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Need for written informed consent was waived. The study was approved by the institutional review board and Medical Ethics Committee UZ Brussel. The aim of this study was to review and determine the prognostic utility of bTg with the new high-sensitive Tg-assays. However, there is still debate regarding the validity and utility of basal Tg (bTg) during follow-up, and many centres still consider stimulated Tg (sTg) inevitable during follow-up care of DTC. A meta-analysis of the diagnostic performance of high-sensitive Tg demonstrated a very high negative predictive value (NPV).
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New Tg-assays with a functional sensitivity lower than or equal to 0.1 ng/mL, the so-called high-sensitive Tg, are now being utilized in the follow-up of low -or intermediate risk patients. However, thyroid hormone withdrawal may have a significant negative impact on quality of life with dangerous adverse events, especially in at-risk patients, while administration of rhTSH causes a significant financial burden for society and the patient. Serum Tg is obtained after thyroid stimulating hormone (TSH) stimulation to improve diagnostic accuracy, either following thyroid hormone withdrawal, or after injection of recombinant human TSH (rhTSH). The advantage of a 123I WBS over a diagnostic 131I WBS is that 123I has no β emission, and a shorter half-life, while the diagnostic performance remains equal. Subsequent follow-up can include a 123I whole-body scan (WBS) when considered necessary. Thyroglobulin (Tg) measurement, in the absence of interfering Tg autoantibodies (TgAbs), together with ultrasound (US) of the neck, should be used to detect recurrent or persistent disease after treatment. Total thyroidectomy, with adjunctive 131I remnant ablation when necessary, is still considered standard of care. In 2015, the American Thyroid Association (ATA) published the latest guidelines on management of DTC. As a result, the challenge is to avoid overtreatment, but recognize high-risk patients and possible recurrence early. Mortality rates have dropped or remained low. The increased incidence is mostly attributed to the improved use of diagnostic imaging.
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It was the fifth most common cancer in women in the USA in 2015, with 62.000 new cases reported. This study shows that an undetectable high-sensitive Tg can change the management of patients with DTC and decrease the use and need of stimulated Tg and 123I WBS.ĭifferentiated thyroid cancer (DTC) is a common malignancy, with increasing incidence every year. Ultrasound of the neck, performed between 6 and 12 months postoperative, was negative in 21 out of the 24 patients. None of these patients had a stimulated Tg above 1 ng/mL, or remnant on the 123I Whole-Body Scan (WBS) after 1 year of follow-up. A total of 24 out of the 40 patients (60%) had an undetectable high-sensitive Tg 6 months after total thyroidectomy. Resultsįorty patients were eligible for analysis.
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Statistical analysis was performed using the IBM SPSS® Statistics 24 software package. Subjects with possible thyroglobulin autoantibody interference were excluded. Patients with pathologically confirmed DTC, treated with total thyroidectomy and 131I remnant ablation, who had their complete follow-up care in our institution were selected (October 2013–December 2018). This was a retrospective, observational study. The aim of the study was to determine the prognostic utility of high-sensitive Tg and the need for other diagnostic tests in DTC. Diagnostic precision has evolved with the introduction of the new high-sensitive Tg-assays (sensitivity ≤0.1 ng/mL). Follow-up care for DTC includes thyroglobulin (Tg) measurement and ultrasound (US) of the neck, combined with 131I remnant ablation when indicated. Differentiated thyroid cancer (DTC) is a common malignancy with increasing incidence.