OE：Oral Presentation-Endocrine (1-6

OE01 CHANGE OF REAL-TIME ULTRASOUND STRAIN ELASTOGRAPHY IN PATIENTS WITH GRAVES’ DISEASE.

KUN-YO LAI, FENG-HSUAN LIU, SHU-FU LIN, SZU-TAH CHEN

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou,Taiwan

Objective: The purpose of this study is to detect the change of tissue stiffness of patients with Graves’ disease (GD) before and after treatment with real-time ultrasound strain elastography (SE) technique.

Methods: A total of 67 subjects (54 women and 13 men) with Graves’ disease, aged from 16 to 68 (42.73 ± 11.74) y/o were enrolled for strain elastography examination. They were divided into hyperthyroid (n = 39) and euthyroid (n = 28) groups in this study. Two measurements of elastic modulus values, i.e. liver fibrosis index (LFI) and strain ratio, were performed in the cross-sectional view, strain ratio was obtained by comparing with the ipsilateral sternocleidomastoid muscle. Thyroid function tests including T4, TSH, and TSH receptor antibody (TRAB) were detected in all patients. Independent sample t-test, logistic regression, Pearson’s correlation and receiver operating characteristic (ROC) curve were applied for statistical analysis.

Results: The elastic modulus value of LFI in hyperthyroid and euthyroid groups ranged from -1.0 to 2.06 (mean 0.49 ± 0.77) and -0.72 to 3.23 (mean 1.05 ± 1.14), p < 0.05, respectively. Patients with higher LFI showed lower risk of hyperthyroidism (OR: 0.53, 95% CI, 0.31-0.92); in contrast, patients with lower LFI showed higher risk of euthyroidism (OR: 1.87; 95% CI: 1.08-3.24). LFI was also found to be negatively correlated with T4 (r = -0.26), TRAB(r = -0.28) and hyperthyroidism (r = -0.28) in GD, all p < 0.05. The area under the curve of ROC (AUC ROC) of euthyroidism evaluated by LFI was 0.63, with the best discrimination point of value of 0.85 (sensitivity 57.1% and specificity 69.2%). In addition, TRAB displayed positive correlation with T4 (r = 0.40, p < 0.001) and hyperthyroidism (r = 0.40, p < 0.001); age showed positive correlation with LFI (r = 0.39, p < 0.01) and strain ratio (r = 0.31, p < 0.05). No correlation was found between strain ratio and T4, TSH or thyroid function status.

Conclusion: LFI of strain elastography correlates with thyroid function status in GD patients. In addition, TRAB and age could influence thyroid stiffness of GD.

OE02 STABILITY OF THYROID STIMULATING HORMONE RECEPTOR ANTIBODY IN THE STORED SERUM SAMPLES

1TA-CHI CHEN, 1I-TE LEE

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan

Background As the measurement of serum thyroid stimulating hormone receptor antibody (TRAb) and thyroid stimulating immunoglobulin (TSI) becoming the standard of care for diagnosis of Graves’ disease, sensitivity and specificity of every test kit also became a research issue. However, before validating those results, we must make sure that the samples we used could reveal consistent result during every test---after all, the difference between each kit was so small, and a minor sample factor could result in different conclusion. This study aimed to discover the impact of sample storage on subsequent test results.

Methods Patient group: Those who came to outpatient clinic of Taichung Veterans General Hospital with thyroid disease. All the patients signed informed consent for additional sample collection during regular blood draw, for the need of further research on thyroid diseases.

According to storage record, all the serum samples were stored in the refrigerator under -70’C in the lab. There was no additional thawing and freezing processes on collected samples before this study.

All the samples tested on the same day for twice with Roche e602 anti-TSHR( the TRAB kit) and twice with Siemens IMMULITE 2000 Xpi(the TSI kit). TSH(thyroid stimulating hormone) and free T4(tetraiodothyronine) level was acquired at the time of blood draw with Siemens IMMULITE i 2000XPi.

Results From 2012/3/20 to 2018/11/22, serum sample of 88 patients were collected. All the samples were tested on 2019/7/12 for this study. Among all the patients there were 15 male, 73 female, aged 21 to 68 years old with median age 39 years old.

According to the patients’ serum level of TSH and free T4, 16 had hypothyroidism, 38 had hyperthyroidism and 34 were under euthyroid status. The test result of TRAB had a very high correlation with TSI (Pearson correlation 0.37, P value < 0.0001). The Mean absolute deviation between 2 TSI tests was not associated with storage time (Pearson correlation 0.16, P value 0.145), but the Mean absolute deviation between 2 TRAB tests was highly associated with storage time (Pearson correlation 0.54, P value <0.0001).

