Evaluation of the response levels of non-metastatic thyroid cancer patients in the postoperative twelfth month

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Hasan İkbal Atılgan
Hülya Yalçın


Objective: Radioactive iodine (RAI) is used to ablate residual thyroid tissue after total thyroidectomy. The aim of this study was to evaluate the response according to the12th-month results of thyroid cancer patients and to investigate the changes in response level during follow-up.

Materials and Methods: The study included 97 patients, comprising 88 (90.7%) females and 9 (9.3%) males, with a mean age of 41.68±13.25 years. None of the patients had lymph node or distant metastasis and all received RAI therapy. Thyroid-stimulating hormone (TSH), thyroglobulin (TG), and anti-TG levels and neck USG were examined in the 12th-month. Response to therapy was evaluated as an excellent response, biochemical incomplete response, structural incomplete response, or indeterminate response.

Results: In the 12th month, 80 patients (82.47%) had excellent response, 13 patients (13.40%) had an indeterminate response, 3 patients (3.09%) had structural incomplete response and 1 patient (1.03 %) had biochemical incomplete response. Of the 80 patients with excellent response, 15 had no follow-up after the 12th month. The remaining 65 patients were followed up for 31.11±9.58 months. The response changed to indeterminate in the 18th month in 1 (1.54%) patient and to structural incomplete response in the 35th month in 1 (1.54%) patient. The 13 patients with indeterminate responses were followed up for 20.61±6.28 months.

Conclusion: The TG level at 12th months provides accurate data about the course of the disease especially in patients with excellent responses. Patients with excellent response in the 12th month may be followed up less often and those with the indeterminate or incomplete responses should be followed up more often.


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Atılgan, H. İkbal, & Yalçın, H. (2020). Evaluation of the response levels of non-metastatic thyroid cancer patients in the postoperative twelfth month . Medical Science and Discovery, 7(8), 584-588. https://doi.org/10.36472/msd.v7i8.401
Research Article


1. Pacini F, Castagna MG. Approach to and treatment of differentiated thyroid carcinoma. Med Clin North Am. 2012;96:369-83.

2. Nixon IJ, Ganly I, Patel SG, Palmer FL, Whitcher MM, Ghossein R, et al. Changing trends in well differentiated thyroid carcinoma over eight decades. Int J Surg. 2012;10:618-23.

3. Caron NR, Clark OH. Papillary thyroid cancer: surgical management of lymph node metastases. Curr Treat Options Oncol. 2005;6:311-22.

4. Lawal IO, Nyakale NE, Harry LM, Lengana T, Mokgoro NP, Vorster M, et al. Higher preablative serum thyroid-stimulating hormone level predicts radioiodine ablation effectiveness in patients with differentiated thyroid carcinoma. Nucl Med Commun. 2017;38:222-227.

5. Wang KL, Lin LY, Chen PM, Lin HD. Chronic myeloid leukemia after treatment with 131 for thyroid carcinoma. J Chin Med Assoc. 2005;68:230-3.

6. Vaisman F, Momesso D, Bulzico DA, Pessoa CH, Dias F, Corbo R, et al. Spontaneous remission in thyroid cancer patients after biochemical incomplete response to initial therapy. Clin Endocrinol (Oxf). 2012;77:132-8.

7. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 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;26:1-133.

8. Zhu C, Zheng T, Kilfoy BA, Han X, Ma S, Ba Y, et al. A birth cohort analysis of the incidence of papillary thyroid cancer in the United States, 1973-2004. Thyroid. 2009;19:1061-6.

9. Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005. Cancer. 2009;115:3801-7.

10. Borges AKDM, Ferreira JD, Koifman S, Koifman RJ. Differentiated thyroid carcinoma: a 5-years survival study at a referral hospital in Brazil. Rev Saude Publica. 2019;53:106.

11. Sciuto R, Romano L, Rea S, Marandino F, Sperduti I, Maini CL. Natural history and clinical outcome of differentiated thyroid carcinoma: a retrospective analysis of 1503 patients treated at a single institution. Ann Oncol. 2009;20:1728-35.

12. Rosario PW, Mourão GF, Calsolari MR. Can the follow-up of patients with papillary thyroid carcinoma of low and intermediate risk and excellent response to initial therapy be simplified using second-generation thyroglobulin assays? Clin Endocrinol (Oxf). 2016;85:596-601.

