Role of Thyroglobulin, Neck Ultrasound, Thyroglobulin Antibodies Trend and Diagnostic Whole Body Scan in the Management of Differentiated Thyroid Cancer Patients with Persistent Thyroglobulin Antibodies

Background: During the follow-up of differentiated thyroid cancer patients, the presence of thyroglobulin antibodies makes thyroglobulin measurements unreliable. For this reason, thyroglobulin antibodies measurement and the evaluation of their titer trend are also recommended. Objective: We aimed to identify the best method among stimulated thyroglobulin, thyroglobulin antibodies titer trend, neck ultrasound and diagnostic whole body scan for detecting the presence of disease in a group of differentiated thyroid cancer patients with thyroglobulin antibodies. Patients and methods: We retrospectively reviewed the data of 212 consecutive differentiated thyroid cancer patients with thyroglobulin antibodies referred to us between 2005 and 2007 for performing a diagnostic whole body scan. All patients were evaluated during the first two years after the initial treatment. Results: Diagnostic whole body scan sensitivity and specificity in detecting persistent diseases were 70% and 72%, respectively. Diagnostic whole body scan alone had the best positive and negative predictive values (93% and 32%, respectively). A low sensitivity and specificity (56% and 10%, respectively) for increasing or stable thyroglobulin antibodies titer trends were also identified. A good compromise between sensitivity and specificity was obtained when diagnostic whole body scan, stimulated thyroglobulin and neck ultrasound were combined without considering thyroglobulin antibodies trend evaluations (82% and 45%, respectively). Conclusions: Diagnostic whole body scan plays an important role in detecting persistent disease in differentiated thyroid cancer patients with thyroglobulin antibodies, both alone and in association with other methods. However, its low negative predictive value suggests that when a suspicious persistent disease is present, the use of other imaging methods, such as computed tomography scan or FDG-positron emission computed tomography, is recommended. Finally, from this study, it appears that the thyroglobulin antibodies titer trend does not add any useful information about the disease status in the first two years after initial treatment

Effect of thyroglobulin autoantibodies on the metabolic clearance of serum thyroglobulin

Background: In order to establish whether thyroglobulin autoantibodies (TgAb) influence the metabolic clearance of thyroglobulin (Tg) in humans, serum Tg and TgAb were correlated shortly after radioiodine (131I) treatment. Methods: Samples were collected from 30 consecutive patients undergoing 131I activity for Graves' hyperthyroidism at the time of treatment and every 15 days thereafter, up to 90 days. Tg and TgAb were measured by immunometric assays (functional sensitivities: 0.1 ng/mL and 8 IU/mL). Results: Tg was detectable in all patients at day 0. Tg concentrations rose from a mean of 33.2 ng/mL [confidence interval (CI) 17.8–61.0 ng/mL] at day 0 to a mean of 214.6 ng/mL [CI 116.9–393.4 ng/mL] at day 30 and then steadily decreased, reaching the lowest concentration at day 90 (M = 10.9 ng/mL [CI 5.5–20.9 ng/mL]). Compared to their levels at day 0 (M = 23.6 IU/mL [CI 10.5–52.9 IU/mL]), TgAb remained stable through day 15 and then gradually increased up to a mean of 116.6 IU/mL [CI 51.9–262.2 IU/mL] at day 90. Patients were then split into two groups according to their TgAb status at day 0: undetectable (<8 IU/mL; 9 patients) or detectable (≥8 IU/mL; 21 patients) TgAb. Compared to the other cohort, patients with detectable TgAb showed significantly lower Tg concentrations at day 0 (M = 20.3 ng/mL [CI 10.1–40.2 ng/mL] vs. M = 101.8 ng/mL [CI 36.6–279.8 ng/mL]), similar at day 15, lower levels at day 30 (M = 146.5 ng/mL [CI 74.3–287.8 ng/mL] vs. M = 514.8 ng/mL [CI 187.8–1407.9 ng/mL]), at day 45 (M = 87.5 ng/mL [CI 43.1–176.6 ng/mL] vs. M = 337.9 ng/mL [CI 120.1–947.0 ng/mL]), at day 60 (M = 61.6 ng/mL [CI 31.0–121.4 ng/mL] vs. M = 255.8 ng/mL [CI 79.0–823.8 ng/mL]), and at day 75 (M = 24.5 ng/mL [CI 11.9–49.2 ng/mL] vs. M = 249.5 ng/mL [CI 63.5–971.1 ng/mL]), and similar levels at day 90. Patients with detectable TgAb showed a lower (M = 182.5 ng/mL [CI 92.0–361.0 ng/mL] vs. M = 514.8 ng/mL [CI 187.8–1407.9 ng/mL]) and an earlier (day 15 vs. day 30) peak of Tg. The mean Tg concentration was lower in patients with detectable TgAb than in those with undetectable TgAb (area under the curve: 17,340 ± 16,481 ng/mL vs. 36,883 ± 44,625 ng/mL; p = 0.02). Conclusions: TgAb influence the changes in Tg concentrations observed immediately after 131I treatment, inducing lower levels and an earlier peak of Tg. These observations indicate that TgAb significantly influence the metabolic clearance of Tg, supporting the concept that their interference in the measurement of Tg is mainly due to an in vivo effect

