Download PDF
CC BY-NC-ND 4.0 · South Asian J Cancer 2022; 11(01): 052-057
DOI: 10.1055/s-0041-1733315
Original Article
Head and Neck Cancer

Thyroglobulin Levels in Patients who have Undergone Hemithyroidectomy for Differentiated Thyroid Cancer. An Assessment of Levels and Trends at a Tertiary Referral Centre

Ashwini Munnagi
1   Department of Head and Neck Surgical Oncology, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
Vijay Pillai
1   Department of Head and Neck Surgical Oncology, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
R. Vidhya Bushan
1   Department of Head and Neck Surgical Oncology, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
Vivek Shetty
1   Department of Head and Neck Surgical Oncology, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
Narayana Subramaniam
1   Department of Head and Neck Surgical Oncology, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
K. S. Shivaprasad
2   Department of Endocrinology, Diabetes and Metabolism, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
Kranti Khadilkar
2   Department of Endocrinology, Diabetes and Metabolism, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
Basavaraj G. Sooragonda
2   Department of Endocrinology, Diabetes and Metabolism, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
Akhila Lakhsmikantha
3   Department of Pathology and Laboratory Medicine, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
Pobbisetty Radhakrishnagupta Rekha
3   Department of Pathology and Laboratory Medicine, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
Shaesta Naseem Zaidi
3   Department of Pathology and Laboratory Medicine, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
Nishtha Batra
3   Department of Pathology and Laboratory Medicine, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
,
Subramanian Kannan
2   Department of Endocrinology, Diabetes and Metabolism, Narayana Hrudhayalaya Hospitals, Bangalore, Karnataka, India
› Author Affiliations Funding Statement This study did not receive any specific fund from a private or government or nonprofit funding agencies.
› Further Information
   Permissions and Reprints

Abstract

Zoom Image
Subramanian Kannan

Serum thyroglobulin (Tg) and thyroglobulin antibody (TgAb) levels are used to monitor patients with differentiated thyroid cancer (DTC) after total thyroidectomy with or without radioiodine (RAI) ablation. However, they are also measured in patients who are treated with thyroid lobectomy (TL)/hemithyroidectomy (HT). Data on the levels of Tg and its trend in those undergoing TL/HT is sparse in India. We reviewed retrospective data of DTC patients who underwent TL/HT and were followed-up with postoperative Tg levels between 2015 and 2020. Out of 247 patients, 17 had undergone either TL or HT, which included papillary thyroid cancer (n = 12), follicular thyroid cancer (n = 4), and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 1 patient. All patients with DTC had tumor size < 4 cm (T1/2, clinical N0, Mx). The median follow-up was 15 months (range, 1–125) and the median Tg level was 7.5 ng/mL (interquartile range [IQR]; 3.6, 7.5) and ranged from 0.9 to 36.7 ng/mL. The median thyroid-stimulating hormone (TSH) level was 2.03 IU/L (IQR; 1.21, 3.59) and it ranged from 0.05 to 8.54 IU/L. As of last follow-up, none of them underwent completion thyroidectomy; however, eight patients had a decline in Tg ranging from 8 to 64%, four patients had increase in Tg ranging from 14 to 145%, three patients had stable Tg, and one of them had an increase in TgAb titers. As per American Thyroid Association (ATA) response-to-treatment category, six patients had indeterminate response, five patients had biochemical incomplete response, four patients had excellent response, and two did not have follow-up Tg and TgAb levels. While absolute values of Tg were well below 30 ng/mL in almost all patients with HT/TL, the Tg trends were difficult to predict, and only 23% of patients were able to satisfy the criteria for “excellent response” on follow-up. We suggest keeping this factor in mind in follow-up and while counselling for HT in patients with low-risk DTC.

Keywords

serum thyroglobulin - hemithyroidectomy - lobectomy - Tg levels - differentiated thyroid cancer

Ethical Approval

This study was approved by an independent institutional review board and ethics committee (Ref number: NHH/AEC-CL-2016-090).




Publication History

Article published online:
24 November 2021

© 2021. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Haugen BR, Alexander EK, Bible KC. et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26 (01) 1-133
    CrossrefPubMedGoogle Scholar
  • 2 Haddad RI, Nasr C, Bischoff L. et al. NCCN Guidelines Insights: Thyroid Carcinoma, Version 2.2018. J Natl Compr Canc Netw 2018; 16 (12) 1429-1440
    CrossrefPubMedGoogle Scholar
  • 3 Momesso DP, Tuttle RM. Update on differentiated thyroid cancer staging. Endocrinol Metab Clin North Am 2014; 43 (02) 401-421
    CrossrefPubMedGoogle Scholar
  • 4 Vaisman F, Momesso D, Bulzico DA. et al. Thyroid lobectomy is associated with excellent clinical outcomes in properly selected differentiated thyroid cancer patients with primary tumors greater than 1 cm. J Thyroid Res 2013; 2013: 398194
    CrossrefPubMedGoogle Scholar
  • 5 Momesso DP, Vaisman F, Yang SP. et al. Dynamic risk stratification in patients with differentiated thyroid cancer treated without radioactive iodine. J Clin Endocrinol Metab 2016; 101 (07) 2692-2700
    CrossrefPubMedGoogle Scholar
  • 6 Shaha AR, Migliacci JC, Nixon IJ. et al. Stage migration with the new American Joint Committee on Cancer (AJCC) staging system (8th edition) for differentiated thyroid cancer. Surgery 2019; 165 (06) 11
    Google Scholar
  • 7 Adam MA, Pura J, Gu L. et al. Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients. Ann Surg 2014; 260 (04) 601-605 , discussion 605–607
    CrossrefPubMedGoogle Scholar
  • 8 Ritter A, Mizrachi A, Bachar G. et al. detecting recurrence following lobectomy for thyroid cancer: role of thyroglobulin and thyroglobulin antibodies. J Clin Endocrinol Metab 2020; 105 (06) dgaa152
    CrossrefPubMedGoogle Scholar
  • 9 Park S, Kim WG, Song E. et al. Dynamic risk stratification for predicting recurrence in patients with differentiated thyroid cancer treated without radioactive iodine remnant ablation therapy. Thyroid 2017; 27 (04) 524-530
    CrossrefPubMedGoogle Scholar