Evaluation thyroglobulin level during suppressive therapy measured by ultrasensitive technique in the prediction of excellent response in patients with differentiated thyroid cancer

Document Type : Original Article

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: When ultrasensitive thyroglobulin (uTg) is measured serially in the first 12 months of treatment, it can probably predict recurrence of thyroid cancer without discontinuation of T4 or administration of rhTSH.
Methods: Measurement of TSH, Tg, Anti-Tg Ab, and uTg was performed in all consecutive patients with low-intermediate risk DTC 2, 6, and 12 months after initial therapy. One year after surgery, response to therapy was evaluated. Tg and uTg levels in different time points and the trend of changes were used to predict response to therapy.
Results: Overall, 37 patients with a mean age of 40.3 years were studied. The mean initial uTg was significantly lower than fTg (P=0.01). Overall, the correlation coefficient was 0.45 and increased to 0.71 in ftg<10 ng/ml (P=0.005). The majority of patients (91.9%) received a mean dose of 3.3± 2.2GBq of I-131.  One year later, there was no significant difference in mean Tg and mean uTg between the two techniques (P=0.62). The mean offT4uTg is not significantly different between patients with incomplete response compared to other groups at the end of the follow-up (P=0.1). The slope of onT4uTg was 0.04±0.18 versus 0.24±0.82 in patients with and without incomplete response respectively (P=0.45). Using ROC analysis, onT4uTg slope of 0.0005 was the best cutoff to differentiate incomplete response from other responses, however, the sensitivity was only 54.5% and specificity was 75%.
Conclusion: The trend of thyroglobulin level during suppressive therapy measured by the ultrasensitive technique cannot accurately predict excellent response in DTC patients.

