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AIM: To evaluate ultrasonography (US) screening for thyroid cancer in children and adolescents who have one parent with familial non-medullary thyroid carcinoma (FNMTC) unrelated to known genetic syndromes. METHODS: In this prospective study, we selected 72 children and adolescents (age ≤18 years) without a palpable thyroid nodule or history of radiation exposure, but who have one parent diagnosed with FNMTC (i.e. at least one other affected first-degree relative). The children and adolescents were evaluated by US during initial assessment and after 5 years. RESULTS: Initial US revealed pure cysts in five participants and nodules in seven, which were ≥5 mm in five. These patients were submitted to fine needle aspiration, which revealed benign cytology in four and a follicular lesion of undetermined significance in one. Fine needle aspiration was repeated in the last case and in one case with benign cytology but suspicious US. The second cytology was benign in both cases. After 5 years, another two participants with initially normal US had nodules <5 mm in the absence of suspicious findings. The frequency of lesions detected by US was not associated with participant sex or age, number of relatives with thyroid cancer (2 or 3), maternal or paternal origin of tumour, or age of the relatives at diagnosis. CONCLUSION: The present results suggest that US screening is not necessary in children or adolescents when one parent has a diagnosis of FNMTC (≥2 affected relatives).

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OBJECTIVE: To evaluate a criterion for the selective indication of radioactive iodine (RAI) based on the short-term behaviour of antithyroglobulin antibodies (TgAb) in patients with papillary thyroid carcinoma (PTC) who have negative thyroglobulin (Tg) and neck ultrasonography (US) without abnormalities after total thyroidectomy but elevated TgAb. DESIGN: This was a prospective study that evaluated 216 patients with low- or intermediate-risk PTC who had nonstimulated Tg ≤ 0.2 ng/ml and no US abnormalities but elevated TgAb 3 months after thyroidectomy. RAI was not indicated in patients with negative TgAb or a >50% reduction in TgAb concentrations 6 months after initial assessment followed by a negative test or an additional reduction (also >50%) after 12 months. RESULTS: Only two of the 114 patients who did not receive RAI developed recurrences; another 108 patients met the criterion of an excellent response to therapy in the last assessment and TgAb persisted in four patients but there was an additional reduction in their concentration during follow-up. Among the 102 patients who received RAI, post-therapy whole-body scanning (RxWBS) detected persistent disease in 8 (8%). Two of the 94 patients without persistent disease on RxWBS developed recurrences. In the last assessment, in the absence of additional treatment, 54/92 patients (58.7%) without structural recurrence had negative TgAb. CONCLUSIONS: The indication for RAI can be based on the short-term behaviour of TgAb in patients with PTC and elevated TgAb after thyroidectomy who are not high risk and who do not have apparent disease (nonstimulated Tg ≤ 0.2 ng/ml and no US abnormalities).

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BACKGROUND: This study evaluated the recurrence in patients with papillary thyroid cancer and an excellent response to initial therapy, comparing those with and without chronic lymphocytic thyroiditis. METHODS: This was a prospective study. Patients who met the following criteria were selected: diagnosis of papillary thyroid cancer; submitted to total thyroidectomy followed or not by ablation with 131I; and neck ultrasonography without abnormalities, nonstimulated thyroglobulina (Tg) ≤0.2 ng/ml, and undetectable antithyroglobulin antibodies (TgAb) 12-18 months after initial therapy. The patients were divided into two groups: group A, with chronic lymphocytic thyroiditis on histology; group B, without chronic lymphocytic thyroiditis on histology. RESULTS: Groups A and B were similar in terms of sex and age of the patients, characteristics of the tumor, tumor-node-metastase stage and risk category. The time of follow-up ranged from 24 to 120 months (median 66 months). During follow-up, 5 patients of group A (2.6 %) and 9 patients of group B (2 %) developed recurrence (p = 0.77). Patients with chronic lymphocytic thyroiditis were more likely to progress to persistently borderline TgAb. No patient had positive TgAb (above the reference value) during follow-up. Recurrences occurred in 12/588 patients (2 %) with undetectable TgAb in all measurements, in 1/32 (3.1 %) with detectable TgAb on some occasion but that returned to undetectable spontaneously, and in 1/13 (7.7 %) with persistently borderline TgAb. These rates did not differ significantly (p = 0.25). CONCLUSION: The results of the present study showed the absence of an association between chronic lymphocytic thyroiditis and recurrence risk at least in patients with an excellent response to initial therapy.

