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Does it work in childhood and adolescence? The predictive role of postoperative/preablative stimulated thyroglobulin levels in paediatric thyroid cancer. A systematic review of the literature

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Abstract

Background

Thyroglobulin is a well-established disease marker during follow-up in paediatric differentiated thyroid cancer. However, no conclusive data on the role of endogenously stimulated thyroglobulin after thyroidectomy (ptTg) in predicting disease-specific outcomes are available. This review aims to establish the prognostic value of ptTg in children with DTC.

Methods

Online medical databases were searched for studies evaluating the association between ptTg and disease-specific outcomes in DTC-affected children. Documents not in English, preclinical studies, other review articles, case reports, and small case series were excluded. The risk of bias was assessed with the QUADAS-2 tool.

Results

Twelve studies, analysing 1043 children in total, were included in the review. They all had a retrospective design and were published between 2016 and 2022. Of all patients, 1008 (97%) and 849 (81%) had undergone thyroidectomy and RAI, respectively. Eight studies (756 children) evaluated the correlation between ptTg and disease persistence/relapse: six reported a significant association between these parameters; a specific ptTg cut-off (10–14 ng/ml) was identified at the multivariate analysis in three studies. The remaining four studies assessed the link between ptTg levels and disease extension, with three reporting a correlation between ptTg and lung/nodal metastases.

Discussion

ptTg is a readily available and inexpensive parameter, bearing a strong prognostic power in identifying disease persistence, relapse, and the presence of metastases in children affected by DTC.

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Abbreviations

AbTg:

Thyroglobulin Antibodies

ATA:

American thyroid association

BMI:

Body mass index

CT:

X-Ray computed tomography

DTC:

Differentiated thyroid cancer

IQR:

Interquartile range

H:

High

L:

Low

M:

Multivariate

N.A.:

Not applicable

NPV:

Negative predictive value

N.R.:

Not reported

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PT:

Post-Therapeutic

ptTg:

Post-thyroidectomy stimulated thyroglobulin

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

R:

Retrospective

RAI:

Radioactive Iodine

SCMCI:

Schneider Children’s Medical Center of Israel

SOR:

Standard of reference

SPECT/CT:

Single-photon emission computed tomography/X-ray computed tomography

Tg:

Thyroglobulin

TSH:

Thyroid-stimulating hormone

U (Table 3):

Univariate

U (Table 4):

Unknown

US:

Ultrasound

WBS:

Whole-body scintigraphy

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Author information

Author notes

  1. Arnoldo Piccardo and Francesco Fiz contributed equally.

Authors and Affiliations

  1. Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Genoa, 16128, Italy

    Arnoldo Piccardo, Francesco Fiz, Gianluca Bottoni, Beatrice Sambucco & Michela Massollo

  2. Centro della Tiroide, E.O. “Ospedali Galliera”, Genoa, Italy

    Arnoldo Piccardo, Francesco Fiz, Gianluca Bottoni, Luca Foppiani, Ugo Catrambone, Federica Mariani, Beatrice Sambucco & Michela Massollo

  3. Department of Internal Medicine, E.O. “Ospedali Galliera”, Genoa, Italy

    Luca Foppiani

  4. Nuclear Medicine Department, University of Brescia and ASST Spedali Civili Di Brescia, P.le Spedali Civili 1, Brescia, 25123, Italy

    Domenico Albano & Francesco Bertagna

  5. Department of General and Endocrine Surgery, “Ospedali Galliera”, Genoa, Italy

    Ugo Catrambone & Federica Mariani

  6. Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Giorgio Treglia

  7. Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland

    Giorgio Treglia

  8. Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland

    Giorgio Treglia & Pierpaolo Trimboli

  9. Clinic of Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Via Ospedale 12, Bellinzona, 6500, Switzerland

    Pierpaolo Trimboli

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  1. Arnoldo Piccardo
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Correspondence to Arnoldo Piccardo or Pierpaolo Trimboli.

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Piccardo, A., Fiz, F., Bottoni, G. et al. Does it work in childhood and adolescence? The predictive role of postoperative/preablative stimulated thyroglobulin levels in paediatric thyroid cancer. A systematic review of the literature. Rev Endocr Metab Disord 25, 53–63 (2024). https://doi.org/10.1007/s11154-023-09835-z

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