Keywords
Thyroid Cancer
DTC
Obesity
How to Cite
Abstract
Introduction. Anti-thyroglobulin antibodies (ATG) are considered predictors of recurrent disease in differentiated thyroid cancer (DTC). Objectives. To determine antibody concentrations in patients undergoing thyroidectomy for DTC with and without obesity and evaluate whether ATG concentrations in these overweight or obese patients behave as an indicator of risk of recurrence or persistence of the disease, keeping in mind that obesity is strongly linked to the development of cancer. Materials and methods. Observational, descriptive cross-sectional study. Thyroidectomized women aged 19 to 74 years, with and without levothyroxine treatment, were included. Anthropometric measurements considered included: Weight (K), Height (m), CC (cm) and BMI (K/m2). Patients were divided by BMI (according to WHO criteria) as: normoweight, overweight and obese, and by Waist Contour (WC, according to NCEP-ATPIII): a-Without Abdominal Obesity (S/O≤88cm) b-With Abdominal Obesity (C/O>88cm). -Biochemical Analysis: ATG and Thyroglobulin. Differences in ATG and age were analyzed by Kruskal-Wallis and Mann-Whitney, according to categories derived from BMI and CC, p<0.05. Results. 172 women were studied and divided into: -Treated patients (PT) and -Patients with suspension of therapy (PNT). ATG(UI/mL) in PT (according to BMI) were: a-Normoweight: 12.8(0.8; 334); b-Overweight: 13.6(0.5; 376.2); c-Obese: 16.0(0.9; 475.1), NS. Patients with overweight and obesity presented higher ATG levels than normoweight ones. According to CC, C/O patients showed significantly higher levels than S/O: (S/O: 12.6(0.5; 244); C/O: 15.2(19; 65); p:< 0.004). In PNT: normoweight: 21.8(14.6; 74.2), Overweight: 49.4(1.4; 286) and Obese: 13.0(0.4; 221.4), NS. Overweight and obese patients showed higher levels of antibodies. According to the CC, a significant difference in ATG levels was observed in patients treated C/O; this was not the case in PNT. According to BMI (in PT and PNT), although there was no significant difference between the groups, ATG values w ere higher in overweight and obese patients compared to normal weight patients. Conclusions. These results, and the close relationship between cancer and obesity, suggest that in thyroidectomized patients with DTC, elevated ATG levels could be a predictor of recurrence risk.
References
1. Xu B, Ghossein R. Evolution of the histological classification of thyroid neoplasms and its impact on clinical management. EUR. J. Surg Oncol 2018;44(3):338-347, https://doi.org/10.1016/j.ejso.2017.05.002
2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE et al. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1-133, https://pubmed.ncbi.nlm.nih.gov/26462967/
3. Kent WD, Hall SF, Isotalo PA, Houlden RL, George RL, Groome PA. Increased incidence of differentiated thyroid carcinoma and detection of subclinical disease. CMAJ. 2007; 177(11):1357-1361, https://doi.org/10.1503/cmaj.061730
4. Cho YA, Kim J. Thyroid cancer risk and smoking status: a meta-analysis. Cancer Causes Control 2014; 25:1187-1195, https://doi.org/10.1007/s10552-014-0422-2
5. Derwahl M. and Nicula D. Estrogen and its role in thyroid cancer. Endocr Relat Cancer 2014; 21(5): T273–T283, https://doi.org/10.1530/erc-14-0053
6. Ma J, Huang M, Wang L, Ye W, Tong Y, Wang H. Obesity and risk of thyroid cancer: Evidence from a meta-analysis of 21 observational studies. Medicine. Science Monitor. 2015; 21:283-291, https://doi.org/10.12659/msm.892035
7. Pappa T, Alevizaki M. Obesity and Thyroid Cancer: A Clinical Update. Thyroid 2014; 24:190-199, https://doi.org/10.1089/thy.2013.0232