Conclusions The level of TSI may decrease over time even if it was stored under -70’C condition. The decay of TRAB may affect the result and the confidence interval of each test may have to change according to storage time of samples, if retrospective study was to perform.

OE03 THE DIAGNOSTIC UTILITY OF LIQUID-BASED CYTOLOGY FOLLOWING INADEQUATE RESULT OF CONVENTIONAL SMEAR IN FINE NEEDLE ASPIRATION OF THYROID NODULES.

1LAY SAN LIM, 1CHEN-KAI CHOU

1Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Background: Thyroid fine-needle aspiration (FNA) is a cost-effective and safe diagnostic tool for evaluation of thyroid lesions. Traditionally, conventional smear (CS) method with modified Romanowsky stain or Papanicolaou stain has been widely used for cytologic preparation of thyroid despite its limitations as blood-obscuring background, poor cellularity and personal smearing skill. Liquid-based cytology (LBC) has been introduced and applied widely in recent years. This study aimed to evaluate the diagnostic utility of LBC following inadequate result of CS in thyroid FNA.

Methods: From September 2019 till October 2020, 210 LBC were collected. Among these 210 LBC cases, 159 cases had previous CS data. Cytomorphological features were categorized using the Bethesda system for reporting thyroid cytopathology (BSRTC). 59 of 159 CS were categorized as BSRTC I had repeated thyroid FNA using LBC and the rate of adequacy were assessed. 32 cases of 210 LBC underwent surgical resection and correlation with the histology diagnosis was done.

Results: Among CS with BSRTC I, adequacy of sampling increased 49% by repeat FNA using LBC method. Two of previous CS with BSRTC I cases were classified as BSRTC V after repeat FNA with LBC. One case received surgical resection and the pathology report turned out papillary thyroid cancer (PTC). LBC has 69% NPV (9/13, 2 cases of incidental findings of papillary thyroid microcarcinoma, 1 case of follicular carcinoma and 1 case of PTC, follicular variant) for cases diagnosed as benign (BSRTC II). For group of suspicious for malignancy (BSRTC V), LBC has 100% PPV.

Conclusions: LBC represent as alternative or additional method to CS of thyroid FNA, especially in CS group with the diagnosis of BSRTC I to obtain informative results. More data and further studies are needed.

OE04 THE IMPACT OF DISTANT METASTASIS ON PROGNOSIS IN PATIENTS WITH FOLLICULAR THYROID CARCINOMA

1,2MING-HSIEN WU, 1,2YI-YIN LEE, 1,2YU-LING LU,

1,2SHU-FU LIN

1 Division of Endocrinology and Metabolism, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital (built and operated by Chang Gung Medical Foundation), New Taipei City, Taiwan; 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan

Background: Follicular thyroid carcinoma (FTC) is the second most common of the thyroid carcinoma and accounts for approximately 10–15% of all thyroid cancers. Patients with FTC usually have favorable prognosis. However, the outcome in patients with metastatic FTC is considered to be poor. We investigated the impact of distant metastasis at presentation or during follow-up on outcomes in patients with FTC.

Methods: Patients with FTC diagnosed between December 1976 and May 2020 were analyzed using a prospectively maintained database of patients with thyroid cancer. A total of 190 patients, including 29 had metastatic FTC at initial presentation (Group A), 14 had metastatic disease during follow-up (Group B), and 147 without metastatic disease thorough the clinical course (Group C) were assessed. Data on basal demographic characteristics, tumor staging, laboratory tests and type of surgical treatment were collected. Statistical analyses used in this study were descriptive statistics, Kaplan-Meier survival curves and Cox proportional hazards regression.

Results: Among three groups, Group A was the oldest (66.1 ± 8.9 years), followed by Group B (59.7 ± 8,7 years) and Group C (42.7 ± 17.3 years). Group A had highest post-surgery thyroglobulin (Tg) level and the most advanced cancer staging as compared with the other two groups. The overall cancer-specific survival was 8.4 years in Group A, 21.7 years in Group B, and no mortality occurred in Group C during a mean follow-up of 7.6 years. Univariate analysis demonstrated older age (> 55 years), metastatic disease, higher accumulated 131I dose (> 100 mCi), higher post-surgery Tg (≥ 30 ng/mL) and advanced TNM classification (stage III and IV) were associated with poorer cancerspecific survival. Multivariate analysis reveals metastasis and advanced TNM classification (stage III and IV) were associated with shorter cancer-specific survival.