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References

  1. Alevizaki M, Papageorgiou G, Rentziou G, Saltiki K, Marafelia P, Loukari E, Koutras DA, Dimopoulos M-A. Increasing prevalence of papillary thyroid carcinoma in recent years in Greece: the majority are incidental. Thyroid. 2009;19(7):749-54.
  2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133.
  3. Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, Brokhin M, Omry G, Fagin JA, Shaha A. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid. 2010;20(12):1341-9.
  4. Taieb D, Sebag F, Cherenko M, Baumstarck‐Barrau K, Fortanier C, Farman‐Ara B, De Micco C, Vaillant J, Thomas S, Conte‐Devolx B. Quality of life changes and clinical outcomes in thyroid cancer patients undergoing radioiodine remnant ablation (RRA) with recombinant human TSH (rhTSH): a randomized controlled study. Clin Endocrinol. 2009;71(1):115-23.
  5. Sabra M, Tuttle R. Recombinant human thyroid-stimulating hormone to stimulate 131-I uptake for remnant ablation and adjuvant therapy. Endocr Pract. 2013;19(1):149-56.
  6. Lee J, Yun MJ, Nam KH, Chung WY, Soh E-Y, Park CS. Quality of life and effectiveness comparisons of thyroxine withdrawal, triiodothyronine withdrawal, and recombinant thyroid-stimulating hormone administration for low-dose radioiodine remnant ablation of differentiated thyroid carcinoma. Thyroid. 2010;20(2):173-9.
  7. Borget I, Bonastre J, Catargi B, Déandréis D, Zerdoud S, Rusu D, Bardet S, Leenhardt L, Bastie D, Schvartz C. Quality of life and cost-effectiveness assessment of radioiodine ablation strategies in patients with thyroid cancer: results from the randomized phase III ESTIMABL trial. J Clin Oncol. 2015;33(26):2885-92.
  8. Smallridge RC, Meek SE, Morgan MA, Gates GS, Fox TP, Grebe S, Fatourechi V. Monitoring thyroglobulin in a sensitive immunoassay has comparable sensitivity to recombinant human TSH-stimulated thyroglobulin in follow-up of thyroid cancer patients. J Clin Endocrinol Metab. 2007;92(1):82-7.
  9. Spencer C, Fatemi S, Singer P, Nicoloff J, LoPresti J. Serum basal thyroglobulin measured by a second-generation assay correlates with the recombinant human thyrotropin–stimulated thyroglobulin response in patients treated for differentiated thyroid cancer. Thyroid. 2010;20(6):587-95.
  10. Huang S-H, Wang P-W, Huang Y-E, Chou F-F, Liu R-T, Tung S-C, Chen J-F, Kuo M-C, Hsieh J-R, Hsieh H-H. Sequential follow-up of serum thyroglobulin and whole body scan in thyroid cancer patients without initial metastasis. Thyroid. 2006;16(12):1273-8.
  11. Padovani RP, Robenshtok E, Brokhin M, Tuttle RM. Even without additional therapy, serum thyroglobulin concentrations often decline for years after total thyroidectomy and radioactive remnant ablation in patients with differentiated thyroid cancer. Thyroid. 2012;22(8):778-83.
  12. Giovanella L, Maffioli M, Ceriani L, De Palma D, Spriano G. Unstimulated high sensitive thyroglobulin measurement predicts outcome of differentiated thyroid carcinoma. Clin Chem Lab Med. 2009;47(8):1001-4.
  13. Liu L, Zhang X, Tian T, Huang R, Liu B. Prognostic value of pre-ablation stimulated thyroglobulin in children and adolescents with differentiated thyroid cancer. Thyroid. 2020;30(7):1017-24.
  14. Zhang Y, Hua W, Zhang X, Peng J, Liang J, Gao Z. The predictive value for excellent response to initial therapy in differentiated thyroid cancer: preablation-stimulated thyroglobulin better than the TNM stage. Nucl Med Commun. 2018;39(5):405-10.
  15. Tang CYL, Thang SP, Zaheer S, Kwan CK, Ng DC-E. Recombinant human thyrotropin versus thyroid hormone withdrawal in an Asian population. Endocrine. 2020;69(1):126-32.
  16. Filetti S, Durante C, Hartl D, Leboulleux S, Locati L, Newbold K, Papotti M, Berruti A. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019;30(12):1856-83.
  17. Giovanella L, Treglia G, Sadeghi R, Trimboli P, Ceriani L, Verburg FA. Unstimulated highly sensitive thyroglobulin in follow-up of differentiated thyroid cancer patients: a meta-analysis. J Clin Endocrinol Metab. 2014;99(2):440-7.
  18. Nascimento C, Borget I, Troalen F, Al Ghuzlan A, Deandreis D, Hartl D, Lumbroso J, Chougnet C, Baudin E, Schlumberger M. Ultrasensitive serum thyroglobulin measurement is useful for the follow-up of patients treated with total thyroidectomy without radioactive iodine ablation. Eur J Endocrinol. 2013;169(5):689-93.
  19. Iervasi A, Iervasi G, Bottoni A, Boni G, Annicchiarico C, Di Cecco P, Zucchelli G. Diagnostic performance of a new highly sensitive thyroglobulin immunoassay. J Endocrinol. 2004;182(2):287-94.
  20. Schlumberger M, Hitzel A, Toubert M, Corone C, Troalen F, Schlageter M, Claustrat F, Koscielny S, Taieb D, Toubeau M. Comparison of seven serum thyroglobulin assays in the follow-up of papillary and follicular thyroid cancer patients. J Clin Endocrinol Metab. 2007;92(7):2487-95.
  21. McGrath RT, Preda VA, Clifton‐Bligh P, Robinson B, Sywak M, Delbridge L, Ward P, Clifton‐Bligh RJ, Learoyd DL. Is there a role for an ultrasensitive thyroglobulin assay in patients with serum antithyroglobulin antibodies? A large (Australian) cohort study in differentiated thyroid cancer. Clin Endocrinol. 2016;84(2):271-7.
  22. Giovanella L, Feldt-Rasmussen U, Verburg FA, Grebe SK, Plebani M, Clark PM. Thyroglobulin measurement by highly sensitive assays: focus on laboratory challenges. Clin Chem Lab Med. 2015;53(9):1301-14.

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