title: Patients with Papillary Thyroid Carcinoma at Intermediate Risk of Recurrence According to American Thyroid Association Criteria Can Be Reclassified as Low Risk When the Postoperative Thyroglobulin Is Low.
abstract: BACKGROUND
  According to American Thyroid Association (ATA), all patients with papillary thyroid carcinoma (PTC) should initially be classified regarding the risk of tumor recurrence. If a very high postoperative thyroglobulin (Tg) classifies patients as high risk of recurrence, it is reasonable to hypothesize that, at the other extreme, a low Tg may reclassify patients from intermediate to low risk. The objective of this study was to evaluate the rate of persistent/recurrent disease in intermediate-risk patients with low postoperative (before 131I) Tg, thereby evaluating whether these patients can be reclassified as low risk based on this finding already at the time of initial therapy rather than one to two years after radioiodine therapy.
  
  
  METHODS
  A total of 181 patients with the following characteristics were evaluated: (i) diagnosis of PTC; (ii) submitted to total thyroidectomy with lymph node dissection in the case of a suspicion of metastases based on preoperative ultrasonography (US) or perioperative evaluation (cN1); (iii) apparently without persistent tumor after surgery; (iv) a postoperative stimulated Tg (sTg) ≤2 ng/mL and negative anti-Tg antibodies (TgAb); and (v) considered to be at intermediate risk by ATA criteria.
  
  
  RESULTS
  When evaluated 9-12 months after radioiodine therapy, 170 patients (94%) had a sTg <1 ng/mL and negative TgAb and a negative neck US (excellent response). Ten patients (5.5%) had a sTg >1 ng/mL (≤2 ng/mL) in the absence of apparent disease detected by imaging methods (indeterminate response). US detected cervical lymph node metastases (not detected at the time of 131I therapy) in one patient (incomplete structural response). During follow-up, recurrence was observed in 5/180 (2.7%) patients without apparent disease in the initial assessment. Thus, persistent or recurrent disease occurred in only 3.3% of cases. The 175 patients without tumor persistence/recurrence were not submitted to any additional therapy, and all had a Tg/thryoxine <1 ng/mL in the last assessment. There was no case of death related to the disease.
  
  
  CONCLUSIONS
  This study suggests that intermediate-risk patients (according to ATA criteria) with a postoperative sTg ≤2 ng/mL can be reclassified as low risk already at the time of initial therapy.
authors.affiliation: 1 Postgraduation Program, Santa Casa de Belo Horizonte , Minas Gerais, Brazil .|2 Endocrinology Service, Santa Casa de Belo Horizonte , Minas Gerais, Brazil .
authors.forename: Pedro Weslley
authors.initials: PW
authors.lastname: Rosario
authors.affiliation: 1 Postgraduation Program, Santa Casa de Belo Horizonte , Minas Gerais, Brazil .|3 IMES/Famevaço, Faculdade de Medicina do Vale do Aço , Ipatinga, Minas Gerais, Brazil .
authors.forename: Mariana de Souza
authors.initials: Mde S
authors.lastname: Furtado
authors.affiliation: 1 Postgraduation Program, Santa Casa de Belo Horizonte , Minas Gerais, Brazil .|2 Endocrinology Service, Santa Casa de Belo Horizonte , Minas Gerais, Brazil .
authors.forename: Gabriela Franco
authors.initials: GF
authors.lastname: Mourão
authors.affiliation: 2 Endocrinology Service, Santa Casa de Belo Horizonte , Minas Gerais, Brazil .
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: Calsolari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D011184:Postoperative Period; D011379:Prognosis; D012306:Risk; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D013954:Thyroglobulin