A Sensitive Tg Assay or rhTSH Stimulated Tg: What's the Best in the Long-Term Follow-Up of Patients with Differentiated Thyroid Carcinoma?

Sensitivity of thyroglobulin (Tg) measurement in the follow-up of differentiated thyroid carcinoma (DTC) can be optimized by using a sensitive Tg assay and rhTSH stimulation. We evaluated the diagnostic yield of a sensitive Tg assay and rhTSH stimulated Tg in the detection of recurrences in the follow-up of DTC. Additionally the value of imaging techniques for the localization of recurrences was evaluated. We included 121 disease free patients in long-term follow-up for DTC (median 10 years, range 1–34). Tg during thyroid hormone suppression therapy (Tg-on) and rhTSH stimulated Tg were measured with a sensitive Tg assay. Patients with rhTSH stimulated Tg ≥1.0 ng/ml underwent imaging with neck ultrasound, FDG-PET and post therapy 131I WBS. Sensitive Tg measurement resulted in 3 patients with Tg-on ≥1.0 ng/ml, recurrence could be localized in 2 of them. RhTSH stimulation resulted in Tg ≥1.0 ng/ml in another 17 of 118 patients. Recurrence could be localized in only 1 additional patient (1 out of 118 patients). Recurrence was localized by neck ultrasound in 1 of 3, by FDG-PET in 2 of 3 and by post therapy 131I WBS in 2 of 3 patients. In the detection of recurrences in DTC, rhTSH stimulation had very limited additional value in comparison to Tg-on measurement with a sensitive Tg assay. We consider this too low to justify rhTSH stimulation in all patients during long-term follow up. Neck ultrasound, FDG-PET and post therapy 131I WBS showed complementary value in localization of disease, but were only positive in a small fracture of all procedures

Anaplastic thyroid carcinoma with rhabdomyoblastic differentiation:A case report with a good clinical outcome

Anaplastic thyroid carcinoma is a rare and highly malignant disease. Usually, this type of tumor is irresectable, and almost all patients die within 1 year after diagnosis. We present a case of anaplastic thyroid carcinoma with rhabdomyoblastic differentiation and good therapeutic outcome. A 76-year-old female was referred to our hospital with a growing, painless neck mass which existed for 3 months. Biopsy of the mass showed microscopically and immunohistochemically a follicular (Hurthle cell) carcinoma of the thyroid, dedifferentiated to an anaplastic carcinoma with divergent differentiation along rhabdomyoblastic cell lines. The patient underwent a total thyroidectomy with additional lymph node dissection, followed by two episodes of 150 mC I-131 therapy and external radiotherapy. After a follow-up of 3 years, the patient still remains in a good condition without any signs of recurrent disease. Other cases of rhabdomyoblastic and rhabdoid anaplastic thyroid carcinomas have been described. Both types of carcinoma are associated with an aggressive clinical course. In our case, the patient is still alive without evidence of disease 3 years after primary therapy. The good clinical outcome of our patient suggests that surgical resection, radiotherapy, and I-131 ablation therapy with curative intent seems to be an adequate treatment option in patients with anaplastic thyroid carcinoma with rhabdoid and rhabdomyoblastic differentiation

Embolization Therapy of Bone Metastases from Epithelial Thyroid Carcinoma: Effect on Symptoms and Serum Thyroglobulin

Background: Selective embolization therapy (SET) has been employed to treat a number of malignant tumors, but experience with its use in metastatic epithelial thyroid carcinoma (ETC) is limited. Here we report our experience with the effect of SET on symptoms and serum thyroglobulin (Tg) in patients with bone metastases from ETC. Methods: This was a retrospective study of 13 patients with bone metastases from ETC who underwent 65 embolizations for bone metastases in 43 sessions. In the treated patients, symptoms considered related to bone metastases were compared before and about 4-7 weeks after the embolization session. Embolization sessions were excluded for analysis if concomitant therapy had taken place within 4-7 weeks before and/or after the session. Serum Tg concentrations were employed as an index of tumor debulking by SET. We attempted to estimate the influence of SET on survival time in patients with disseminated ETC who did, and an historical control group of patients with disseminated ETC who did not receive SET. Results: After exclusion of 12 (of which 3 sessions failed) out of 43 sessions, clinical symptoms, such as pain, and neurological symptoms decreased after 17, increased after 6, and did not change after 8 procedures. In 43 sessions, 20 of which were excluded (including the 3 sessions that failed), serum Tg decreased after 14 and increased after 9. The median standardized survival time of the group that received embolization was not significantly different to that of the group that did not receive embolization. Conclusions: Embolization therapy does not appear to improve life expectancy, but in selected patients can achieve palliation of pain, prevent neurological damage, reduce tumor burden, and give devascularization of the tumor before surgery

