Objective
To investigate the role of preoperative serum thyroid stimulating hormone (TSH) in evaluating differentiated thyroid cancer (DTC).
Methods
A total of 551 patients with thyroid nodules met the study criteria, who got treatment in the First Affiliated Hospital of Jiamusi University between Aug. 2017 and Dec. 2017. And the patients were divided into DTC group (n=110) and benign group (n=441) according to the postoperative pathological results. The difference of serum TSH level between the 2 groups was compared and then explored the diagnostic significance of serum TSH level, thyroid imaging report and data system (TI-RADS), and serum TSH combined withTI-RADS.
Results
The serum TSH level was higher in the DTC group than that of the benign group (Z=5.198, P<0.05). The sensitivity of preoperative serum TSH level in the diagnosis of DTC was 80.9% (89/110), the specificity was 74.4% (328/441), and the area under receiver operating characteristic (ROC) curve was 0.660 ［95%CI was (0.602, 0.719), P<0.05］. The sensitivity of TI-RADS in the diagnosis of DTC was 82.7% (91/110), the specificity was 73.5% (324/441), and the area under the ROC curve was 0.772 ［95%CI was (0.711, 0.823), P<0.05］. The sensitivity of preoperative serum TSH combined with TI-RADS in the diagnosis of DTC was 91.8% (101/110), the specificity was 87.5% (386/441), and the area under the ROC curve was 0.831 ［95%CI was (0.786, 0.876), P<0.05］.
Conclusions
Preoperative serum TSH level may be a potential risk factor for the occurrence of DTC. Preoperative serum TSH level combined with TI-RADS classification can improve the accuracy of preoperative diagnosis of DTC, not only to reduce the misdiagnosis of thyroid cancer, but also can avoid excessive treatment.
ObjectiveTo analyze the influencing factors of fear of cancer recurrence (FCR) and its correlation with social support and quality of life in patients with differentiated thyroid cancer (DTC) at 5 years after surgery. MethodsA total of 116 patients with DTC from West China Hospital, Sichuan University at 5 years after surgery were selected as the research objects. The patients were investigated using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Social Support Rating Scale (SSRS) and the European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30 (EORTC QLQ-C30, hereinafter referred to as QLQ-C30). The χ2 test or Fisher exact probability method were used for univariate analysis, and multivariate logistic regression analysis was used for influencing factor analysis. The diagnostic value of variables with significant influence on FCR in multivariate logistic regression was further studied by receiver operating characteristic (ROC) curve, and Pearson correlation analysis was finally adopted to analyze the relationship between FCR and social support and quality of life in patients with DTC at 5 years after operation. ResultsThe questionnaire survey showed that the FoP-Q-SF score of 116 patients with DTC at 5 years after surgery was (35.92±2.52) scores, of which 75 patients had FoP-Q-SF score ≥34 scores, 41 patients had FoP-Q-SF score <34 scores, and the FCR rate was 64.66% (75/116). Multivariate logistic regression showed that gender, family annual income, SSRS score and total QLQ-C30 score were the main factors of FCR in patients with DTC at 5 years after surgery (P<0.05). Further ROC curve diagnosis showed that the accuracy rate of diagnosis of FCR with SSRS score ≤47.5 scores was 70.70%, the total score of QLQ-C30 ≤617.225 scores was 69.02%. The accuracy rate of diagnosis of FCR was 66.03% when the annual income of family was less than 150 000 yuan. The accuracy of women’s diagnosis of FCR was 62.28%. Pearson correlation analysis showed that FoP-Q-SF score was negatively correlated with SSRS score and total score of QLQ-C30 in DTC patients at 5 years after operation (r=–0.629 6, P=0.000 1; r=–0.568 5, P=0.000 1). ConclusionsThe proportion of patients who have FCR at 5 years after DTC operation is high, and gender, family annual income, SSRS score and total score of QLQ-C30 are the influencing factors. Therefore, we can develop targeted management strategies to reduce patients’ FCR and improve their quality of life.
