patients, 81 (2.75%) patients had familial NMTC. We compared 66 patients with familial NMTC and 66 sporadic NMTC patients. There was no significant difference in first thyroglobulin, initial and accumulative iodine dose, and additional treatments (additional surgery and radiotherapy) between patients and controls. Although no significant difference was noted in one and two years' responses to treatment between the case and control groups, familial NMTC patients required more time to achieve excellent response (26.7 ± 24.9 versus 15.9 ± 9.0 months, P = 0.01). No significant difference was noted between familial NMTC patients with two or more than two involved relatives. CONCLUSIONS: Our study showed that if patients with familial NMTCs were treated in the same way as non-familial patients, the time to excellent response would be significantly longer, even when they have only one other involved relative.

Comparison of Treatment Response Achieved by Tablet Splitting Versus Whole Tablet Administration of Levothyroxine in Patients with Thyroid Cancer.

OBJECTIVES: TSH suppression by Levothyroxine consumption is a mainstay of thyroid cancer treatment. Tablet-splitting is a worldwide approach in dose adjustment in patients. However, it is highly recommended to evaluate the validity of tablet splitting for each distinctive drug by clinical trials before routinely using tablet halves in clinical practice. In this study we compared the effect of 150 µg dose of Levothyroxine by use of a100 and a 50 µg tablets or one and half 100 µg tablets in Differentiated thyroid cancer (DTC) patients. METHODS: One hundred DTC patients treated with one and half 100 µg Levothyroxine tablets were randomly divided into two groups. The first group continued taking medication as before and the second group received the same daily dose by taking one 100 and one 50 microgram Levothyroxine tablets. The mean changes in TSH and T3 levels and patients weight were compared between the groups. RESULTS: 91 patients completed the study. Levothyroxine consumption pattern, age, gender distribution, weight and TSH levels were comparable between groups at the beginning of the study. The mean change of body weights, serum levels of T3 and TSH showed no significant difference between groups in different time points during the study (P>0.05). CONCLUSION: This study showed similar efficacy of tablet splitting and two tablets administration for Levothyroxine; however, patients preferred two tablets at the end of the study. It can be concluded that tablet splitting can be used as an alternative way when the 50 µg tablet is not available.