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Thyroid Cancer: New Advances from Diagnosis to Therapy

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Causes, Screening and Diagnosis".

Deadline for manuscript submissions: closed (15 October 2023) | Viewed by 23328

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Special Issue Editor

Prof. Dr. Michael Kreißl

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Guest Editor

Department of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany
Interests: thyroid cancer; thyroid nodules

Special Issue Information

Dear Colleagues,

Thyroid cancer is the most common endocrine malignancy. In recent years, the incidence of thyroid cancer has been on the rise in many countries. It is expected that the disease will become the fourth leading cancer in the world. However, the rise in incidence appears to at least in part be attributable to the increasing use of diagnostic imaging, which has led to enhanced detection and diagnosis of subclinical thyroid cancer, and also environmental factors.

Mortality is low in this tumor entity; however, it is still rising in some countries in spite of the advances in diagnosis and treatment in the recent years. Therefore, there is definitely a need to improve diagnostic procedures and also treatment in order to minimize treatment in indolent tumors and intensify therapy in others. Our Special Issue seeks research papers on various aspects of thyroid cancer, including diagnosis, prognosis, and current options of treatment.

Prof. Dr. Michael Kreißl
Guest Editor

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Keywords

thyroid scintigraphy
thyroid nodules
thyroid cancer
multikinase inhibitors
precision oncology
radioiodine

Published Papers (13 papers)

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13 pages, 1515 KiB

Open AccessArticle

How [¹⁸F]FDG-PET/CT Affects the Management of Patients with Differentiated Thyroid Carcinoma in Clinical Routines

by Jonas Vogel, Julia Sekler, Brigitte Gückel, Christina Pfannenberg, Konstantin Nikolaou, Christian La Fougère, Helmut Dittmann and Christian Philipp Reinert

Cancers 2024, 16(3), 588; https://doi.org/10.3390/cancers16030588 - 30 Jan 2024

Viewed by 817

Abstract

Purpose: To investigate the impact of [¹⁸F]FDG-PET/CT on the management of differentiated thyroid carcinoma (DTC) in routine clinical settings. Material and methods: In total, 98 patients (55 females, age 56 ± 18 years) with histologically confirmed thyroid cancer, including all types of DTC and poorly differentiated thyroid cancer (PDTC, n = 7), underwent [¹⁸F]FDG-PET/CT for staging or recurrence diagnostics performed using a state-of-the art clinical scanner (Biograph mCT, Siemens Healthineers) with a standardized examination protocol. The impact of PET/CT on clinical decision making was prospectively evaluated using standardized questionnaires completed by the referring physicians before and after PET/CT. Patient outcome was analyzed for OS drawn from patient records. Results: Referring physicians were unable to establish a treatment plan for 81% of patients with thyroid cancer in the absence of PET/CT. The use of PET/CT had a notable influence on patient management, leading to the development of a well-defined treatment plan for 92% of patients. Moreover, after PET/CT a change in pre-PET/CT-intended treatments occurred in 32% of cases, and further invasive diagnostic could be waived in 7% of cases. [¹⁸F]FDG-PET/CT revealed a tumor detection rate of 68% (local tumor: 19%, lymph node metastases: 40%, distant metastases: 42%). HTg levels, when stimulated via TSH, were considerably higher in patients with metastases detected on PET/CT, compared to those without metastatic findings (p = 0.02). OS was significantly worse in patients with PDTC (p = 0.002) compared to follicular thyroid cancer (FTC) and PTC or even in patients with distant metastases at first diagnosis (p = 0.03). Conclusions: This prospective registry study confirms that [¹⁸F]FDG-PET/CT used in a routine clinical setting has a very important impact on the management of patients with thyroid cancer by initiating treatments and reducing the uses of additional imaging and invasive tests. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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17 pages, 683 KiB

Open AccessArticle

Association of HOTAIR, MIR155HG, TERC, miR-155, -196a2, and -146a Genes Polymorphisms with Papillary Thyroid Cancer Susceptibility and Prognosis

by Jelena Karajovic, Bozidar Kovacevic, Bojana Uzelac, Debora Stefik, Bojana Jovanovic, Petar Ristic, Snezana Cerovic and Gordana Supic

