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. 2021 May 18;64(6):764-771.
doi: 10.20945/2359-3997000000290.

Intermediate-risk thyroid carcinoma: indicators of a poor prognosis

Fernanda Nascimento Faro  1 , Ângela Maria Leal Barros Bezerra  1 , Nilza Maria Scalissi  1   2 , Adriano Namo Cury  1   2 , Marília Martins Marone  3 , Carolina Ferraz  1   2 , Rosália do Prado Padovani  1   2   4
Affiliations

Intermediate-risk thyroid carcinoma: indicators of a poor prognosis

Fernanda Nascimento Faro et al. Arch Endocrinol Metab. .

Abstract

Objective: The intermediate-risk (IR) category includes tumors with different degrees of aggression. We aimed to identify the risk factors associated with unfavorable response to initial treatment and compare the effect of low/high radioactive iodine (RAI) therapy.

Methods: A total of 614 IR patients were selected from a database, during 1972-2015. All patients underwent total thyroidectomy and RAI therapy and were reclassified after 12-18 months into the favorable (complete/indeterminate) response group and the unfavorable (biochemical/incomplete structural) response group. A total of 92 patients were assessed for late response (mean: 9.19 ± 5.73 years). Age, gender, tumor size, histology, multifocality, vascular invasion, extrathyroidal extension, presence and number of lymph node metastasis, and stimulated thyroglobulin at ablation (sTg) were evaluated.

Results: Mean age at diagnosis was 41.47 ± 15.81 years, and 83.6% of the patients were female. Within 12-18 months after initial therapy, unfavorable response was detected in 41.2% of the patients and was associated, in multivariate analysis, with lymph node metastasis (p = 0.041; odds ratio [OR] = 1.9), presence of more than five metastatic lymph nodes (p = 0,017; OR = 2.6), and sTg > 10 ng/mL (p = 0.005; OR = 10.0). For patients with a longer follow-up, sTg >10 ng/mL was associated with unfavorable response (p = 0.002; OR = 6.8). A higher RAI dose was not related to better prognosis at the end of the follow-up.

Conclusion: A sTg level of >10 ng/mL and lymph node metastasis were associated with an unfavorable response 12-18 months after initial treatment. A RAI dose below 150 mCi was proven sufficient to treat IR patients.

Keywords: Thyroid neoplasms; differentiated thyroid cancer; prognosis; radioactive iodine therapy; thyroglobulin; thyroid cancer.

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Conflict of interest statement

Disclosure: no potential conflict of interest relevant to this article was reported.

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