Donnici Alessandra, Mirabelli Maria, Giuliano Stefania, Misiti Roberta, Tocci Vera, Greco Marta, Aiello Vincenzo, Brunetti Francesco S, Chiefari Eusebio, Aversa Antonio, Foti Daniela P, Brunetti Antonio
Endocrinology Unit, University Hospital "Renato Dulbecco" of Catanzaro, 88100 Catanzaro, Italy.
Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy.
Diagnostics (Basel). 2024 Jan 11;14(2):166. doi: 10.3390/diagnostics14020166.
Differentiated thyroid carcinoma (DTC) is frequently found in conjunction with autoimmune thyroid disorders, particularly Hashimoto's thyroiditis (HT). This study investigates the impact of coexisting HT on the persistence of an indeterminate response to therapy due to positive anti-thyroglobulin antibodies (AbTg), measured via competitive immunoassay, in a consecutive patient series from Calabria, Southern Italy.
This retrospective longitudinal study analyzed 259 consecutive DTC patients managed at the Endocrinology Unit of Renato Dulbecco Hospital (Catanzaro, Italy) up to 2023. Patients with medullary and undifferentiated thyroid carcinoma, partial thyroidectomy, less than six months of post-operative monitoring, or missing clinical data were excluded. Demographic information, histological findings, initial tumor stage, and ATA risk category were collected. The response to therapy was assessed based on ATA guidelines.
Among the 259 patients, 29% had coexisting HT. Patients with HT exhibited distinct characteristics: a higher proportion of females (87.0% vs. 74.7%), a shorter post-operative monitoring duration (median 3 vs. 5 years), and a higher prevalence of papillary thyroid carcinoma (PTC) (97.4% vs. 86.3%). The tumor size, lymph node involvement, and distant metastasis were similar between the groups, with patients without HT having a higher incidence of extrathyroidal tumor extension. However, the initial TNM stage and ATA risk category did not differ significantly. At the six-month follow-up, HT patients showed a higher rate of indeterminate responses, primarily due to positive AbTg. After 12 months, the response categories aligned, with decreasing AbTg levels in the HT group. After 24 months, most patients with long-term follow-up demonstrated an excellent response to DTC therapy, irrespective of HT coexistence.
While HT does not worsen DTC prognosis, it may result in indeterminate responses. AbTg measurements in the peri-operative period should be encouraged to facilitate post-operative monitoring, emphasizing the importance of using standardized assays. Further research in larger populations with extended follow-up is needed to comprehensively understand the HT-DTC relationship.
分化型甲状腺癌（DTC）常与自身免疫性甲状腺疾病同时出现，尤其是桥本甲状腺炎（HT）。本研究调查了在意大利南部卡拉布里亚的一系列连续患者中，共存的HT对因通过竞争性免疫测定法测得的抗甲状腺球蛋白抗体（AbTg）呈阳性而导致的治疗不确定反应持续性的影响。
这项回顾性纵向研究分析了截至2023年在雷纳托·杜尔贝科医院（意大利卡坦扎罗）内分泌科接受治疗的259例连续DTC患者。排除患有髓样和未分化甲状腺癌、部分甲状腺切除术、术后监测少于六个月或临床数据缺失的患者。收集人口统计学信息、组织学检查结果、初始肿瘤分期和ATA风险类别。根据ATA指南评估治疗反应。
在259例患者中，29%共存HT。HT患者表现出不同特征：女性比例更高（87.0%对74.7%）、术后监测持续时间更短（中位数3年对5年）以及甲状腺乳头状癌（PTC）患病率更高（97.4%对86.3%）。两组之间的肿瘤大小、淋巴结受累情况和远处转移相似，无HT患者的甲状腺外肿瘤扩展发生率更高。然而，初始TNM分期和ATA风险类别没有显著差异。在六个月的随访中，HT患者显示出更高的不确定反应率，主要是由于AbTg呈阳性。12个月后，反应类别趋于一致，HT组的AbTg水平下降。24个月后，大多数长期随访的患者对DTC治疗表现出良好反应，无论是否共存HT。
虽然HT不会恶化DTC预后，但可能导致不确定反应。应鼓励在围手术期进行AbTg测量以促进术后监测，强调使用标准化检测方法的重要性。需要在更大规模人群中进行更长时间随访的进一步研究，以全面了解HT与DTC的关系。
