title: Combination of initial stimulation thyroglobulins and staging system by revised ATA guidelines can elaborately discriminate prognosis of patients with differentiated thyroid carcinoma after high-dose remnant ablation.
abstract: OBJECTIVE
  The aim of this study was to evaluate prognostic role of thyroglobulin (Tg) levels at the time of ablation (A-Tg) and stimulation Tg levels at 6-12 months after remnant ablation (S-Tg) combined with revised American Thyroid Association (ATA) guidelines risk stratification.
  
  
  METHODS
  Data of 359 patients (median follow-up duration: 66.3 months) with papillary thyroid carcinoma who had high-dose remnant ablation were analyzed. The cutoff value of A-Tg to predict the persistent/recurrent disease was calculated by receiver operating characteristic curve analysis. In each risk group by ATA guidelines, the association of A-Tg with persistent/recurrent disease was evaluated. The role of A-Tg and ATA risk stratification in each S-Tg group (group with S-Tg <2 ng/mL, 2-10 ng/mL, or >10 ng/mL) was also evaluated. Tg response was determined by the difference between A-Tg and S-Tg with consideration of the dose of radioactive iodine ablation.
  
  
  RESULTS
  A-Tg above 5.22 ng/mL was associated with persistent/recurrent disease in all risk groups by ATA guidelines. A-Tg above the cutoff value and ATA risk assessment was related to persistent/recurrent disease in patients with S-Tg 2 to 10 ng/mL (P = 0.003) and S-Tg above 10 ng/mL (P = 0.019). However, no difference in the incidence of persistent/recurrent disease was found according to Tg response. The scoring system made up of A-Tg, S-Tg, and ATA staging showed elaborate discrimination of prognosis.
  
  
  CONCLUSIONS
  Risk stratification using combined scoring with initial stimulated Tg levels, including A-Tg and S-Tg, and staging system by revised ATA guidelines can effectively predict persistent/recurrent disease in patients with papillary thyroid carcinoma.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors.forename: Min-Hee
authors.initials: MH
authors.lastname: Kim
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Ko
authors.forename: Ja-Seong
authors.initials: JS
authors.lastname: Bae
authors.forename: Dong-Jun
authors.initials: DJ
authors.lastname: Lim
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Baek
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Moo-Il
authors.initials: MI
authors.lastname: Kang
authors.forename: Bong-Yun
authors.initials: BY
authors.lastname: Cha
mesh_terms: D055011:Ablation Techniques; D002454:Cell Differentiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011877:Radionuclide Imaging; D012307:Risk Factors; D012955:Societies, Medical; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*
chemical_list: D007457:Iodine Radioisotopes; D013954:Thyroglobulin