Cancers 2024, 16(3), 485; https://doi.org/10.3390/cancers16030485 - 23 Jan 2024

Viewed by 870

Abstract

Polymorphisms in long non-coding RNA and microRNA genes may play a significant role in the susceptibility and progression of papillary thyroid carcinoma (PTC). The current study investigates the polymorphisms HOTAIR rs920778, MIR155HG rs1893650, TERC rs10936599, miR-155 rs767649, miR-196a2 rs11614913 and miR-146a rs2910164 in 102 PTC patients and 106 age- and sex-matched controls of the Caucasian Serbian population, using real-time PCR. We observed differences in genotype distributions of the HOTAIR rs920778 (p = 0.016) and MIR155HG rs1893650 (p = 0.0002) polymorphisms between PTC patients and controls. HOTAIR rs920778 was associated with increased PTC susceptibility (adjusted OR = 1.497, p = 0.021), with the TT variant genotype increasing the risk compared to the CC genotype (OR = 2.466, p = 0.012) and C allele carriers (CC + CT) (OR = 1.585, p = 0.006). The HOTAIR rs920778 TT genotype was associated with lymph node metastasis (p = 0.022), tumor recurrence (p = 0.016), and progression-free survival (p = 0.010) compared to C allele carriers. Multivariate Cox regression revealed that ATA risk (HR = 14.210, p = 0.000004) and HOTAIR rs920778 (HR = 2.811, p = 0.010) emerged as independent prognostic factors in PTC. A novel polymorphism, MIR155HG rs1893650, was negatively correlated with susceptibility to PTC, with TC heterozygotes exerting a protective effect (OR = 0.268, p = 0.0001). These results suggest that the polymorphisms HOTAIR rs920778 and MIR155HG rs1893650 could be potential prognostic and risk biomarkers in papillary thyroid carcinomas. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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12 pages, 2149 KiB

Open AccessArticle

Diffuse C-Cells Hyperplasia Is the Source of False Positive Calcitonin Measurement in FNA Washout Fluids of Thyroid Nodules: A Rational Clinical Approach to Avoiding Unnecessary Surgery

by Chiara Mura, Rossella Rodia, Silvia Corrias, Antonello Cappai, Maria Letizia Lai, Gian Luigi Canu, Fabio Medas, Pietro Giorgio Calò, Stefano Mariotti and Francesco Boi

Cancers 2024, 16(1), 210; https://doi.org/10.3390/cancers16010210 - 2 Jan 2024

Viewed by 976

Abstract

Purpose: The FNA-CT is useful for the diagnosis of MTC. The aim of this study was to evaluate the performance of FNA-CT in TNs coexisting with CCH. Methods: This study retrospectively reviewed the records of 11 patients with TNs submitted to thyroidectomy on the basis of elevated basal and/or stimulated serum CT values, which at histology were not confirmed to be MTC. The results obtained in this group were compared with those of a previously reported group of histologically proven MTC patients submitted to an identical presurgical evaluation. All patients, negative for known mutations in the RET proto-oncogene, were preoperatively submitted to neck ultrasound, FNA-cytology, and FNA-CT. Results: Approximately 6 of 11 patients showed increased (>36 ng/mL, as established in previous studies not involving patients with CCH) FNA-CT. All these patients showed diffuse CCH at histology in the thyroid lobe submitted to FNA; 5 of them were benign at histology, while only one was malignant (papillary thyroid carcinoma, PTC). The remaining 5 of 11 patients had low FNA-CT (<36 ng/mL), and all of them showed only focal CCH in the lobe submitted to FNA; three of them were malignant (2 PTC, 1 follicular carcinoma), while two were benign. Conclusions: Employing the currently proposed cut-off values, false-positive FNA-CT results may be observed in benign/malignant TNs with coexisting diffuse CCH. FNA-CT must therefore be cautiously used in the diagnostic approach for patients with TNs and a slightly increased basal or stimulated serum CT concentration in order to avoid unnecessary surgery. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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11 pages, 2852 KiB

Open AccessArticle

Long-Term Survival Analysis and Prognostic Factors of Arabic Patients with Differentiated Thyroid Carcinoma: A 20-Year Observational Study at the King Hussein Cancer Center (KHCC) Involving 528 Patients

by Akram Al-Ibraheem, Ula Al-Rasheed, Noor Mashhadani, Ahmed Saad Abdlkadir, Dhuha Ali Al-Adhami, Saad Ruzzeh, Feras Istatieh, Areen Mansour, Basem Hamdan, Reem Kheetan, Marwa Al-Shatti, Issa Mohamad, Malik E. Juweid, Areej Abu Sheikha, Kamal Al-Rabi, Gerasimos P. Sykiotis, Michael C. Kreissl, Taleb Ismael, Iyad Sultan and Hikmat Abdel-Razeq

