SFEBES2013 Poster Presentations Thyroid (37 abstracts)
Prevalence of anti-thyroglobulin antibodies, their prognostic significance and impact on patient care in a cohort of patients with differentiated thyroid cancer
Sam O’Toole , James Pittaway , Omair Raja , Matthew Buckland , Nick Plowman , Carmel Brennan , Mona Waterhouse , Scott Akker , Will Drake & Maralyn Druce
Barts and the London School of Medicine and Dentistry/Barts Health NHS Trust, London, UK.
Background: The measurement of thyroglobulin (Tg) is important in the follow-up of patients with differentiated thyroid cancer (DTC), but interpretation is subject to interference by anti-thyroglobulin antibodies (TgAb). National guidelines recommend measurement of TgAb status but no consensus exists on how surveillance should be adapted in cases of TgAb positivity.
Aims: To evaluate the impact of TgAbs on clinical management, in a single-centre cohort of DTC patients.
Methods: Retrospective analysis of patients receiving radio-iodine ablation at St Bartholomew’s Hospital, London, 1/12/05–31/7/11.
Results: 236 consecutive patients met inclusion criteria, of whom 161 were followed-up locally (median duration 1023 days). Forty-three patients (27%) required further treatment and eight (5%) died of DTC during the follow-up period.
96 patients (53.1%) had their TgAb status assessed. Six patients (6%) were TgAb positive. All were female and they were more likely to be younger (median age 32.5 vs 44.1years), and have larger tumours (median size 30.8 vs 22.8 mm), with vascular invasion (66.7 vs 24.4%) and lymph node involvement (66.7 vs 24.4%) at diagnosis. All were alive at most recent follow-up; four had evidence of locally recurrent (three) or metastatic disease (one). Three patients required additional radio-iodine therapy and one had a selective neck dissection. Four patients never had a detectable Tg.
Discussion: Even over a short follow-up period, TgAb positive patients had a high prevalence of recurrent or metastatic disease. The decision to embark on further treatment was based upon the presence of radio-iodine avid or palpable disease as Tg levels were falsely reassuring. The presence of TgAb renders Tg an unreliable recurrence marker. Beyond the usual practices of clinical examination and chest radiography, optimal surveillance strategies in this ‘high risk’ group are unclear. In our cohort we did not observe that sequential measurement of TgAb resulted in any overt amendments to decision-making.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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