ObjectiveTo investigate the effects of thyroid globulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) statuses on central lymph node (CLN) metastasis in patients with differentiated thyroid cancer (DTC).MethodsA retrospective analysis was performed on 526 patients with DTC confirmed by pathology from nine participating institutions, who underwent the bilateral thyroidectomy plus bilateral CLN dissection. The clinicopathologic characteristics of different TGAb and TPOAb statuses of patients with DTC were compared, and whether the TGAb and TPOAb statuses were the independent risk factors of CLN metastasis in DTC patients or not was analyzed.ResultsAll of 526 patients with DTC were included in this study, 152 were males and 374 were females. The age was (44±11) years old. There were 63 cases of TgAb＋TPOAb＋, 60 cases of TgAb＋TPOAb－, 30 cases of TgAb－TPOAb＋, and 373 cases of TgAb－TPOAb－. It was found that there was a significant difference in the gender among the four different antibody statuses of patients, that was, women with abnormal antibodies were more common (P<0.001), not found that there were related to the tumor size, blood vessel invasion, nerve invasion, CLN metastasis, tumor multifocality, and bilateral tumor or not (P>0.050). In this study, there were 389 cases of CLN with metastasis and 137 cases of CLN without metastasis. The results of multivariate analysis found that the age and gender of the patients were the independent risk factors (P<0.001), but didn’t find the TgAb and TPOAb Statuses and other factors were related to the CLN metastasis (P>0.050).ConclusionsStatuses of TGAb and TPOAb aren’t obviously associated with CLN metastasis in patients with DTC, which is inconsistent with other studies. It needs to be further researched after expanding existing sample size and determining new predictive factors.
Lung metastases are more common in metastatic disease in differentiated thyroid carcinoma (DTC). Because of its insidious onset and slow development, clinical diagnosis is relatively difficult. Some possible diagnostic methods for detecting the lung metastasis of DTC including serological examination, radionuclide imaging and other medical imaging patterns are discussed in this paper. The progress and the current situation about investigation of those modalities which are in the early diagnosis, recurrent and clinical evaluation for the lung metastasis of DTC are briefly reviewed. Therefore, it is expected to promote DTC with lung metastasis to a higher diagnostic level.
Thyroglobulin (Tg) and radioiodine whole body scan (WBS) have been commonly used in follow-up of patients with differentiated thyroid carcinoma (DTC). Tg is associated with radioiodine uptake in local or distant metastases. In minority of patients, the follow-up scan shows no functioning thyroid tissue, but the serum thyroglobulin is still elevated. Therefore, we review recent developments of diagnosis and treatment of those patients with differentiated thyroid cancer and with thyroglobulin elevation but negative iodine scintigraphy.
ObjectiveTo evaluate the diagnostic efficacy of thyroglobulin in fine-needle aspirate fluid (FNA-Tg) for detecting cervical lateral lymph node metastases (LLNM) in differentiated thyroid cancer (DTC). MethodsThe clinical data of DTC patients who underwent (selective) cervical lateral lymph node dissection at the 900th Hospital of the Joint Logistics Support Force from February 1, 2021 to November 30, 2023 were retrospectively analyzed. The significance level (α) was set as 0.05. ResultsAccording to the inclusion and exclusion criteria, a total of 155 patients with 179 lymph nodes were included, among which 49 lymph nodes were not metastatic and 130 were metastatic. The results of the integral patients showed that the area under the receiver operating characteristic curve (AUC) of FNA-Tg for distinguishing cervical LLNM in the patients with DTC was superior to that of fine-needle aspiration cytology (FNAC). The AUCs (95% confidence intervals) were 0.973 (0.950, 0.995) and 0.778 (0.708, 0.849) respectively, P<0.05, and the AUC (95% confidence interval) of the combination of the two was higher [0.978 (0.959, 0.997)]. The optimal diagnostic threshold of FNA-Tg was determined to be 16.45 μg/L or FNA-Tg/serum thyroglobulin (sTg) was 1.02. After stratification based on the size of the lymph nodes, a paired analysis of the two methods (FNA-Tg and FNAC) showed that the diagnostic efficiency of FNA-Tg was significantly higher than that of FNAC only when the short diameter of the lymph node was ≤0.8 cm [0.955 (0.919, 0.992) vs. 0.718 (0.630, 0.806), P<0.001], and there was no additional benefit from the combination of the two [0.950 (0.912, 0.989)]. ConclusionsThe results of this study suggest that FNA-Tg shows a good diagnostic efficacy for cervical LLNM in patients with DTC, especially has an obvious advantage for small lymph nodes with a short-axis diameter of lymph node ≤0.8 cm. Its optimal diagnostic threshold is 16.45 μg/L or FNA-Tg/sTG is 1.02.