Cancers 2023, 15(16), 4102; https://doi.org/10.3390/cancers15164102 - 15 Aug 2023

Cited by 4 | Viewed by 2274

Abstract

DTC accounts for the majority of endocrine tumors. While the incidence of thyroid cancer has been increasing globally over the past few decades, papillary thyroid carcinoma (PTC) generally shows an excellent prognosis, except in cases with aggressive clinicopathological features. This study aimed to assess the 5- and 10-year overall survival (OS) and progression-free survival (PFS) of 528 Arabic patients diagnosed with primary DTC from 1998 to 2021. Additionally, the study aimed to analyze the impact of various factors on both OS and PFS. An univariable survival analysis was conducted using Kaplan–Meier curves. The 5- and 10-year OS for patients with DTC have exceeded 95%. Additionally, PFS showed very good rates (ranging between 96.5 and 85% at 5 and 10 years, respectively). Age, male gender, risk of recurrence, and distant metastasis were identified as the main negative prognostic factors for both OS and PFS, while RAI treatment was found to be a significant factor in improving OS. Moreover, adherence to the King Hussein Cancer Center’s (KHCC) CPG demonstrated significant improvement in PFS. These findings highlight common prognostic factors and favorable outcomes in Arabic patients with DTC treated at a tertiary cancer center using standard of care approaches. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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Graphical abstract

19 pages, 5960 KiB

Open AccessArticle

Significance of Furin Expression in Thyroid Neoplastic Transformation

by Maria Teresa Azevedo, Sofia Macedo, Sule Canberk, Luís Cardoso, Tiago Bordeira Gaspar, Ana Pestana, Rui Batista, Manuel Sobrinho-Simões and Paula Soares

Cancers 2023, 15(15), 3909; https://doi.org/10.3390/cancers15153909 - 1 Aug 2023

Viewed by 1062

Abstract

Angiotensin-Converting Enzyme 2 (ACE2), Transmembrane Serine Protease 2 (TMPRSS2), and Furin were known to be key players in the SARS-CoV-2 infection, and the thyroid gland was revealed to be one of the relevant targets of the virus. Regardless of the viral infection, the expression of these molecules in the thyroid gland and their putative role in the neoplastic transformation of the thyrocytes has not been thoroughly explored. In this work, we aimed to characterize the mRNA and protein expression pattern of ACE2, TMPRSS2, and Furin in a series of patients with thyroid lesions. Our main results revealed a significantly decreased expression of ACE2 mRNA in the thyroid neoplasms in comparison to normal adjacent tissue. Furin mRNA was significantly increased in thyroid neoplasms when compared to normal adjacent tissue. In addition, a higher Furin mRNA level in thyroid carcinomas was associated with the presence of lymph node metastasis. Furin mRNA expression revealed a high discriminatory power between adjacent tissue and neoplasms. Protein expression of these molecules did not correlate with mRNA expression. Our study shows the mRNA downregulation of ACE2 and overexpression of Furin in thyroid neoplasms. Further studies are required to clarify if Furin expression can be a potential diagnostic indicator in thyroid neoplasia. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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11 pages, 5939 KiB

Open AccessArticle

Differentiating Thyroid Follicular Adenoma from Follicular Carcinoma via G-Protein Coupled Receptor-Associated Sorting Protein 1 (GASP-1)

by Yuan Rong, Cesar Torres-Luna, George Tuszynski, Richard Siderits and Frank N. Chang

Cancers 2023, 15(13), 3404; https://doi.org/10.3390/cancers15133404 - 29 Jun 2023

Viewed by 3676

Abstract

Follicular neoplasms are classified as benign or malignant depending on the presence or absence of capsular and/or vascular invasion. Due to incomplete capsular penetration or equivocal vascular invasion, the evaluation of these features can be challenging using histologic examination. In the current study, we analyzed the involvement of G-protein coupled receptor-associated sorting protein 1 (GASP-1) in the development and progression of thyroid neoplasms. Affinity-purified anti-GASP-1 polyclonal antibodies were used for routine immunohistochemistry (IHC) analysis. Thyroid tissue microarrays containing normal thyroid tissue, follicular adenoma, follicular carcinoma, papillary thyroid carcinoma, and anaplastic carcinoma were analyzed. We found that the level of GASP-1 expression can differentiate follicular adenoma from follicular carcinoma. When numerous cases were scored for GASP-1 expression by a board-certified pathologist, we found that GASP-1 expression is 7-fold higher in thyroid malignant neoplasms compared to normal thyroid tissue, and about 4-fold higher in follicular carcinoma compared to follicular adenoma. In follicular adenoma tissues, we observed the presence of many mini-glands that are enriched in GASP-1 and some mini-glands contain as few as three cells. GASP-1 IHC also possesses several advantages over the conventional H&E and can be used to identify early thyroid cancer and monitor cancer progression. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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11 pages, 508 KiB

