Diagnostic and Treatment Considerations for Thyroid Cancer in Women of Reproductive Age and the Perinatal Period

Radioactive Iodine in Differentiated Thyroid Cancer: Effect on Detection of Distant Metastases Comparing 4 Guidelines

Context

Guidelines vary in their recommendations for postoperative radioactive iodine (RAI) in differentiated thyroid cancer (DTC). Omitting RAI reduces overtreatment but poses the possibility of missing distant metastases.

Objective

This study compares 4 guidelines on RAI indications and potentially missed metastases.

Methods

DTC patients were included retrospectively, including 48 patients with distant metastases after first RAI cycle, and 469 without distant metastases. The percentage of distant metastases missed was calculated if RAI had been omitted following the 2015 American Thyroid Association (ATA), 2019 European Society for Medical Oncology (ESMO), 2022 European Thyroid Association (ETA), and 2022 American Society of Nuclear Medicine and Molecular Imaging/European Association of Nuclear Medicine (SNMMI/EANM) guidelines.

Results

In patients without RAI indication, 1.3% to 1.6% of distant metastases may initially be missed with the ATA, ESMO, and ETA guidelines. All these cases had postoperative thyroglobulin (Tg) between 1 and 10 ng/mL or positive Tg antibodies (Tg-abs). In patients for whom RAI should be considered following the ATA, ESMO, and ETA guidelines, 2.6% to 4.0% of distant metastases may initially be missed, with all but 1 case having Tg greater than 10 ng/mL or positive Tg-abs. With the SNMMI/EANM guideline, no distant metastases would be missed, but it resulted in markedly higher RAI use in low-risk patients (82% vs 0%).

Conclusion

Omitting postoperative RAI in low- and intermediate-risk patients, as recommended by the 2015 ATA, 2019 ESMO, and 2022 ETA guidelines, may lead to a small number of initially undetected distant metastases. However, these metastases could potentially be detected later due to the presence of biochemical disease. In contrast, the broader RAI indications endorsed by SNMMI/EANM reduce the likelihood of missed metastases, but substantially increases RAI use, exposing patients to unnecessary treatment and side effects.

Risk of Infertility in Reproductive-Age Patients With Thyroid Cancer Receiving or Not Receiving 131I Treatment: A Nationwide Population-Based Cohort Study

BACKGROUND

Fertility is the crucial concern for many survivors of cancer diagnosed as children, adolescents, and young adults. The objective of this study was to determine the risk of infertility in reproductive-age patients with thyroid cancer receiving or not receiving radioiodine treatment in Taiwan.

METHODS

This nationwide population-based cohort study was conducted using data obtained from the Taiwan National Health Insurance Database from 2009 to 2019. A total of 20,259 thyroid cancer patients aged from 15 to 50 years (8037 did not receive 131I treatment, and 12,222 received 131I treatment) and 20,259 controls were enrolled. A Cox proportional hazards model was applied to estimate the risk of infertility in thyroid cancer patients receiving or not receiving 131I treatment in terms of hazard ratios and 95% confidence intervals.

RESULTS

The incidence rates of infertility in thyroid cancer receiving 131I therapy, those not receiving 131I therapy, and controls were 5.55, 5.07, and 3.61 per 1000 person-years, respectively. Compared with thyroid cancer patients treated with a cumulative 131I dose of 4.44 GBq or less, the risk of infertility was not significantly increased in those treated with a cumulative 131I dose of more than 4.44 GBq (adjusted hazard ratio, 1.13; 95% confidence interval, 0.95-1.36).

CONCLUSIONS

The greatest increased risk of infertility in reproductive-age patients with thyroid cancer is associated with the fact that the patient has thyroid cancer regardless of 131I administration. 131I treatment or cumulative dose of 131I greater than 4.44 GBq did not further increase the risk of infertility.

Conformal thyroidectomy is a feasible option in papillary thyroid microcarcinoma: a retrospective cohort study with 10-year follow-up results

BACKGROUND

In recent years, there has been an increasing prevalence of patients with papillary thyroid microcarcinoma (PTMC) without lymph node involvement in medical centers worldwide. For patients who are unable to undergo active surveillance (AS) and are afraid of postoperative complications, conformal thyroidectomy may be a suitable option to ensure both preservation of function and complete removal of the tumor.

METHODS

The patients in the cohort during 2010 to 2015 were retrospectively enrolled strictly following the inclusion and exclusion criteria. The observation and control groups were defined based on the surgical approach, with patients in the observation group undergoing conformal thyroidectomy and patients in the control group undergoing lobectomy. Event-free survival (EFS), the interval from initial surgery to the detection of recurrent or metastatic disease, was defined as the primary observation endpoint.

RESULTS

A total of 319 patients were included in the study, with 124 patients undergoing conformal thyroidectomy and 195 patients undergoing lobectomy. When compared to lobectomy, conformal thyroidectomy demonstrated reduced hospital stays, shorter operative times, and lower rates of vocal cord paralysis and hypoparathyroidism. Furthermore, the mean bleeding volume during the operation and the rate of permanent hypothyroidism were also lower in the conformal thyroidectomy group than in the lobectomy group. However, there was no statistically significant difference observed in the 5- and 10-year EFS between the two groups.

CONCLUSIONS

Conformal thyroidectomy had advantages in perioperative management and short-term complication rates, with an EFS that was not inferior to that of lobectomy. Thus, conformal thyroidectomy is a feasible option for low-risk PTMC patients.

Multi-view progression diagnosis of thyroid cancer by integrating platelet transcriptomes and blood routine tests

Thyroid cancer is the most common type of endocrine system cancer. The pre-cancer and early stages are usually benign or slowly growing, and do not need invasive treatments. This study investigated the challenging classification task of four classes of samples, i.e., normal controls (N), thyroid adenomas (TA), papillary thyroid cancers (PTC) and metastasized papillary thyroid cancers (MPTC). We proposed a multi-view progression diagnosis framework ThyroidBloodTest to integrate the two views of RNAseq platelet transcriptomes (View-T) and blood routine (View-B) features. Platelet transcriptome represented the molecular-level information, while the blood routine features were easy to obtain in the clinical practice. Eleven feature selection algorithms and seven classifiers were evaluated for both views. The experimental data suggested the importance of choosing appropriate data analysis algorithms and feature engineering techniques like principal component analysis (PCA). The best ThyroidBloodTest model achieved Acc = 0.8750 for the four-class classification of the N/TA/PTC/MPTC samples based on the integrated feature space of View-T and View-B. The cellular localization cytosol and three post-translational modification types acetylation/phosphorylation/ubiquitination were observed to be enriched in the proteins encoded by the View-T biomarkers. The numbers of different immune cells also contributed positively to the progression diagnosis of thyroid cancer. The proposed multi-view prediction model demonstrated the necessity of integrating both platelet transcriptomes and blood routine tests for the progression diagnosis of thyroid cancer.

Thyroid cancer in women of reproductive age: Key issues for the clinical team

Women who are fertile experience a significant burden from thyroid cancer. In reality, delaying childbirth is the current trend in maternity. Women who have thyroid cancer may later want to get pregnant after it has been treated, which presents a multidisciplinary issue for their doctors. A variety of specialists are frequently involved in the treatment of thyroid cancer. This review aims to address the key elements of the strategy and places special emphasis on the significance of fertility in women with thyroid cancer diagnosis and remission. We will cover topics including the role of thyroid hormones in pregnancy and fertility.