Positron emission tomography (PET) is a highly sensitive and low invasive technology for cancer biological imaging. Integrated PET/computed tomography (PET/CT) cameras combine functional and anatomical information in a synergistic manner that improves diagnostic interpretation. The role of 18F FDG PET/CT in differentiated thyroid cancer (DTC) is well established, particularly in patients presenting with elevated thyroglobulin (Tg) levels and negative radioactive iodine scan. This review presents the evidence supporting the use of 18F FDG PET/CT throughout the diagnosis and management of thyroid cancer, and provides suggestions for its clinical uses.
ObjectiveTo analyze the current research status of radioactive iodine (RAI) therapy for differentiated thyroid cancer (DTC) in the past 10 years so as to understand the research hotspots and future development in this field through a bibliometric visualization analysis. MethodsThe literature relevant DTC RAI therapy published from 2014 to 2023 was screened using the Web of Science database. The publication time, country, institution, author, keywords, and other content of literature were analyzed, and the multidimensional scientific research network was constructed, and the visualization analysis was performed using RStudio and Flourish software. ResultsA total of 2 018 studies related to DTC RAI therapy were screened out from the publications from 2014 to 2023, with a fluctuating trend of increasing publication numbers. The publication numbers in China ranked first (422 articles), followed by the United States (374 articles) and Italy (182 articles). In terms of international cooperation, the United States ranked first with the most leading collaborations (289 times), and the top 3 countries in terms of cooperation with the United States were Italy (33 times), China (21 times), and France (21 times). China ranked fifth in leading cooperation, relatively less (52 times), with the main collaborators being Japan (7 times), South Korea (6 times), and Australia (5 times). Half of the top 6 institutions in terms of publication numbers were from the United States, with the top 3 being Unicancer from France (135 articles), Memorial Sloan Kettering Cancer Center from the United States (134 articles), and the UT MD Anderson Cancer Center from the United States (89 articles). Beijing Union Medical College Hospital and Shanghai Jiao Tong University ranked 19th and 23rd, respectively, with article counts of 46 and 44 articles. Tuttle RM, an author from the United States, ranked first in both publication numbers and contribution, with a total of 48 articles published from 2014 to 2023. There were two authors, Lin YS and Tan J, from China who had made it into the top 10 in terms of publication numbers, with 32 and 25 publications, respectively. The trend topics showed the evolution of hot topics, covering from the relation between urinary iodine and DTC, lymph node metastasis, to innovative research and prognosis assessment, as well as in-depth exploration of new therapies for iodine-refractory DTC. The co-occurrence and clustering of keywords included 4 aspects, namely, the standardized management of DTC, related contents during the peri-treatment period, papillary thyroid carcinoma, and the exploration of targeted therapy for iodine-refractory DTC. ConclusionsIn recent years, the research focus in the field of DTC RAI therapy has shifted from technical applications to management concepts, which has also promoted the improvement of treatment modes and made patients’ treatment plans increasingly personalized and precise. Future research will focus on precision medicine, individualized treatment, the combination of targeted therapy and immunotherapy, resistance mechanisms to treatment, and long-term management after treatment, aiming to improve patients’ treatment outcomes and quality of life and achieve a revolutionary breakthrough in treatment.
