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Thyroglobulin (Tg) is an important tool to evaluate the persistence and recurrence risk in differentiated thyroid cancer (DTC). We aimed to evaluate the correlation between pre-radioiodine therapy stimulated Tg (pre-RAI Tg) levels and the first response to treatment evaluation, and to establish a cut-off pre-RAI Tg threshold for predicting an initial excellent response. Retrospective cohort study of DTC patients who underwent total thyroidectomy and radioiodine therapy. Response to therapy was evaluated 6 to 24 months after initial therapy, and patients were classified as: excellent response (ER); indeterminate response (IndR) and incomplete response (IncR). Total patients: 166 among which 85.5% female with mean age of 47.6 ± 13 years. The ER had a significantly lower pre-RAI Tg in comparison to IndR (p<0.001) and IncR (p<0.001), and pre-RAI Tg were different between the IndR and IncR (p=0.02). A cut-off pre-RAI Tg value at 7.55ng/ml was obtained by receiver operating characteristics curve for differentiating ER from IndR and IncR. The area under curve was 0.832 (95% CI 0.76–0.91). In multivariate analysis, ATA low-risk (RR 1.61, 95% CI 1.06–2.43, p=0.025) and Tg below 7.55ng/ml (RR 2.17, 95% CI 1.52–3.10, p<0.001) were associated with ER. After a median of 7.4-year follow-up, 124 (74.7%) patients were allocated into ER, 22 (13.2%) into IndR, and 20 (12%) into IncR. In conclusion, pre-RAI Tg predicts first evaluation of treatment response. Pre-RAI Tg cut-off was a key predictor of initial excellent response to therapy and may be an important tool in the follow-up of DTC patients. [ABSTRACT FROM AUTHOR]

Objective: Prospective data on the accuracy of ultrasound (US) classification systems in thyroid nodules are still scarce. The aim of this study is to compare the accuracy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR‐TIRADS) and European (EU)‐TIRADS classification systems. Design and Patients: Consecutive patients with one or more thyroid nodule(s) who underwent fine‐needle aspiration (FNA) under ultrasonographic guidance (FNA‐US) were prospectively evaluated. Measurements: Clinical evaluation and US data were collected. The reference standard used for this study was FNA‐US cytology and histopathological diagnosis. Results: A total of 186 thyroid nodules in 166 patients were evaluated, resulting in 168 nodules from 149 patients with conclusive benign or malignant results. Sensitivity, specificity, negative predictive value (NPV) and false negative (FN) were 100.0%, 28.7%, 100.0% and 0.0%, respectively, for ACR‐TIRADS; and 90.0%, 19.1%, 96.8% and 9.1% (n = 1), respectively, for EU‐TIRADS. The number of unnecessary FNA‐US indicated by ACR‐TIRADS was lower than EU‐TIRADS (71.3% vs. 80.9%, p =.017), and the number of possibly avoided FNA‐US was higher (26.7% vs. 17.8%). Using the same threshold of ACR‐TIRADS to indicate FNA‐US in EU‐TIRADS 3 nodules (2.5 cm), there was an improvement in specificity (30.6%) and avoided FNA‐US (28.6%). The best performance of both systems was demonstrated when FNA‐US would be indicated only in highly suspicious nodules and/or in the presence of lymphadenopathy, with 85.7% and 89.3% of possibly avoided FNA‐US for ACR‐TIRADS and EU‐TIRADS, respectively, without increasing FN. Conclusion: Both systems presented high sensitivity, but low specificity in selecting nodules for FNA‐US. The use of nodular size for FNA‐US selection is questioned. [ABSTRACT FROM AUTHOR]

The clinical outcome of papillary thyroid carcinoma (PTC) patients with an indeterminate response after initial therapy is reported to be intermediate, between incomplete and excellent responses. This study evaluated the outcomes of PTC patients with indeterminate response after initial therapy. It was further determined whether the indeterminate findings predicted outcomes more precisely. Patients were further classified into 3 groups based on risk of structural persistence/recurrence: Tg group : detectable thyroglobulin, negative antithyroglobulin antibody, regardless nonspecific imaging findings; TgAb group : positive antithyroglobulin antibody, regardless thyroglobulin levels and nonspecific imaging findings, and Image group: nonspecific findings on neck ultrasonography or faint uptake in the thyroid bed on whole-body scan, undetectable thyroglobulin and negative antithyroglobulin antibody. Sixty-six patients aged 44.1±12.7 years were studied, of whom 58 (87.9%) were females. All patients underwent total thyroidectomy, and 52 patients (78.8%) received radioiodine. After 5.7 years (P25–75 2.6–9.75 years) of follow-up, most patients (89.4%) were reclassified as having an excellent response or remained in the indeterminate response to therapy. Structural recurrence/persistence disease was detected in 7 (10.6%) patients. The persistence/recurrence rate in groups were as follow: Tg , 2.63%; TgAb , 31.25%; Image , 8.3% (p=0.007). The 10-years disease-free survival rate in the TgAb group was significantly reduced (p=0.022). Our results suggest that patients with PTC and indeterminate response due to positive serum antithyroglobulin antibody have more risk of development of structural disease. These findings suggest a more individualized follow-up strategy for patients with an indeterminate response. [ABSTRACT FROM AUTHOR]

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Thyroid carcinoma accounts for roughly 1% of all new malignant diseases. Of these, at least 94% are differentiated thyroid carcinoma (DTC), either papillary thyroid carcinoma or follicular thyroid carcinoma. Patients with DTC are usually considered as having a good prognosis, 80% of patients are cured, 20% will develop loco-regional recurrence and 5-10% distant metastasis. However, the disease may have an aggressive course in some patients. The identification of these patients has a major impact in the clinical management of DTC. Several prognostic factors and classification will be addressed, as well the most useful tests for patients follow-up.