Related Experiment Video
Updated: May 9, 2025
Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
Published on: June 9, 2023
Postoperative Unstimulated Thyroglobulin Accurately Predicts Outcomes in High-Risk Differentiated Thyroid Cancer: A
Julia Isabel Richter Cicogna1,2, Sophia Yada Noguchi1, Adriano Namo Cury1,2
1Faculdade de Ciências Médicas da Santa Casa de São Paulo (Faculty of Medical Sciences of Santa Casa de São Paulo), São Paulo, Brazil.
Objective:
High-risk differentiated thyroid cancer (DTC) patients show variable outcomes. While postoperative stimulated thyroglobulin (STg) is a recognized predictive marker, the prognostic significance of unstimulated thyroglobulin (UTg) is still unexplored. This study aims to assess the prognostic value of postoperative UTg in high-risk DTC patients.
Design:
Retrospective cohort study (2015-2024) at two Brazilian tertiary hospitals.
Patients:
One thousand DTC patients were identified, of which 144 were high-risk. Fifty seven patients met the inclusion criteria.
Methods:
Clinical, pathological, and laboratory data were collected. Outcomes were categorized as favorable (excellent/indeterminate responses) or unfavorable (biochemical/structural incomplete responses). Receiver Operating Characteristic (ROC) curves determined cutoff values for predicting outcomes and metastases.
Results:
Significant predictors of unfavorable outcomes included advanced age (p = 0.048), larger tumor size (p = 0.002), higher UTg (p < 0.001), and STg (p < 0.001). UTg was an independent risk factor for 1-year outcomes (OR = 0.008; 95% CI: 0.001-0.088; p < 0.001). UTg cutoff of 2.1 ng/mL distinguished outcomes with high sensitivity (83.3%), specificity (96.0%), and accuracy (90.7%). A higher cutoff of 3.8 ng/mL identified metastases (sensitivity 86.4%, specificity 90.5%). UTg showed non-inferiority to stimulated thyroglobulin (STg) in predicting outcomes (p = 0.964) and metastasis (p = 0.980).
Conclusion:
Postoperative UTg is a strong prognostic marker in high-risk DTC patients, providing a non-inferior alternative to STg with greater accessibility and fewer side effects. We propose a clinical algorithm to optimize the management of these cases. When UTg levels exceed 2.1 ng/mL, particularly higher than 3.8 ng/mL, investigation of potentially resectable metastatic foci should be considered before radioiodine therapy. Prospective studies are needed to validate this algorithm.