Conclusions: Our data indicate patients with metastatic FTC at presentation had poor prognosis. However, the patients developing metastatic PTC during follow-up usually harbored favorable overall survival.

OE05 THERAPEUTIC OUTCOMES USING TARGETED THERAPY IN PATIENTS WITH ANAPLASTIC THYROID CANCER

1,2YI-YIN LEE, 1,2MING-HSIEN WU, 1,2YU-LING LU, 3YU-TUNG HUANG, 1,2SHU-FU LIN

1 Division of Endocrinology and Metabolism, New Taipei Municipal TuCheng Hospital (Built and operated by Chang Gung Medical Foundation), New Taipei City, Taiwan; 2 Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taoyuan, Taiwan; for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Background: Anaplastic thyroid carcinoma (ATC) is a rare but fatal disease, with median survival of 3-6 months. Multimodality treatment, including surgery, chemotherapy and radiotherapy provides limited therapeutic benefits. Recently, US FDA approved a BRAF inhibitor (dabrafenib) plus a MEK inhibitor (trametinib) for locally advanced, metastatic ATC with BRAFV600E mutation. Lenvatinib and sorafenib have demonstrated activity against ATC in clinical trials.

Methods: Patients with ATC were analyzed using a prospectively maintained database of patients with thyroid cancer registered at a medical center between January 2000 and November 2020. Subjects were classified into three groups according to treatment modalities: best supportive care (Group 1), conventional treatment (Group 2) and targeted therapy (Group 3). Baseline characteristics, tumor staging, BRAF mutation status, and comorbidities were assessed. Survival were analyzed using Kaplan-Meier method.

Results: A total of 38 patients were identified, including 9 in Group 1, 23 in Group 2, and 6 in Group 3. Most patients were female (60.5%) and the median age was 74.4 years. Most patients had stage IVC disease (65.8%), followed by stage IVB (21.1%) and stage IVA (13.2%). Five patients had concurrent papillary thyroid cancer. The most common comorbidities were hypertension (48.6%), followed by diabetes (21.2%), coronary heart disease (8.1%), cerebrovascular accident (8.1%), and the other malignancy (8.1%). Twenty patients (52.6%) received surgery and 23 patients (62.2%) received radiotherapy. Targeted therapies used were dabrafenib plus trametinib (n = 3), lenvatinib (n = 1), and sorafenib (n = 2). Six-month and 12-month survival rates were 10% and 0% in Group 1, 30.4% and 13% in Group 2, and 100% and 75% in Group 3. Targeted therapy significantly improved survival compared with either best supportive care or conventional treatment (P < 0.05 for both comparison).

Conclusions: Patient with ATC had dismal outcomes either treated with best supportive care or conventional therapy. However, targeted therapy improved survival in this papulation.

OE06 CLINICAL EXPERIENCE WITH RECOMBINANT HUMAN THYROTROPHIN (RHTSH) IN DIFFERENTIATED THYROID CANCER FROM A MEDICAL CENTER IN SOUTH TAIWAN

JIA-RUEI TSI, CHEN-KAI CHOU

Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

INTRODUCTION: The use of recombinant human thyroid-stimulating hormone (rhTSH), which is known to be efficient in remnant ablation. The objective of the current study was to assess the impact of age and cancer stage influence on cancer treatment response with use of recombinant human TSH (rhTSH, commercially available as Thyrogen) in the management of patients with differentiated thyroid cancer (DTC).

METHOD: From 2013 to 2019, total of 1421 DTC cases received radioiodine ablation in Kaohsiung Chang Gung Memorial Hospital were included in this study. We analyzed sequential follow up treatment response defined by America Thyroid Association guideline in the DTC patients who use of rhTSH and levothyroxine withdrawal (THW) after thyroid remnant ablation.

RESULT: Among 1421 received radioiodine ablation cases, 1089 of them were female and 334 of them are males. All subjects were classified as rhTSH group (N = 396) and THW (N = 1027). No obvious treatment response difference was noted between rhTSH group (30.2%) versus THW group (27.9%). Furthermore, no significant treatment response differences between different age and cancer stage group (P > 0.05, respectively).

CONCLUSION: In conclusion, treatment response by either rhTSH or THW are comparable for DTC patients, even in different cancer stage or age based on current study observations.