Open AccessArticle

Comparison of 1.1 GBq and 2.2 GBq Activities in Patients with Low-Risk Differentiated Thyroid Cancer Requiring Postoperative ¹³¹I Administration: A Real Life Study

by Alfredo Campennì, Rosaria Maddalena Ruggeri, Maria Luisa Garo, Massimiliano Siracusa, Giovanna Restuccia, Andrea Rappazzo, Helena Rosarno, Antonio Nicocia, Davide Cardile, Petra Petranović Ovčariček, Sergio Baldari and Luca Giovanella

Cancers 2023, 15(9), 2416; https://doi.org/10.3390/cancers15092416 - 22 Apr 2023

Cited by 2 | Viewed by 1407

Abstract

Objectives: To compare the efficacy of low and moderate ¹³¹I activities in low-risk differentiated thyroid carcinoma (DTC) patients requiring postoperative thyroid remnant ablation in a real-world clinical setting. Methods: We retrospectively reviewed the records of 299 low-risk DTC patients (pT1-T2, Nx(0) Mx) who had undergone (near)-total thyroidectomy followed by ¹³¹I therapy, using either low (1.1 GBq) or moderate (2.2 GBq) radioiodine activities. The response to initial treatments was evaluated after 8–12 months, and patient responses were classified according to the 2015 American Thyroid Association guidelines. Results: An excellent response was observed in 274/299 (91.6%) patients, specifically, in 119/139 (85.6%) and 155/160 (96.9%) patients treated with low and moderate ¹³¹I activities, respectively (p = 0.029). A biochemically indeterminate or incomplete response was observed in seventeen (22.2%) patients treated with low ¹³¹I activities and three (1.8%) patients treated with moderate ¹³¹I activities (p = 0.001). Finally, five patients showed an incomplete structural response, among which three and two received low and moderate ¹³¹I activities, respectively (p = 0.654). Conclusions: When ¹³¹I ablation is indicated, we encourage the use of moderate instead of low activities, in order to reach an excellent response in a significantly larger proportion of patients, including patients with the unexpected persistence of the disease. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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12 pages, 3310 KiB

Open AccessArticle

Immunomorphological Patterns of Chaperone System Components in Rare Thyroid Tumors with Promise as Biomarkers for Differential Diagnosis and Providing Clues on Molecular Mechanisms of Carcinogenesis

by Letizia Paladino, Radha Santonocito, Giuseppa Graceffa, Calogero Cipolla, Alessandro Pitruzzella, Daniela Cabibi, Francesco Cappello, Everly Conway de Macario, Alberto J. L. Macario, Fabio Bucchieri and Francesca Rappa

Cancers 2023, 15(8), 2403; https://doi.org/10.3390/cancers15082403 - 21 Apr 2023

Viewed by 1296

Abstract

Hurthle cell (HC), anaplastic (AC), and medullary (MC) carcinomas are low frequency thyroid tumors that pose several challenges for physicians and pathologists due to the scarcity of cases, information, and histopathological images, especially in the many areas around the world in which sophisticated molecular and genetic diagnostic facilities are unavailable. It is, therefore, cogent to provide tools for microscopists to achieve accurate diagnosis, such as histopathological images with reliable biomarkers, which can help them to reach a differential diagnosis. We are investigating whether components of the chaperone system (CS), such as the molecular chaperones, can be considered dependable biomarkers, whose levels and distribution inside and outside cells in the tumor tissue could present a distinctive histopathological pattern for each tumor type. Here, we report data on the chaperones Hsp27, Hsp60, and Hsp90. They presented quantitative levels and distribution patterns that were different for each tumor and differed from those of a benign thyroid pathology, goiter (BG). Therefore, the reported methodology can be beneficial when the microscopist must differentiate between HC, AC, MC, and BG. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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20 pages, 979 KiB