Objective
To summarize the value of serum thyroglobulin (Tg) in diagnosis before surgery and monitoring after surgery for differentiated thyroid cancer (DTC).
Methods
By using the method of literature review, the literatures related to the diagnosis and monitoring value of serum Tg for DTC were studied.
Results
① Serum thyroglobulin had a certain value in diagnosis of thyroid nodules, especially in follicular cancer or Hürthle cancer whose diagnosis undetermined by fine-needle aspiration biopsy (FNAB), and it was closely linked with the tumor’s size and distant metastasis of the DTC. ② Raise of serum Tg postoperatively was important for judging the recurrence and metastasis of DTC. However, how to establish an appropriate threshold of serum Tg, identify the differences of results for different measurement methods, make the accurate judgment for false positive and false negative, and combine with other imaging methods appropriately, needed our attention.
Conclusion
Serum Tg plays a very important role in diagnosis before surgery and monitoring after surgery of DTC, clinical doctors need pay high attention on it.
Objective To explore the efficacy and safety of levothyroxine (L-T4) combined with desiccated thyroid extract (DTE) in patients with differentiated thyroid cancer (DTC) who had suboptimal response to long-term (≥6 months) thyroid-stimulating hormone (TSH) suppression therapy with L-T4 alone after surgery. MethodsA total of 123 eligible patients were prospectively enrolled and received TSH suppression therapy with DTE combined with L-T4. The Kaplan?Meier (KM) curve was used to analyze the TSH suppression rate and assess the efficacy of this combination therapy. The Thyroid-Related Patient-Reported Outcome-39 (THyPRO-39) questionnaire was used to assess the patient-reported symptoms before medication adjustment and at 1, 3, 6, 9, and 12 months after adjustment. ResultsAmong the 123 patients, 100 were ultimately included and completed follow-up, with a follow-up period of one year. After the first adjustment to L-T4+DTE combination therapy, the rate of TSH suppression was raised to 71.0% (71/100). The KM curve revealed that the TSH suppression rate gradually increased during the follow-up period, with a cumulative rate of 82.0%. The median TSH suppression time to reach the standard was 1.4 months. Eighteen patients (18.0%) still did not meet the target after multiple regimen adjustments. Univariate analysis indicated that sex and pre-treatment serum free triiodothyronine (FT3) levels were associated with the attainment rate of TSH suppression therapy (P<0.05). However, multivariate logistic regression analysis revealed that neither sex (OR=0.353, P=0.148) nor pre-treatment serum FT3 level (OR=2.596, P=0.101) was an independent influencing factor of TSH suppression attainment rate. Following L-T4+DTE combination therapy, the serum FT3 level significantly increased [(4.5±0.6) pmol/L vs. (5.5±1.1) pmol/L, P<0.001] but remained within the normal range, whereas the free thyroxine (FT4) level did not significantly change [(21.9±2.1) pmol/L vs. (21.5±3.0) pmol/L, P=0.075]. However, patients who did not achieve target levels exhibited a decrease in serum FT4 levels compared to baseline, and the magnitude of this decrease was significantly greater than that observed in the target-achieved group [–0.8 (–2.1, –0.9) pmol/L vs. –2.5 (–3.8, –0.8) pmol/L, P=0.022]. The questionnaire results indicated that the combined L-T4+DTE treatment regimen had no significant impact on overall quality of life scores during the follow-up period (χ2=4.006, P=0.548). Conversely, the hyperthyroidism symptom scores showed significant improvement over the treatment period (χ2=23.120, P<0.001), with the median scores demonstrating an overall downward trend. ConclusionFor postoperative DTC patients who fail to achieve TSH suppression with L-T4 monotherapy, L-T4+DTE combination therapy can significantly increase the TSH suppression attainment rate while alleviating thyrotoxicosis-related symptoms.
