Objective To evaluate the quality of controlled trials on 131I therapy for thyroglobulin positive and radioactive iodine negative metastases（131I WBS-/Tg+）. Methods We electronically searched MEDLINE (1966 to Mar. 2004), EMBASE (1984 to 2003), The Cochrane Central Register of Controlled Trial, CENTRAL (Issue 2, 2004), CBMdisc (1978 to 2004) and CNKI (1994 to 2004), and handsearched 5 radiotherapy and endocrinology journals (Jan. 1980 to Apr. 2003). The methodological quality of included studies was assessed by using quality assessment criteria of the Cochrane systematic review guideline. Results Three non-randomized controlled trials were included. One was historical controlled trial, and two prospective trials. The sample sizes of three trials were 26, 60 and 70 respectively without mentioning the calculation base. The comparability of baseline was mentioned but not comparable across the trials. No double blind studies were used in the assessment of 131I efficacy. The time of follow-up varied from 2 to 15 years. None studies mentioned the side effects of 131I therapy for 131I WBS-/Tg+ metastases. Only two studies applied statistical methods properly. Conclusions Problems about allocation of groups, double blind, sample size, and follow-up period continue to exist in published controlled trials. RCT or prospective controlled trials of high quality are urgently needed in order to define the efficacy and safety of 131I therapy for 131I WBS-/Tg+ metastases.
Objective To summarize the advanced researchs of autoimmune thyroid disease(ATD) complicated with differentiated thyroid cancer (DTC). Methods The related literatures about concurrent ATD and DTC were consulted and reviewed. Results Hashimoto diseas (HD) complicated with DTC at home and abroad were reported more and more, whether merging with HD or other ATD disease could affect the prognosis of papillary thyroid cancer (PTC) was a controversial topic. HD and DTC (mainly PTC) had some same epidemiological and molecular features. Conclusion Better understanding of clinical pathology and characteristic of DTC concurrent with ATD can provide some new insights to immunotherapy for DTC.
Thyroglobulin (Tg) and radioiodine whole body scan (WBS) have been commonly used in follow-up of patients with differentiated thyroid carcinoma (DTC). Tg is associated with radioiodine uptake in local or distant metastases. In minority of patients, the follow-up scan shows no functioning thyroid tissue, but the serum thyroglobulin is still elevated. Therefore, we review recent developments of diagnosis and treatment of those patients with differentiated thyroid cancer and with thyroglobulin elevation but negative iodine scintigraphy.
ObjectiveTo explore the application value of carbon nanoparticles during radical operation of differentiated thyroid cancer (DTC).MethodsThe DTC patients underwent total thyroidectomy plus neck lymph node (area Ⅳ) dissection from September 2017 to September 2019 in this hospital were retrospectively collected, who were divided into observation group and control group according to using carbon nanoparticles or not during the operation. The operation related informations [operation time, intraoperative blood loss, total drainage volume on day 3 after operation, postoperative hospitalization time, number of lymph nodes dissection (area Ⅳ), lymph node metastasis rate, and rate of parathyroid glands resected by mistake during operation] and blood calcium (Ca2+) level and parathyroid hormone (PTH) level before and after (24 h and 1 month) operation were compared between the two groups.ResultsA total of 134 patients with DTC were collected, including 76 patients in the observation group and 58 patients in the control group. There were no significant differences in baseline data such as gender, age, etc. between the two groups (P>0.05). Although there were no significant differences in terms of operation time, intraoperative blood loss, total drainage volume on day 3 after operation, postoperative hospitalization time, lymph node metastasis rate between the two groups (P>0.05), the numbers of lymph node dissection and metastasis (area Ⅳ) were more and rate of parathyroid glands resected by mistake during operation was lower in the observation group as compared with the control group (P<0.05). On hour 24 after operation, the levels of Ca2+ and PTH in the observation group were higher than those in the control group (P<0.05). On month 1 after operation, the PTH level in the observation group was still higher than that in the control group (P<0.05), but there was no significant difference in Ca2+ level between the two groups (P>0.05). ConclusionCarbon nanoparticles can better protect the function of parathyroid gland during radical operation of DTC and clean neck lymph nodes more thoroughly.