Open AccessArticle

Update on Calcitonin Screening for Medullary Thyroid Carcinoma and the Results of a Retrospective Analysis of 12,984 Patients with Thyroid Nodules

by Martina Broecker-Preuss, Dietmar Simon, Mirka Fries, Elisabeth Kornely, Manuel Weber, Irfan Vardarli, Elena Gilman, Ken Herrmann and Rainer Görges

Cancers 2023, 15(8), 2333; https://doi.org/10.3390/cancers15082333 - 17 Apr 2023

Cited by 2 | Viewed by 2318

Abstract

Background: We provide an update on calcitonin (Ctn) screening for the early detection of medullary thyroid carcinoma (MTC) and present the results of a large single-center analysis evaluating sex-specific cut-off-levels and long-term courses. Methods: A total of 12,984 consecutive adult patients (20.1% male and 79.9% female) with thyroid nodules who had undergone routine Ctn measurement were retrospectively analyzed. Patients with confirmed suspicious Ctn values were referred for surgery. Results: Ctn measurements were elevated in 207 (1.6%) patients, with values below twice the sex-specific reference limit in 82% of these cases. Further clarification was possible in 124/207 cases, of which MTC could be ruled out in 108 cases. Histopathological assessment confirmed MTC in 16/12,984 patients. Conclusions: Our extrapolated MTC prevalence of 0.14% is significantly lower than that described in early international screening studies. The stimulation test can usually be dispensable when using a decision-making concept based on sex-specific basal Ctn cut-off values. Ctn screening is recommended even in patients with very small thyroid nodules. High quality standards in pre-analytics, laboratory measurements, and the interpretation of data must be ensured, as well as close interdisciplinary cooperation between medical disciplines. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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10 pages, 1615 KiB

Open AccessArticle

Temporal Evolution and Prognostic Role of Indeterminate Response Sub-Groups in Patients with Differentiated Thyroid Cancer after Initial Therapy with Radioiodine

by Domenico Albano, Pietro Bellini, Francesco Dondi, Anna Calabrò, Claudio Casella, Stefano Taboni, Davide Lombardi, Giorgio Treglia and Francesco Bertagna

Cancers 2023, 15(4), 1270; https://doi.org/10.3390/cancers15041270 - 16 Feb 2023

Cited by 2 | Viewed by 1515

Abstract

The clinical outcome of patients affected by Differentiated Thyroid Carcinoma (DTC) and an indeterminate response (IR) after initial therapy is not yet clear. IR includes three different sub-groups of patients: (1) IRTg+ group: Detectable thyroglobulin (Tg), regardless of antithyroglobulin antibodies (TgAb) presence or imaging studies; (2) IRTgAb+ group: Positive TgAb, regardless of Tg levels and nonspecific imaging findings; (3) IRImaging+ group: Nonspecific findings on neck ultrasonography or faint uptake in the thyroid bed on the whole-body scan, negative TgAb, and undetectable Tg. The main aim of this retrospective study was to investigate the dynamic evolution and prognostic role of these patients. From January 2010 to December 2017, 2176 patients who received radioiodine for DTC after total thyroidectomy were included. Two-hundred-eighty-eight patients had IR one year after therapy (187 TgAb+, 76 Tg+, 25 imaging+). After two years, 110 patients (38%) were reclassified as an excellent response and 5 (2%) as an incomplete response; after five years, 221 (77%) achieved an excellent response and 11 (4%) showed an incomplete response. One-year stimulated Tg and nodal disease at diagnosis may predict the final status of the disease. Progression-free survival was significantly shorter in IRTg+ than in IRTgAb+ and IRimaging+ groups. Considering Tg+ patients, a threshold of 3.3 ng/mL is best to predict prognosis. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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Review

Jump to: Research

19 pages, 7199 KiB

Open AccessReview

Role of Prehabilitation and Rehabilitation on Functional Recovery and Quality of Life in Thyroid Cancer Patients: A Comprehensive Review

by Lorenzo Lippi, Alessio Turco, Stefano Moalli, Marco Gallo, Claudio Curci, Antonio Maconi, Alessandro de Sire and Marco Invernizzi

Cancers 2023, 15(18), 4502; https://doi.org/10.3390/cancers15184502 - 10 Sep 2023

