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Elevated serum thyroglobulin levels at the time of ablative radioactive iodine therapy indicate a worse prognosis in thyroid cancer: an Australian retrospective cohort study

Published online by Cambridge University Press:  04 August 2016

T J Matthews ,
E Chua ,
A Gargya ,
J Clark ,
K Gao  and
M Elliott
T J Matthews*
Affiliation:
Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
E Chua
Affiliation:
Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, New South Wales, Australia
A Gargya
Affiliation:
Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, New South Wales, Australia
J Clark
Affiliation:
Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, New South Wales, Australia
K Gao
Affiliation:
Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse at Royal Prince Alfred Hospital, New South Wales, Australia
M Elliott
Affiliation:
Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, New South Wales, Australia
*
Address for correspondence: Dr Timothy James Matthews, Suite 7–155, Missenden Rd, Newtown, NSW 2042, Australia Fax: +61 2 8078 4408 E-mail: [email protected]
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Abstract

Background:

Serum thyroglobulin is used as a surrogate marker for well-differentiated thyroid carcinoma recurrence. This study investigates whether thyroglobulin measured at the time of ablative radioactive iodine therapy predicts disease-free survival.

Methods:

A retrospective review was conducted of patients with well-differentiated thyroid carcinoma presenting from 1989 to 2010 at the Royal Prince Alfred Hospital, New South Wales, Australia. Disease-free survival of patients with a significantly elevated stimulated thyroglobulin level (27.5 µg/l or higher) at the time of ablative radioactive iodine therapy was compared to that of patients without a significantly elevated thyroglobulin level using univariate analysis.

Results:

Patients with a thyroglobulin level of 27.5 µg/l or higher had an increased relative risk of disease recurrence of 4.50 (95 per cent confidence interval = 1.35–15.04). If lateral neck dissection was required at the time of surgery, patients also had an increased relative risk of macroscopic disease recurrence of 4.94 (95 per cent confidence interval = 1.47–16.55).

Conclusion:

An elevated thyroglobulin level of 27.5 µg/l or higher at the time of ablative radioactive iodine therapy is a prognostic indicator for macroscopic disease recurrence in well-differentiated thyroid carcinoma.

Keywords

ThyroglobulinPrognosisThyroid NeoplasmsIodineBiochemical Tumor MarkersDisease-Free Survival
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Supplement S4 , July 2016 , pp. S50 - S53
Copyright
Copyright © JLO (1984) Limited 2016 

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References

1 Currow, D, Thomson, S. Cancer in New South Wales: Incidence Report 2009. Sydney: Cancer Institute NSW, 2014 Google Scholar
2 Busnardo, B, De Vido, D. The epidemiology and etiology of differentiated thyroid carcinoma. Biomed Pharmacother 2000;54:322–6CrossRefGoogle ScholarPubMed
3 Brierley, JD, Panzarella, T, Tsang, RW, Gospodarowicz, MK, O'Sullivan, B. A comparison of different staging systems predictability of patient outcome. Thyroid carcinoma as an example. Cancer 1997;79:2414–233.0.CO;2-U>CrossRefGoogle ScholarPubMed
4 Hundahl, SA, Fleming, ID, Fremgen, AM, Menck, HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985–1995. Cancer 1998;83:2638–483.0.CO;2-1>CrossRefGoogle Scholar
5 Gilliland, FD. Prognostic factors for thyroid carcinoma. A population-based study of 15,698 cases from the Surveillance, Epidemiology and End Results (SEER) program 1973–1991. Cancer 1997;79:564–733.0.CO;2-0>CrossRefGoogle Scholar
6 Mazzaferri, EL, Robbins, RJ, Spencer, CA, Braverman, LE, Pacini, F, Wartofsky, L et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 2003;88:1433–41CrossRefGoogle ScholarPubMed
7 Pelttari, H, Laitinen, K, Schalin-Jantti, C, Valimaki, MJ. Long-term outcome of 495 TNM stage I or II patients with differentiated thyroid carcinoma followed up with neck ultrasonography and thyroglobulin measurements on T4 treatment. Clin Endocrinol (Oxf) 2008;69:323–31Google Scholar
8 American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper, DS, Doherty, GM, Haugen, BR, Kloos, RT, Lee, SL et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–214Google Scholar
9 Ronga, G, Filesi, M, Ventroni, G, Vestri, AR, Signore, A. Value of the first serum thyroglobulin level after total thyroidectomy for the diagnosis of metastases from differentiated thyroid carcinoma. Eur J Nucl Med 1999;26:1448–52Google Scholar
10 Giovanella, L, Ceriani, L, Suriano, S, Ghelfo, A, Maffioli, M. Thyroglobulin measurement before rhTSH-aided 131I ablation in detecting metastases from differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2008;69:659–63Google Scholar
11 Heemstra, KA, Liu, YY, Stokkel, M, Kievit, J, Corssmit, E, Pereira, AM et al. Serum thyroglobulin concentrations predict disease-free remission and death in differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2007;66:58–64 Google Scholar
12 Aras, G, Gultekin, SS, Kucuk, NO. The additive clinical value of combined thyroglobulin and antithyroglobulin antibody measurements to define persistent and recurrent disease in patients with differentiated thyroid cancer. Nucl Med Commun 2008;29:880–4CrossRefGoogle ScholarPubMed
13 Spencer, CA. Challenges of serum thyroglobulin (Tg) measurement in the presence of Tg autoantibodies. J Clin Endocrinol Metab 2004;89:3702–4CrossRefGoogle ScholarPubMed
14 Kim, TY, Kim, WB, Kim, ES, Ryu, JS, Yeo, JS, Kim, SC et al. Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 2005;90:1440–5Google Scholar
15 Kloos, RT. Approach to the patient with a positive serum thyroglobulin and a negative radioiodine scan after initial therapy for differentiated thyroid cancer. J Clin Endocrinol Metab 2008;93:1519–25Google Scholar
16 Ma, C, Kuang, A, Xie, J. Radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases. Cochrane Database Syst Rev 2009;(1):CD006988CrossRefGoogle ScholarPubMed
17 Vaisman, A, Orlov, S, Yip, J, Hu, C, Lim, T, Dowar, M et al. Application of post-surgical stimulated thyroglobulin for radioiodine remnant ablation selection in low-risk papillary thyroid carcinoma. Head Neck 2010;32:689–98Google Scholar
18 Iyer, NG, Morris, LG, Tuttle, RM, Shaha, AR, Ganly, I. Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy. Cancer 2011;117:4439–46Google Scholar
19 Ballivet, S, Chua, E, Bautovich, G, Turtle, JR. Thyroid Cancer in New Caledonia. Radiation and Thyroid Cancer. London: World Publishing, 1999;107–16Google Scholar