Is it Possible to avoid rh-TSH test in Patients with Differentiated Thyroid Carcinoma by Using the Association between Ablation and Suppressive Thyroglobulin?

Background: The follow-up of differentiated thyroid cancers is based on neck ultrasonography and serum thyroglobulin assay (Tg), during l-T4 therapy and after recombinant human TSH administration; this test appears quite expensive, considering that only a small percentage of patients with undetectable Tg on TSH suppression therapy shows a response after TSH stimulation. Objectives: The aim of our study was to verify whether low levels of serum thyroglobulin at the time of remnant ablation (A-Tg) associated with undetectable thyroglobulin levels on TSH suppression (S-Tg), have sufficient negative predictive value for recurrence of disease, thus avoiding rh-TSH test in Differentiated Thyroid Cancer patients. Methods: we retrospectively enrolled 975 DTC patients treated with thyroidectomy+131-I remnant ablation showing undetectable S-Tg measured after 12 months follow-up. The availability of A-Tg and rh-TSH stimulated Tg (R-Tg) obtained 1 year later were considered as inclusion criteria. Patients with positive circulating Ab-Tg and/or histological dedifferentiation were excluded. Patients were subdivided in high and low risk of recurrence according to the criteria proposed by the European Thyroid Cancer Taskforce. Results: Using rh-TSH test as gold standard, the NPV for A-Tg<10 μg/L was 98.5% in group A (low risk patients) and 95.5% in group B (high risk patients); it significantly raised to 99.2% in group A (p-value 0.03) and 99.3% in group B (p-value 0.02) when the association between A-Tg<10 μg/L and S-Tg<0.6 μg/L was considered. When we evaluated the whole population the negative predictive value was 97% for A-Tg<10 μg/L alone, raising to 99.3% when associated with S-Tg<0.6 μg/L (p-value<0.008). Conclusion: our data confirmed the very high negative predictive value of the association between low levels of A-Tg and undetectable S-Tg in the early risk stratification of differentiated thyroid cancer patients, leading to avoid rh-TSH test with an important economic impact

The Footprints of Poly-Autoimmunity: Evidence for Common Biological Factors Involved in Multiple Sclerosis and Hashimoto’s Thyroiditis

Autoimmune diseases are a diverse group of chronic disorders and affect a multitude of organs and systems. However, the existence of common pathophysiological mechanisms is hypothesized and reports of shared risk are emerging as well. In this regard, patients with multiple sclerosis (MS) have been shown to have an increased susceptibility to develop chronic autoimmune thyroid diseases, in particular Hashimoto’s thyroiditis (HT), suggesting an autoimmune predisposition. However, studies comparing such different pathologies of autoimmune origin are still missing till date. In the present study, we sought to investigate mechanisms which may lead to the frequent coexistence of MS and HT by analyzing several factors related to the pathogenesis of MS and HT in patients affected by one or both diseases, as well as in healthy donors. In particular, we analyzed peripheral blood mononuclear cell gene-expression levels of common candidate genes such as TNFAIP3, NR4A family, BACH2, FOXP3, and PDCD5, in addition to the regulatory T cell (Treg) percentage and the 25-hydroxy vitamin D serum levels. Our findings support the plausibility of the existence of common deregulated mechanisms shared by MS and HT, such as BACH2/PDCD5-FOXP3 pathways and Tregs. Although the biological implications of these data need to be further investigated, we have highlighted the relevance of studies comparing different autoimmune pathologies for the understanding of the core concepts of autoimmunity