Cited by 3 | Viewed by 1859

Abstract

Background: This narrative review aims to provide a comprehensive overview of the current prehabilitation and rehabilitation strategies for thyroid cancer survivors to optimize functional outcomes and enhance their quality of life. Methods: The review follows the SANRA quality criteria and includes an extensive literature search conducted in PubMed/Medline, Web of Science, and Scopus. Results: The review emphasizes the role of a comprehensive rehabilitation approach in targeting the different domains that generate disability in thyroid cancer patients. In this context, physical activity, range of motion exercises, myofascial release, joint mobilization, and postural exercises are crucial for improving functional outcomes and reducing treatment-related discomfort and disability. Moreover, tailored rehabilitative management addressing dysphonia and dysphagia might have a positive impact on the quality of life of these patients. Despite these considerations, several barriers still affect the implementation of a multimodal rehabilitative approach in common clinical practice. Thus, sustainable and effective strategies like digital innovation and patient-centered approaches are strongly needed in order to implement the rehabilitative treatment framework of these subjects. Conclusions: This narrative review provides valuable insights into the current prehabilitation and rehabilitation strategies to treat thyroid cancer survivors, addressing physical, psychological, and vocational needs to optimize functional outcomes and enhance their quality of life. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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Graphical abstract

15 pages, 1880 KiB

Open AccessReview

Molecular Theranostics in Radioiodine-Refractory Differentiated Thyroid Cancer

by Petra Petranović Ovčariček, Alfredo Campenni, Bart de Keizer, Desiree Deandreis, Michael C. Kreissl, Alexis Vrachimis, Murat Tuncel and Luca Giovanella

Cancers 2023, 15(17), 4290; https://doi.org/10.3390/cancers15174290 - 27 Aug 2023

Cited by 2 | Viewed by 1754

Abstract

Differentiated thyroid cancer (DTC) is the most common subtype of thyroid cancer and has an excellent overall prognosis. However, metastatic DTC in certain cases may have a poor prognosis as it becomes radioiodine-refractory. Molecular imaging is essential for disease evaluation and further management. The most commonly used tracers are [¹⁸F]FDG and isotopes of radioiodine. Several other radiopharmaceuticals may be used as well, with different diagnostic performances. This review article aims to summarize radiopharmaceuticals used in patients with radioiodine-refractory DTC (RAI-R DTC), focusing on their different molecular pathways. Additionally, it will demonstrate possible applications of the theranostics approach to this subgroup of metastatic DTC. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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17 pages, 4729 KiB

Open AccessReview

Thyroid Hormone Withdrawal versus Recombinant Human TSH as Preparation for I-131 Therapy in Patients with Metastatic Thyroid Cancer: A Systematic Review and Meta-Analysis

by Luca Giovanella, Maria Luisa Garo, Alfredo Campenní, Petra Petranović Ovčariček and Rainer Görges

Cancers 2023, 15(9), 2510; https://doi.org/10.3390/cancers15092510 - 27 Apr 2023

Cited by 3 | Viewed by 2173

Abstract

Background. Differentiated thyroid carcinoma (DTC) is characterized by an excellent prognosis with a 10-year survival rate > 90%. However, when DTC develops in a metastatic form, it has been shown to significantly impact patient survival and quality of life. Although I-131 has been shown to be an effective therapy in patients with metastatic DTC, whether its efficacy after recombinant human TSH (rhTSH) is comparable to endogenous TSH stimulation by thyroid hormone deprivation (THW) is still debated. Our present study was prompted to compare clinical results obtained in metastatic DTC by I-131 administered after rhTSH and THW stimulation protocols, respectively. Methods. A systematic search on PubMed, Web of Science, and Scopus was performed from January to February 2023. Pooled risk ratios with 95% CI were determined for evaluating the initial response after to I-131 therapy after preparation with rhTSH or THW and the disease progression. To track the accumulation of evidence and reduce type I errors because of small data, a cumulative meta-analysis was performed. A sensitivity analysis was also performed to examine the impact of individual studies on overall prevalence results. Results. Ten studies were included with a total of 1929 patients pre-treated with rhTSH (n = 953) and THW (n = 976), respectively. The cumulative data of our systematic review and meta-analysis showed an increase in the risk ratio over the years without any change in favour of a pre-treatment or the other on the effectiveness of I-131 therapy of metastatic DTC. Conclusions. Our data suggest that pretreatment with rhTSH or THW has no significant impact on the effectiveness of I-131 therapy for metastatic DTC. This implies that concerns about the use of one or the other pretreatment should be deferred to clinical evaluations made considering patient characteristics and reduction in side effects. Full article

(This article belongs to the Special Issue Thyroid Cancer: New Advances from Diagnosis to Therapy)

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