Disease characteristics.

a<p>Data are medians with interquartile range (25^th and 75^th centile) in the groups “All patients, n = 121” and “Patients with undetectable Tg-Tg-on”, N = 115”.</p><p>Data are medians and range in the groups “Patients with Tg-on 0.6–1.0 ng/ml, N = 3”and “Patients with Tg-on >1.0, N = 3”.</p>b<p>TNM-classification and staging according to Hermanek & Sobin, 1992 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000816#pone.0000816-Hermanek1" target="_blank">[34]</a>.</p>c<p>Low-risk patients are stage I disease if younger than 45 years or Stage I or II if older than 45 years.</p

Patients with Tg-on 0.6–1.0 ng/ml and rhTSH stimulated Tg ≥1.0 ng/ml.

a<p>M: male, F:female.</p>b<p>Pap: papillary, Foll: follicular, Hürthle: Hürthle cell.</p>c<p>TNM, TNM classification and risk group staging <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000816#pone.0000816-Hermanek1" target="_blank">[34]</a>.</p>d<p>Tg-on: Tg during thyroid hormone suppression therapy.</p>e<p>All Tg results in ng/ml.</p>f<p>Tg-off: Tg after thyroid hormone withdrawal.</p>g<p>NP: not performed.</p>h<p>Recurrence: recurrence localized, NRL: no recurrence localized.</p

Serum Tg and TSH levels.

a<p>Data are medians with range.</p>b<p>Tg-on: Tg during thyroid hormone suppression therapy.</p>c<p>Tg-off: Tg after 6 weeks thyroid hormone withdrawal.</p>d<p>N = 1: RhTSH stimulated Tg measurement, 4 months after radioiodine treatment was performed in one of three patients. One patient refused, the second patient was not stimulated because of extensive disease.</p>e<p>N = 2: RhTSH stimulated Tg was ≥1.0 ng/ml in 2 patients, these patients were referred for imaging.</p>f<p>N = 14: RhTSH stimulated Tg was ≥1.0 ng/ml in 15 patients, imaging was performed in 14 patients. In one patient imaging was not performed because of pregnancy wish.</p>g<p>Data are medians with interquartile range (25^th and 75^th centile)</p

Patients with undtectable Tg-on and rhTSH stimulated Tg ≥1.0 ng/ml.

a<p>M: male, F:female.</p>b<p>Pap: papillary, Foll: follicular, Hürthle: Hürthle cell.</p>c<p>TNM, TNM classification and risk group staging <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000816#pone.0000816-Hermanek1" target="_blank">[34]</a>.</p>d<p>Tg-on: Tg during thyroid hormone suppression therapy.</p>e<p>All Tg results in ng/ml.</p>f<p>Tg-off: Tg after thyroid hormone withdrawal.</p>g<p>NP: not performed.</p>h<p>Recurrence: recurrence localized, NRL: no recurrence localized.</p

Patients with Tg-on ≥1.0 ng/ml.

a<p>M: male, F:female.</p>b<p>Pap: papillary, Foll: follicular, Hürthle: Hürthle cell.</p>c<p>TNM, TNM classification and risk group staging <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000816#pone.0000816-Hermanek1" target="_blank">[34]</a>.</p>d<p>Tg-on: Tg during thyroid hormone suppression therapy.</p>e<p>All Tg results in ng/ml.</p>f<p>Tg-off: Tg after thyroid hormone withdrawal.</p>g<p>NP: not performed.</p>h<p>Recurrence: recurrence localized, NRL: no recurrence localized.</p