Identification and Functional Studies of Two New Dual-Oxidase 2 (DUOX2) Mutations in a Child with Congenital Hypothyroidism and a Eutopic Normal-Size Thyroid Gland

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Thyroglobulin Autoantibodies Switch to IgG1 and IgG3 Subclasses after 131I Treatment for Graves' Hyperthyroidism: Autoantibodies Subclasses Are Related to the Activity of Autoimmune Thyroid Disease

Context. Thyroglobulin autoantibodies (TgAb) are considered non-pathogenic, because they can be detected in the sera of subjects with no evidence of thyroid disease and do not bind the complement. Their subclass distribution is debated. Radioidine (131I) treatment for Graves’ disease (GD) is one of the events inducing a rise in TgAb levels. Design. Sera with positive TgAb (AIA-Pack, Tosoh Bioscience, Japan) were collected from 25 GD patients (18 females and 7 males), age 41.5 (30.8-56.8) yr, at the time of 131I treatment and three and six months thereafter. To prevent the exacerbation of Graves’ Ophthalmopathy, all patients received oral prednisone. Total TgAb, TgAb light chains and TgAb subclasses weremeasured by ELISA at each time point. Data were analysed by the non-parametric Friedman test and, when the results were significant, values at baseline were compared with those after three and six months in the post-hoc analysis. Results. Total TgAb IgG assessed by ELISA rose significantly (p=0.024): 1:100 (1:100-1:330) before 131I treatment, 1:330 (1:100-1:660) at three months (p=0.10) and 1:330 (1:330-1:1000) at six months (p=0.048). TgAb κ chains did not change (p=0.052), TgAb λ chains increased significantly (p=0.001), being 0 (0-1:100) before 131I treatment, 0 (0-1:330) at three months (p=0.03) and 1:100 (0-1:330) at six months (p=0.002). A significant rise in IgG1 and IgG3 levels was observed after 131I (p=0.008 and 0.006, respectively), while IgG2 and IgG4 levels did not change. The increase in IgG1 levels was persistent: 0 (0-1:100) before 131I treatment, 1:100 (0-1:100) at three months (p=0.028) and 1:100 (0-1:100) at six months (p=0.024). At variance, the increase in TgAb IgG3 was transient: 0 (0-1:100) before 131I treatment, 1:100 (0-1:330) at three months (p=0.028) and 0 (0-1:100) at six months (p=0.72). Conclusions. 131I treatment for GD increases the levels of the complement-activating IgG1 and IgG3 subclasses. In autoimmune thyroid disease the rise in TgAb levels is associated with a switch in their subclass distribution

"Alter Elios". The 2016 MNPG International Arch Competition for the design of a tech port beacon that infuses architecture, technology, ecology and modern living. Sapphire Coast, Australia. MNPG LTD.

Designed by two architects and ten students, the natural setting is what this is really all about. And then there is a new approach to magnetic levitation light projection from inside the building. A zero cost plan for the transference of the beacon, which acts as the nucleus for further scientific and experimental thought. Inventing not just a new way to perceive energy, but also the display of the possibility of architecture as more than a field of design, but that of an arena that can infuse other disciplines to create the next breakthrough. Il progetto proposto, condotto all’interno della ricerca sviluppata nell’insegnamento di Architettura Tecnica 2 presso il Corso di Laurea in Ingegneria Edile-Architettura dell’Università di Pisa, tenuto dal sottoscritto G. Santi, consiste nella sperimentazione edilizia di un modello di faro sostenibile, sia come impatto ambientale che come consumo delle risorse energetiche, a lievitazione magnetica

Patients with differentiated thyroid cancer who underwent radioiodine thyroid remnant ablation with low-activity ¹³¹I after either recombinant human TSH or thyroid hormone therapy withdrawal showed the same outcome after a 10-year follow-up

No long-term follow-up data are available for differentiated thyroid carcinoma (DTC) patients prepared with either exogenous or endogenous TSH and treated with low-activity (1.1 GBq [30 mCi]) radioiodine (¹³¹I)