ObjectiveTo analyze the current research status of radioactive iodine (RAI) therapy for differentiated thyroid cancer (DTC) in the past 10 years so as to understand the research hotspots and future development in this field through a bibliometric visualization analysis. MethodsThe literature relevant DTC RAI therapy published from 2014 to 2023 was screened using the Web of Science database. The publication time, country, institution, author, keywords, and other content of literature were analyzed, and the multidimensional scientific research network was constructed, and the visualization analysis was performed using RStudio and Flourish software. ResultsA total of 2 018 studies related to DTC RAI therapy were screened out from the publications from 2014 to 2023, with a fluctuating trend of increasing publication numbers. The publication numbers in China ranked first (422 articles), followed by the United States (374 articles) and Italy (182 articles). In terms of international cooperation, the United States ranked first with the most leading collaborations (289 times), and the top 3 countries in terms of cooperation with the United States were Italy (33 times), China (21 times), and France (21 times). China ranked fifth in leading cooperation, relatively less (52 times), with the main collaborators being Japan (7 times), South Korea (6 times), and Australia (5 times). Half of the top 6 institutions in terms of publication numbers were from the United States, with the top 3 being Unicancer from France (135 articles), Memorial Sloan Kettering Cancer Center from the United States (134 articles), and the UT MD Anderson Cancer Center from the United States (89 articles). Beijing Union Medical College Hospital and Shanghai Jiao Tong University ranked 19th and 23rd, respectively, with article counts of 46 and 44 articles. Tuttle RM, an author from the United States, ranked first in both publication numbers and contribution, with a total of 48 articles published from 2014 to 2023. There were two authors, Lin YS and Tan J, from China who had made it into the top 10 in terms of publication numbers, with 32 and 25 publications, respectively. The trend topics showed the evolution of hot topics, covering from the relation between urinary iodine and DTC, lymph node metastasis, to innovative research and prognosis assessment, as well as in-depth exploration of new therapies for iodine-refractory DTC. The co-occurrence and clustering of keywords included 4 aspects, namely, the standardized management of DTC, related contents during the peri-treatment period, papillary thyroid carcinoma, and the exploration of targeted therapy for iodine-refractory DTC. ConclusionsIn recent years, the research focus in the field of DTC RAI therapy has shifted from technical applications to management concepts, which has also promoted the improvement of treatment modes and made patients’ treatment plans increasingly personalized and precise. Future research will focus on precision medicine, individualized treatment, the combination of targeted therapy and immunotherapy, resistance mechanisms to treatment, and long-term management after treatment, aiming to improve patients’ treatment outcomes and quality of life and achieve a revolutionary breakthrough in treatment.
ObjectiveTo analyze the influencing factors of fear of cancer recurrence (FCR) and its correlation with social support and quality of life in patients with differentiated thyroid cancer (DTC) at 5 years after surgery. MethodsA total of 116 patients with DTC from West China Hospital, Sichuan University at 5 years after surgery were selected as the research objects. The patients were investigated using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Social Support Rating Scale (SSRS) and the European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30 (EORTC QLQ-C30, hereinafter referred to as QLQ-C30). The χ2 test or Fisher exact probability method were used for univariate analysis, and multivariate logistic regression analysis was used for influencing factor analysis. The diagnostic value of variables with significant influence on FCR in multivariate logistic regression was further studied by receiver operating characteristic (ROC) curve, and Pearson correlation analysis was finally adopted to analyze the relationship between FCR and social support and quality of life in patients with DTC at 5 years after operation. ResultsThe questionnaire survey showed that the FoP-Q-SF score of 116 patients with DTC at 5 years after surgery was (35.92±2.52) scores, of which 75 patients had FoP-Q-SF score ≥34 scores, 41 patients had FoP-Q-SF score <34 scores, and the FCR rate was 64.66% (75/116). Multivariate logistic regression showed that gender, family annual income, SSRS score and total QLQ-C30 score were the main factors of FCR in patients with DTC at 5 years after surgery (P<0.05). Further ROC curve diagnosis showed that the accuracy rate of diagnosis of FCR with SSRS score ≤47.5 scores was 70.70%, the total score of QLQ-C30 ≤617.225 scores was 69.02%. The accuracy rate of diagnosis of FCR was 66.03% when the annual income of family was less than 150 000 yuan. The accuracy of women’s diagnosis of FCR was 62.28%. Pearson correlation analysis showed that FoP-Q-SF score was negatively correlated with SSRS score and total score of QLQ-C30 in DTC patients at 5 years after operation (r=–0.629 6, P=0.000 1; r=–0.568 5, P=0.000 1). ConclusionsThe proportion of patients who have FCR at 5 years after DTC operation is high, and gender, family annual income, SSRS score and total score of QLQ-C30 are the influencing factors. Therefore, we can develop targeted management strategies to reduce patients’ FCR and improve their quality of life.