13. Amin A, Badwey A, El-Fatah S. Differentiated thyroid carcinoma: an analysis of 249 patients undergoing therapy and aftercare at a single institution. Clin Nucl Med. 2014;39:142-6.

14. Rosario PW, Mourão GF, Siman TL, Calsolari MR. A low postoperative nonstimulated serum thyroglobulin level excludes the presence of persistent disease in low-risk papillary thyroid cancer patients: implication for radioiodine indication. Clin Endocrinol (Oxf). 2015;83:957-61.

15. González C, Aulinas A, Colom C, Tundidor D, Mendoza L, Corcoy R, et al. Thyroglobulin as early prognostic marker to predict remission at 18-24 months in differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 2014;80:301-6.

16. Giovanella L, Castellana M, Trimboli P. Unstimulated high-sensitive thyroglobulin is a powerful prognostic predictor in patients with thyroid cancer. Clin Chem Lab Med. 2019;58:130-37.

17. Spaas M, Decallonne B, Laenen A, Billen J, Nuyts S. Prognostic Value of Stimulated Thyroglobulin Levels at the Time of Radioiodine Administration in Differentiated Thyroid Cancer. Eur Thyroid J. 2018;7:211-217.

18. Prpić M, Franceschi M, Romić M, Jukić T, Kusić Z. Thyroglobulin as a tumor marker in differentıatedthyroıd cancer - clinical considerations. Acta Clin Croat. 2018;57:518-27.

19. Girelli ME, De Vido D. Serum thyroglobulin measurements in differentiated thyroid cancer. Biomed Pharmacother. 2000;54:330-3.

20. de Meer SGA, Vorselaars WMCM, Kist JW, Stokkel MPM, de Keizer B, Valk GD, et al. Follow-up of patients with thyroglobulin-antibodies: Rising Tg-Ab trend is a risk factor for recurrence of differentiated thyroid cancer. Endocr Res. 2017;42:302-10.

21. Spencer CA, Takeuchi M, Kazarosyan M, Wang CC, Guttler RB, Singer PA, et al. Serum thyroglobulin autoantibodies: prevalence, influence on serum thyroglobulin measurement, and prognostic significance in patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab. 1998;83:1121-7.

22. Gianoukakis AG. Thyroglobulin antibody status and differentiated thyroid cancer: what does it mean for prognosis and surveillance? CurrOpin Oncol. 2015;27:26-32.

23. Carrillo JF, Vázquez-Romo R, Ramírez-Ortega MC, Carrillo LC, Gómez-Argumosa E, Oñate-Ocaña LF. Prognostic Impact of Direct 131I Therapy After Detection of Biochemical Recurrence in Intermediate or High-Risk Differentiated Thyroid Cancer: A Retrospective Cohort Study. Front Endocrinol (Lausanne). 2019;10:737.

24. Kim WG, Ryu JS, Kim EY, Lee JH, Baek JH, Yoon JH, et al. Empiric high-dose 131-iodine therapy lacks efficacy for treated papillary thyroid cancer patients with detectable serum thyroglobulin, but negative cervical sonography and 18F-fluorodeoxyglucose positron emission tomography scan. J Clin Endocrinol Metab. 2010;95:1169-73.

25. Schlumberger M, Brose M, Elisei R, Leboulleux S, Luster M, Pitoia F, et al. Definition and management of radioactive iodine-refractory differentiated thyroid cancer. Lancet Diabetes Endocrinol. 2014;2:356-8.

26. Chow TL, Choi CY, Lam SH. Disease control of differentiated thyroid carcinomas by hemithyroidectomy. Singapore Med J. 2010;51:311-4.

27. Michalaki M, Bountouris P, Roupas ND, Theodoropoulou A, Agalianou N, Alexandrides T, et al. Low-risk papillary thyroid carcinoma patients who underwent near-total thyroidectomy without prophylactic central compartment lymph node dissection and were ablated with low-dose 50mCi RAI had excellent 10-year prognosis. Hormones (Athens). 2016;15:511-17.

28. Albano D, Bonacina M, Durmo R, Bertagna F, Giubbini R. Efficacy of low radioiodine activity versus intermediate-high activity in the ablation of low-risk differentiated thyroid cancer. Endocrine. 2020;68:124-31.

29. Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, et al. 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;20:1341-9.

30. Vaisman F, Shaha A, Fish S, Michael Tuttle R. Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer. Clin Endocrinol (Oxf). 2011;75:112-9.