The Efficacy Prediction Value Of Thyroglobulin In The Stimulated State Before ¹³¹I Treatment After Surgery Of Differentiated Thyroid Cancer

Thyroglobulin(Tg)is an important indicator for the differentiated thyroid cancer(DTC)after surgery to judge the curative effect and guide the dosage of 131I prescription.The purpose of this study was to evaluate the guidance and efficacy prediction value of serum Tg(preablation stimulated Tg,ps-Tg)before 131I treatment,that is,to look for serum ps-Tg that affects different treatment responses before 131I treatment after DTC.Stimulated thyroglobulin(sTg)is affected by a variety of factors.At present,more research is on the effect of serum anti-thyroglobulin antibody(TgAb)on sTg,while TSH is also a very important factor.In clinical practice,the sTg detection value of the same patient is gradually increased under the stimulating state of TSH.Most clinicians believe that when the sTg is 10 ng/ml,the patient's treatment response is poor,but it is not clearly pointed out that TSH measured simultaneously values,and so far there have been few reports indicating at what TSH level the detected sTg is the most suitable for evaluating treatment responses.In view of the importance of s-Tg and ps-Tg in the efficacy judgment of patients with thyroid surgery,This study intends to observe the guidance and predictive value of ps-Tg measurements on 131I therapy at specific TSH levels.The first step is to find the appropriate TSH measurement.The second step is to find the ps-Tg value at this specific.TSH level to better evaluate the curative effect,so as to provide a basis for clinical treatment,follow-up plan selection and implementation.Part 1:The best TSH threshold for accurate observation of sTg after 131I treatment after DTCObjectiveTo obtain the best TSH threshold that can accurately observe the Tg under stimulation after 131I treatment after DTC.Materials and MethodsA total of 76 DTC patients who had undergone 131I treatment and took thyroxine tablets regularly for 5 months were treated in the nuclear medicine of the First Afiliated Hospital of Zhengzhou University from July 2017 to September 2019.Prospective studies were discontinued.The TSH and sTg values of the patients were recorded weekly thereafter(respectively as TSH 1-4,sTg1-4).The results of diagnostic radioiodine 131I Diagnostic Whole Body Scan(131I-DxWBS)and cervical ultrasound(Ultrasound,US)were recorded after the fourth week of measurement,Exclude patients with positive Thyroglobulin Antibody(TgAb).Taking sTg4 as 10g/ml as the cut-off point,patients were divided into recurrence and metastasis group(n=21)and non-recurrence metastasis group(n=55)according to sTg4,131I-DxWBS and cervical US.Comparisons between groups were performed using t test,?2test,a modified x2test,Fisher's exact probability method,and the Mann-Whitney rank sum test.The correlation was obtained by Spearman rank correlation,the best diagnostic cut-off point(DCP)of TSH value was obtained by.ROC curve,and the area AUC,sensitivity,and specificity under the ROC curve were calculated.ResultsThere were differences in sTg1-4 between the two groups,both P values were 0.000,and there was also a statistical difference between TSH4,P=0.003;according to the change trend of TSH value and Tg value around four weeks,it can be seen that most Tg shows.an upward trend with the rise of TSH,and TSH and sTg have a correlation;comparing the two groups through the ROC curve,the optimal threshold of TSH is 85.375 ?IU/mL,the corresponding AUC is 0.724(95%CI:0.607?0.840),the sensitivity is 100%,and the specificity is 41.8%.ConclusionThe best TSH threshold for reflecting accurate Tg after 131I treatment after DTC is 85.375?IU/mL.Part ?:Judging the best ps-Tg value of different curative effects under a specific TSH stateObjectiveTo obtain the best ps-Tg threshold for judging different curative effects after 131I treatment.MethodsA retrospective analysis of the clinical data from the Department of Nuclear Medicine of the First Affiliated Hospital of Zhengzhou University from September 2018 to December 2019 is complete.It meets the 131I treatment after 6 months of discontinuation of TSH greater than 85.375 ?IU/mL and excludes TgAb positive DTC patients 280 people.According to the treatment response system in the 2015 ATA guidelines,comprehensive assessment of 131I-DxWBS,neck US and sTg values,and divide patients into excellent response(ER)group(n=167),acceptable response(AR)group(n=66),and incomplete response(IR)group(n=47)3 groups,using Kruskal-Wallis rank sum test,?2test to compare the differences between the three groups.Multivariate logistic regression was used to obtain the influencing factors between the three groups.The DCP of the ps-Tg value was obtained through the ROC curve,and the area under the ROC curve,AUC,sensitivity,specificity,positive predictive value,and negative predictive value were calculated.ResultsThere were significant differences in age,tumor invasion and ps-Tg in the three groups.Multivariate logistic regression analysis showed that the comparison between the IR group and the AR group showed age(OR:0.965,95%CI:0.926-1.006,P=0.092),gross invasion(OR:0.602,95%CI:0.224-1.616,P=0.314)has nothing to do with different curative effect;ps-Tg(OR:1.054,95%CI:1.028-1.081,P=0.000)is related to two different curative effect.The comparison of the ER group and the AR group showed that age(OR:0.976,95%CI:0.950-1.002,P=0.073)was not related to different curative effect;and gross invasion(OR:1.869,95%CI:1.004-3.481,P=0.049),ps-Tg(OR:0.901,95%CI:0.863-0.941,P=0.000)are related to two different curative effect.The ROC curves of the ER group and the AR group were established,with an AUC of 0.799(95%CI:0.742-0.856),According to the results obtained from the ROC curve,when the ps-Tg is 3.225ng/ml,the Jordan index is the largest(0.465),the corresponding sensitivity is 70.7%,the specificity is 75.8%,the accuracy is 72.10%,And the positive predictive value(The positive predictive value(PPV)was 88.06%,and the negative predictive value(NPV)was 50.51%.The ROC curves of the IR and AR groups were established,with an AUC of 0.917(95%CI:0.857?0.977).According to the results obtained from the ROC curve,when the ps-Tg is 20.775ng/ml,the Jordan index is the largest(0.79),the corresponding sensitivity is 85.1%,the specificity is 93.9%,the accuracy is 90.27%,and the PPV is 90.91%.The NPV was 89.86%.ConclusionFor patients without macroscopic invasion and ps-Tg?3.225ng/ml,the therapeutic effect is better after treatment.For patients with ps-Tg?20.775ng/ml,the efficacy after treatment is poor.