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Related Concept Videos

Synthesis and Regulation of Thyroid Hormones01:20

Synthesis and Regulation of Thyroid Hormones

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Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The...
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Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
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Response assessment in advanced differentiated thyroid cancer.

Savvas Frangos1, Evanthia Giannoula2, Ioannis Iakovou2

  • 1Nuclear Medicine Theragnostics Department, Bank of Cyprus Oncology Center, 2060 Nicosia, Cyprus.

Seminars in Nuclear Medicine
|December 14, 2025
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Summary

Accurate assessment of advanced differentiated thyroid carcinoma (aDTC) response is crucial. Integrating biomarkers, molecular profiling, and advanced imaging aids personalized treatment and improves outcomes for this rare endocrine malignancy.

Keywords:
Advanced differentiated thyroid carcinomaBiomarkersGuidelinesNuclear medicine imagingRadioiodine therapyTherapy response evaluation

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Area of Science:

  • Endocrinology and Oncology
  • Nuclear Medicine and Radiology
  • Molecular Diagnostics

Background:

  • Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy, but advanced disease (aDTC) presents therapeutic challenges, especially when refractory to radioactive iodine (RAIR).
  • Optimizing patient management requires accurate, individualized assessment of treatment response in aDTC.
  • Current diagnostic strategies for aDTC need refinement to improve patient outcomes.

Purpose of the Study:

  • To review current principles for biomarker- and imaging-based evaluation of advanced differentiated thyroid carcinoma (aDTC).
  • To summarize the role of molecular profiling and advanced imaging in assessing treatment response.
  • To highlight the importance of integrating diverse diagnostic data for personalized aDTC management.

Main Methods:

  • Review of current guidelines and literature on biomarker and imaging modalities for aDTC response assessment.
  • Analysis of serum thyroglobulin (Tg) and anti-thyroglobulin antibodies (TgAb) dynamics.
  • Evaluation of molecular profiling (BRAF, TERT, RAS mutations) and advanced imaging techniques (RAIR WBS, SPECT/CT, 18F-FDG PET/CT, 68Ga-DOTATATE, PSMA PET/CT).

Main Results:

  • Serum Tg and TgAb dynamics are central biomarkers for detecting persistent, recurrent, or metastatic disease.
  • Molecular profiling offers prognostic and predictive information, guiding targeted therapies.
  • Advanced imaging modalities provide complementary anatomical and functional data, crucial for RAIR-refractory or metabolically active disease.

Conclusions:

  • Integrating biomarker trends with imaging findings in a dynamic risk stratification framework is essential for individualized treatment decisions in aDTC.
  • Despite established recommendations, real-world application varies, necessitating further research into emerging technologies.
  • Future directions include leveraging advanced imaging, quantitative PET metrics, and AI for enhanced prognostic accuracy and personalized follow-up.