Objective To explore the efficacy and safety of levothyroxine (L-T4) combined with desiccated thyroid extract (DTE) in patients with differentiated thyroid cancer (DTC) who had suboptimal response to long-term (≥6 months) thyroid-stimulating hormone (TSH) suppression therapy with L-T4 alone after surgery. MethodsA total of 123 eligible patients were prospectively enrolled and received TSH suppression therapy with DTE combined with L-T4. The Kaplan?Meier (KM) curve was used to analyze the TSH suppression rate and assess the efficacy of this combination therapy. The Thyroid-Related Patient-Reported Outcome-39 (THyPRO-39) questionnaire was used to assess the patient-reported symptoms before medication adjustment and at 1, 3, 6, 9, and 12 months after. ResultsAmong the 123 patients, 100 were ultimately included and completed follow-up, with a follow-up period of one year. After the first adjustment to L-T4+DTE combination therapy, the rate of TSH suppression was raised to 71% (71/100). The KM curve revealed that the TSH suppression rate gradually increased in the follow-uptime, with a cumulative rate of 82.0%. The median TSH suppression time to reach the standard was 1.4 months. Following L-T4+DTE combination therapy, the serum free Triiodothyronine (FT3) level significantly increased [(4.5±0.6) pmol/L vs. (5.5±1.1) pmol/L, P<0.001] but remained within the normal range, whereas the free thyroxine (FT4) level did not significantly change [(21.9±2.1) pmol/L vs. (21.5±3.0) pmol/L, P=0.075]. However, patients who did not achieve target levels exhibited a decrease in serum FT4 levels compared to baseline, and the magnitude of this decrease was significantly greater than that observed in the target-achieved group [–0.8 (–2.1, –0.9) pmol/L vs. –2.5 (–3.8, –0.8) pmol/L, P=0.022]. The questionnaire results indicated that the combined L-T4+DTE treatment regimen had no significant impact on quality of life scores during the follow-up period (χ2=4.006, P=0.548). Conversely, the hyperthyroidism symptom scores showed significant improvement over the treatment period (χ2=23.120, P<0.001), with the median scores demonstrating an overall downward trend. ConclusionFor postoperative DTC patients who fail to achieve TSH suppression with L-T4 monotherapy, L-T4+DTE combination therapy can significantly increase the TSH suppression attainment rate while alleviating thyrotoxicosis-related symptoms.
Initial surgical treatment plays an important role in the treatment of differentiated thyroid cancer, and standardized surgical treatment can help to reduce underdiagnosis and overtreatment. Accurate preoperative diagnosis is the premise of standardized surgical treatment, which helps to reduce the overtreatment of thyroid nodules. Preoperative clinical TN staging assessment for differentiated thyroid cancer should be highly valued, the extent of thyroidectomy should be individualized, and the cervical lymph nodes should be performed in a standardized manner. In addition, the indications for endoscopic thyroid surgery should be strictly selected to maximize the benefit of the patient.