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Anti-thyroglobulin antibodies do not significantly increase the risk of finding iodine avid metastases on post-radioactive iodine ablation scan in low-risk thyroid cancer patients

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Abstract

Objective

Post-operative thyroglobulin (Tg) levels can predict the likelihood of residual cancer, including distant metastases, thereby influencing postsurgical treatment strategies even in patients with low-risk disease. Circulating anti-thyroglobulin antibodies (anti-Tg Abs) interfere with Tg measurement preventing this clinical use. It is not known if the presence of anti-Tg Abs predicts metastatic disease on post-therapy scan in patients with low-risk disease or if they should influence the use or dose of I-131 therapy. In the present study, we compare post-therapy scans in low-risk patients with and without anti-Tg Abs.

Methods

This is a single-institution retrospective study. The study population (Group A) included all patients with low-risk differentiated thyroid cancer (DTC) who underwent total thyroidectomy and RAI between 1/1/2006 to 9/11/2015 with intrathyroidal T1-T2, Nx, N0 or N1a (≤5 nodes all measuring, when reported, <2 mm) that had anti-thyroglobulin antibodies. Patients were excluded if they had known distant metastases and/or extensive vascular invasion. A second group of patients (Group B) treated during the same period but without anti-Tg antibodies was selected to match group A by propensity core matching with a logistic regression model.

Results

Each group included 37 patients. In group A: Median age was 40 years, 86% female and 76% PTC. Median tumor size was 2 cm (0.2–3.8), 32% had multifocal disease, 16% were N1a and 4% had vascular invasion. Parameters in group B were not statistically different from Group A, as expected based on the selection criteria, except being less likely to have Hashimoto’s thyroiditis on pathology (p < 0.001). Post-therapy scan results were compared by Chi-square test with 86% negative post therapy scan frequency in group A and 92% in group B without evidence of a difference (p = 0.45).

Conclusion

In patients with low-risk DTC, anti-Tg Abs did not significantly predict metastatic disease on post-therapy scan. If confirmed, these data suggest that the presence of anti-Tg Abs alone should not influence initial therapy in patients with low-risk DTC.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Medical Center, The Ohio State University and Arthur G. James Cancer Center, 575 McCampbell Hall, 1581 Dodd Dr, Columbus, OH, 43210, USA

    F. Nabhan & M. D. Ringel

  2. Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, 43235, USA

    K. Porter

  3. Division of Human Genetics, The Ohio State University and Arthur G. James Cancer Center, Columbus, OH, 43235, USA

    L. Senter

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  1. F. Nabhan
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  2. K. Porter
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  3. L. Senter
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  4. M. D. Ringel
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Correspondence to F. Nabhan.

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This study was approved by the Ohio State University Institutional Review Board.

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Informed consent was obtained from all individual participants included in the study.

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Nabhan, F., Porter, K., Senter, L. et al. Anti-thyroglobulin antibodies do not significantly increase the risk of finding iodine avid metastases on post-radioactive iodine ablation scan in low-risk thyroid cancer patients. J Endocrinol Invest 40, 1015–1021 (2017). https://doi.org/10.1007/s40618-017-0685-z

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  • DOI: https://doi.org/10.1007/s40618-017-0685-z

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