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      Impact of thyroiditis on 131I uptake during ablative therapy for differentiated thyroid cancer

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          Differentiated thyroid cancer (DTC) is usually treated by thyroidectomy followed by radioiodine ablation and generally has a good prognosis. It may now be possible to limit the amount of treatment without impacting on efficacy. It is not known whether coexistent thyroiditis impacts on radioiodine uptake or on its potential efficacy, but this could provide a rationale for modification to current therapeutic protocols.


          This was a retrospective cohort study of radioiodine uptake on imaging after radioiodine ablation for DTC in patients with and without concurrent thyroiditis. All patients with histologically confirmed DTC treated with radioiodine ablation after thyroidectomy in a single centre from 2012 to 2015 were included. The primary outcome assessed was the presence of low or no iodine uptake on post-ablation scan, as reported by a nuclear medicine physician blinded to the presence or absence of thyroiditis.


          One hundred thirty patients with available histopathology results were included. Thyroiditis was identified in 42 post-operative specimens and 15 of these patients had low or no iodine uptake on post-ablation scan, compared to only 2 of 88 patients without thyroiditis ( P < 0.0001) with further data analysis dividing the groups by ablation activity received (1100 MBq or 3000 MBq).


          Concurrent thyroiditis may impair the uptake of radioactive iodine in management of DTC. Given that patients with DTC and thyroiditis already have a good prognosis, adopting a more selective approach to this step in therapy may be indicated. Large, longitudinal studies would be required to determine if omitting radioactive iodine therapy from those patients with concurrent thyroiditis has a measurable impact on mortality from thyroid cancer.

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          Most cited references 15

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          The association between papillary thyroid carcinoma and histologically proven Hashimoto's thyroiditis: a meta-analysis.

          No consensus exists on the association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT). To resolve this controversy, this study aimed to evaluate the relationship between the two conditions using a meta-analysis. We searched relevant published studies using citation databases including PubMed, Embase, and ISI Web of Science. The effect sizes of clinicopathologic parameters were calculated by odds ratio (OR), weighted mean difference, or hazard ratio (HR). The effect sizes were combined using a random-effects model. Thirty-eight eligible studies including 10 648 PTC cases were selected. Histologically proven HT was identified in 2471 (23.2%) PTCs. HT was more frequently observed in PTCs than in benign thyroid diseases and other carcinomas (OR=2.8 and 2.4; P<0.001). PTCs with coexisting HT were significantly related to female patients (OR=2.7; P<0.001), multifocal involvement (OR=1.5; P=0.010), no extrathyroidal extension (OR=1.3; P=0.002), and no lymph node metastasis (OR=1.3; P=0.041). Moreover, PTCs with HT were significantly associated with long recurrence-free survival (HR=0.6; P=0.001). Our meta-analysis showed that PTC is significantly associated with pathologically confirmed HT. PTC patients with HT have favorable clinicopathologic characteristics compared with PTCs without HT. However, patients with HT need to be carefully monitored for the development of PTC.
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            Differentiated Thyroid Cancer: Management of Patients with Radioiodine Nonresponsive Disease

            Differentiated thyroid carcinoma (papillary and follicular) has a favorable prognosis with an 85% 10-year survival. The patients that recur often require surgery and further radioactive iodine to render them disease-free. Five percent of thyroid cancer patients, however, will eventually succumb to their disease. Metastatic thyroid cancer is treated with radioactive iodine if the metastases are radioiodine avid. Cytotoxic chemotherapies for advanced or metastatic noniodine avid thyroid cancers show no prolonged responses and in general have fallen out of favor. Novel targeted therapies have recently been discovered that have given rise to clinical trials for thyroid cancer. Newer aberrations in molecular pathways and oncogenic mutations in thyroid cancer together with the role of angiogenesis in tumor growth have been central to these discoveries. This paper will focus on the management and treatment of metastatic differentiated thyroid cancers that do not take up radioactive iodine.
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              Differentiated thyroid cancer.

              Differentiated thyroid cancer, which includes papillary and follicular histologies, is a common malignancy and is increasing in incidence. It carries a favorable prognosis compared to other cancers. However, optimal outcomes are achieved only via coordinated multimodal therapy. Of these treatments, surgery is the cornerstone of initial management. Most patients should undergo thyroidectomy with concomitant central neck (level VI) lymph node dissection. On the other hand, thyroidectomy alone may be appropriate for patients with smaller tumors (T1 or T2) and no evidence of suspicious lymphadenopathy. Surgery is also indicated in cases of cervical lymph node metastases and locoregional recurrence. The principal adjuvant therapy is radioactive iodine, which should be considered in patients with a high risk of locoregional recurrence or with metastatic disease. Similarly, suppression of endogenous thyroid-stimulating hormone is recommended in patients with an elevated risk of recurrence. External-beam radiotherapy is indicated in patients with gross extrathyroidal extension or residual disease not amenable to surgery. Finally, molecular therapies, especially those targeting key tyrosine kinases and/or inhibiting angiogenesis, are emerging treatment modalities that could replace the limited efficacy of conventional chemotherapy. Copyright © 2010 Elsevier Inc. All rights reserved.

                Author and article information

                Endocr Connect
                Endocr Connect
                Endocrine Connections
                Bioscientifica Ltd (Bristol )
                May 2019
                09 April 2019
                : 8
                : 5
                : 571-578
                [1 ]Barts Health NHS Trust , Barts and the London School of Medicine and Dentistry, London, UK
                [2 ]Barts and the London School of Medicine and Dentistry , QMUL, London, UK
                Author notes
                Correspondence should be addressed to M Druce: m.r.druce@
                © 2019 The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.



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