Taprogge Jan, Murray Iain, Sharman Hannah, Gape Paul, Leek Francesca, Abreu Carla, Vávrová Lenka, Newbold Kate, Wong Kee H, Luster Markus, Verburg Frederik A, Schurrat Tino, Vija Lavinia, Courbon Frédéric, Vallot Delphine, Bardiès Manuel, Schumann Sarah, Eberlein Uta, Lassmann Michael, Flux Glenn
Eur Thyroid J. 2025 Jul 1;14(4). doi: 10.1530/ETJ-25-0097. Print 2025 Aug 1.
Serum thyroglobulin measurements are used in the long-term management of patients with differentiated thyroid cancer following thyroidectomy and radioiodine therapy. The use of predictive biomarkers, such as post-operative stimulated thyroglobulin levels and absorbed dose, may help to identify patients at risk of disease recurrence or an unsuccessful initial treatment.
Differentiated thyroid cancer patients treated with 1.1 or 3.7 GBq of radioiodine using recombinant human thyrotropin stimulation or thyroid hormone withdrawal were recruited into observational clinical studies in France, Germany and the UK with aligned study endpoints (MEDIRAD). The maximum absorbed dose to the thyroid remnant was determined and compared to post-operative stimulated thyroglobulin with respect to its ability to predict ablation success. Radioiodine therapy success was defined as unstimulated or stimulated thyroglobulin level of <0.2 or <1.0 ng/mL 9-12 months post-radioiodine.
Ninety-four patients had follow-up data and negative antithyroglobulin antibody tests. Seventy-eight patients (83%) were deemed excellent biochemical responders. Post-operative thyroglobulin and maximum absorbed dose predicted ablation success with receiver operating characteristic area under the curves of 0.83 ± 0.05 (P < 0.001) and 0.64 ± 0.08 (P = 0.12). A dose-response relationship between maximum absorbed dose and ablation success was found for patients with a post-operative stimulated thyroglobulin of ≥1 ng/mL.
Predictions of ablation success using post-operative stimulated thyroglobulin or the absorbed dose to the thyroid remnant could inform personalisation of management of differentiated thyroid cancer and identify patients where further treatments or more intensive follow-up are required. Patients with a post-operative stimulated Tg of <1 ng/mL likely do not benefit from radioiodine.
血清甲状腺球蛋白检测用于分化型甲状腺癌患者甲状腺切除术后及放射性碘治疗的长期管理。使用预测性生物标志物，如术后刺激甲状腺球蛋白水平和吸收剂量，可能有助于识别有疾病复发风险或初始治疗失败的患者。
在法国、德国和英国开展观察性临床研究（MEDIRAD），招募使用重组人促甲状腺素刺激或甲状腺激素撤减接受1.1或3.7GBq放射性碘治疗的分化型甲状腺癌患者，研究终点一致。确定甲状腺残余组织的最大吸收剂量，并将其与术后刺激甲状腺球蛋白在预测消融成功方面的能力进行比较。放射性碘治疗成功的定义为放射性碘治疗后9 - 12个月未刺激或刺激后的甲状腺球蛋白水平<0.2或<1.0ng/mL。
94例患者有随访数据且抗甲状腺球蛋白抗体检测为阴性。78例患者（83%）被视为生化反应良好者。术后甲状腺球蛋白和最大吸收剂量预测消融成功的受试者操作特征曲线下面积分别为0.83±0.05（P<0.001）和0.64±0.08（P = 0.12）。对于术后刺激甲状腺球蛋白≥1ng/mL的患者，发现最大吸收剂量与消融成功之间存在剂量反应关系。
使用术后刺激甲状腺球蛋白或甲状腺残余组织的吸收剂量预测消融成功，可为分化型甲状腺癌的个体化管理提供依据，并识别需要进一步治疗或更密切随访的患者。术后刺激甲状腺球蛋白<1ng/mL的患者可能无法从放射性碘治疗中获益。
