The thyroglobulin to TSH ratio to predict successful ablation after iodine therapy in papillary thyroid carcinoma

Document Type : Original Article

Authors

1 Clinical Research Development Unit, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran

2 Department of Radiology and Radiotherapy, Shahid Beheshti Hospital, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran

3 Student Research Committee, Babol University of Medical Sciences, Babol, Iran

4 Health Research Institute, Babol University of Medical Sciences, Babol, Iran

5 Department of Radiation Technology, Allied Medicine Faculty, Babol University of Medical Sciences, Babol, Iran

Abstract

Introduction: In recent years, thyroidectomy and radioactive iodine remnant ablation and thyroid-stimulating hormone suppression therapy with thyroxine have emerged as the optimal treatment for differentiated thyroid cancer. The aim of the study was to analyze the sTg/TSH ratio to predict the value of successful ablation and also to evaluate whether this ratio can be used as a suitable predictor and compared with stimulated thyroglobulin (sTg).
Methods: We investigated patients who underwent total thyroidectomy for DTC, with or without neck lymph node dissection, from 2015 to 2024. The administered dose was determined by experienced nuclear medicine physician based on thyroid remnant status and the presence of distant metastases Four to six months after I-131 treatment, all patients underwent follow-up assessments. Successful ablation was defined as the absence of detectable lesions on diagnostic iodine scan, neck ultrasound, Tg levels below 1 ng/mL and negative TgAb results.
Results: Of the total 154, 115 patients (74.7%) achieved successful ablation, while 39 patients (25.3%) had unsuccessful ablation. Primary tumor size, multifocality and cervical lymph node involvement were associated with a higher rate of failure to successful ablation (P = 0.004). Patients were classified based on a Tg cutoff of 2.25 ng/mL. At sTg levels greater than 2.25 ng/mL, the chance of successful ablation decreased by 89% (OR=0.11). At a Tg/TSH ratio cutoff of 0.046, patients with ratios below this value had a success rate of 70.4%, which was statistically significant compared to those with higher ratios (P < 0.001).
Conclusion: The present study showed that both sTg and sTg/TSH ratio can predict ablation outcome in the PTC patients. With the equal specificity (70.4 %), the sensitivity of sTg/TSH ratio (82 %) is slightly higher than sTg (79.5%) as a better predictor of the efficacy of RAI treatment and successful ablation.

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References

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