8. Yeo Y, Ma SH, Hwang Y, Horn-Ross PL, Hsing A, Lee KE, et al. Diabetes mellitus and risk of thyroid cancer: a meta-analysis. PLoS ONE 2014;9(6): e98135, https://doi.org/10.1371/journal.pone.0098135
9. Arnold M, Pandeya N, Byrnes G, Renehan AG, Stevens GA, Ezzati M et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. The Lancet Oncology 2015;16(1):36-46, https://doi.org/10.1016/s1470-2045(14)71123-4
10. Clavel-Chapelon F, Guillas G, Tondeur L, Kernaleguen C, Boutron-Ruault MC. Risk of differentiated thyroid cancer in relation to adult weight, height and body shape over life: The French E3N cohort. Int J Cancer 2010;126(12): 2984-90, https://doi.org/10.1002/ijc.25066
11. Carvalho MS, Rosario PW, Mourão GF, Calsolari MR. Chronic lymphocytic thyroiditis does not influence the risk of recurrence in patients with papillary thyroid carcinoma and excellent response to initial therapy. Endocrine 2016;55(3):954-958, https://doi.org/10.1007/s12020-016-1185-1
12. Côrtes MCS, Rosario PW, Oliveira LFF, Calsolari MR. Clinical impact of detectable antithyroglobulin antibodies Below the reference limit (borderline) in patients with papillary thyroid carcinoma with undetectable serum thyroglobulin and normal neck ultrasonography after ablation: A prospective study. Thyroid. 2018; 28(2):229-235, https://doi.org/10.1089/thy.2017.0350
13. Scappaticcio L, Trimboli P, Verburg FA, Giovanella L. Significance of«de novo» appearance of thyroglobulin antibodies in patients withdifferentiated thyroid cancer. Int J Biol Markers, 2020;35(3):41-49, https://doi.org/10.1177/1724600820931517
14. Pedro-Weslley R, Carvalho-Souza-Côrtes M, Franco-Mourão G. Followup of patients with thyroid cancer and antithyroglobulin antibodies: a review for clinicians. Endocr Relat Cancer. 2021;28(4):111-119, https://doi.org/10.1530/erc-21-0012
15. Pedro-Weslley R, Carvalho M, Mourão GF, Calsolari MR. Comparison of antithyroglobulin antibody concentrations before and after ablation with 131I as a predictor of structural disease in differentiated thyroid carcinoma patients with undetectable basal thyroglobulin and negative neck ultrasonography Thyroid. 2016; 26(4):525-531, https://doi.org/10.1089/thy.2015.0445
16. Cléro É, Leux C, Brindel P, Truong T, Anger A, Vathaire F et al. Pooled Analysis of Two Case–Control Studies in New Caledonia and French Polynesia of Body Mass Index and Differentiated Thyroid Cancer: The Importance of Body Surface Area. Thyroid 2010; 20(11):1285-93, https://doi.org/10.1089/thy.2009.0456
17. Kitahara CM, Platz EA, Park Y, Hollenbeck AR, Schatzkin A, Berrington de González A. Body fat distribution, weight change during adulthood, and thyroid cancer risk in the NIH-AARP Diet and Health Study. International Journal of Cancer 2011;130(6):1411-19, https://doi.org/10.1002/ijc.26161
18. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and metaanalysis of prospective observational studies. Lancet 2008;371(9612):569-578, https://doi.org/10.1016/s0140-6736(08)60269-x
19. Arduc A, Dogan BA, Tuna MM, Tutuncu Y, Isik S, Berker D, et al. Higher body mass index and larger waist circumference may be predictors of thyroid carcinoma in patients with H€urthle-cell lesion/neoplasm fineneedle aspiration diagnosis. Clinl Endocrinol (Oxf) 2015;83(3):405-411, https://doi.org/10.1111/cen.12628
20. Kabat GC, Kim MY, Thomson CA, Luo J, Wactawski-Wende J, Rohan TE. Anthropometric factors and physical activity and risk of thyroid cancer in postmenopausal women. Cancer Causes Control 2012;23(3):421-430, https://doi.org/10.1007/s10552-011-9890-9