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AIM: This study evaluated the efficacy of adjuvant therapy with 3.7 GBq radioactive iodine (RAI) in patients with papillary thyroid carcinoma (PTC) of intermediate risk with higher risk features and determined the predictive value of postoperative nonstimulated thyroglobulin (Tg). METHODS: This was a prospective study including 85 patients with PTC of intermediate risk and higher risk features: tumor greater than 1 cm and aggressive histological subtype or vascular invasion; and/or more than three positive lymph node (LN) or LN greater than 1.5 cm or showing macroscopic extracapsular extension; and/or a combination of tumor greater than 4 cm, microscopic extrathyroidal extension, aggressive histology, and LN metastases (cN1). After thyroidectomy, all patients had nonstimulated Tg of at least 0.3 ng/ml and ultrasonography showed no anomalies. RESULTS: When evaluated 12 months after RAI therapy, an excellent response to initial therapy was achieved in 61 patients (71.7%). Structural disease was detected in five patients (5.9%). During follow-up, 6/80 patients (7.5%) without structural disease 1 year after RAI developed relapse. In the last assessment, 80 patients (94.1%) had nonstimulated Tg less than 1 ng/ml and no evidence of structural disease. There was no case of death because of the tumor. Postoperative nonstimulated Tg was a predictive factor of the main outcome (structural disease 1 year after RAI or recurrence) and the best cut-off was 1.8 ng/ml (sensitivity: 72.7%, specificity: 83.4%, negative predictive value: 95.4%). CONCLUSION: In patients with PTC of intermediate risk with higher risk features treated with 3.7 GBq RAI, postoperative nonstimulated Tg up to 1.8 ng/ml was a predictor of low risk of structural disease 1 year after therapy or recurrence.

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AIM: This study evaluated the long-term results of ablation with low iodine-131 (131I) activity in patients with papillary thyroid carcinoma (PTC) with a lower risk of recurrence and who remained with nonstimulated thyroglobulin (Tg) of at least 0.3 ng/ml after total thyroidectomy. METHODS: This was a prospective study including 119 patients with PTC (except for microcarcinoma restricted to the thyroid and tumor with extensive extrathyroidal extension, aggressive histology, extensive lymph node involvement, or known residual disease). After thyroidectomy, all patients had nonstimulated Tg of at least 0.3 ng/ml (range: 0.3-8.5 ng/ml). The patients were treated with low 131I activity (30 or 50 mCi). RESULTS: Post-therapy whole-body scanning showed ectopic uptake in two patients. When evaluated 12 months after ablation, nonstimulated Tg up to 0.2 ng/ml with negative antithyroglobulin antibodies and neck ultrasonography, defined as excellent response to initial therapy, was achieved in 92 patients (77.3%). Only one patient had persistent structural disease. During follow-up, 3/118 patients (2.5%) developed structural recurrence. In the last assessment, 102/115 patients who were not subjected to any additional therapy had nonstimulated Tg up to 0.2 ng/ml, negative antithyroglobulin antibodies, and ultrasonography with no anomalies. No death occurred because of the tumor. CONCLUSIONS: Postoperative nonstimulated Tg up to 2 ng/ml had a negative predictive value of 98% for recurrent or persistent structural disease. In patients with PTC who have a lower risk of recurrence and who remain with nonstimulated Tg of at least 0.3 ng/ml after total thyroidectomy, Tg up to 2 ng/ml can be used as a criterion for ablation with low 131I activity.

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OBJECTIVE: To evaluate the presence of persistent disease, including on post-therapy whole-body scan (RxWBS), in low-risk patients with papillary thyroid carcinoma (PTC) >1 cm who have low nonstimulated thyroglobulin (Tg) (measured with a sensitive assay), negative anti-Tg antibodies (TgAb) and neck ultrasound (US) showing no metastases after total thyroidectomy. PATIENTS: We studied 154 patients with PTC >1 cm classified as low risk, who had US without metastases, negative TgAb, nonstimulated Tg ≤ 0·25 ng/ml and TSH ≤ 2 mIU/l about 3 months after total thyroidectomy. RESULTS: Tg measured immediately before (131) I was ≤ 1 ng/ml in 89·5% of the patients and >1 ng/ml in 10·5%. None of the patients showed ectopic uptake on RxWBS. Uptake in the thyroid bed was observed in 146 (94·8%) patients and was ≤ 2% in all of them. In the control assessment 9-12 months after ablation, stimulated Tg (sTg) ≤ 1 ng/ml was achieved in 150 patients (97·4%). Only one patient had sTg >2 ng/ml (2·5 ng/ml) and none of the patients had apparent disease detected by imaging methods. During further short-term follow-up after control assessment (median of 24 months), none of the patients had tumour recurrence. CONCLUSIONS: The combination of nonstimulated Tg ≤0·25 ng/ml, negative TgAb and US without metastases after thyroidectomy rules out the presence of persistent disease (including on RxWBS) in low-risk patients with PTC >1 cm. This demonstration weakens the indication of ablation with (131) I in these cases.

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