Thyroglobulin assay during thyroxine treatment in low-risk differentiated thyroid cancer management: comparison with recombinant human thyrotropin-stimulated assay and imaging procedures
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Luca Giovanella
Abstract
Background: Circulating human thyroglobulin (TG) measurement has a pivotal role in the management of patients affected by differentiated thyroid cancer (DTC). Undetectable thyrotropin (TSH)-stimulated serum TG after thyroid ablation (i.e., thyroidectomy and radioiodine) implies the absence of residual or relapsing DTC. Recently, high-cost recombinant human TSH (rhTSH) was proposed for TG stimulation to avoid uncomfortable thyroxine (T4) withdrawal. However, only a small fraction of relapsing DTC patients showed undetectable TG under T4 treatment (onT4-TG) by high-sensitivity assays. The present study was undertaken to compare onT4-TG with the rhTSH-stimulated TG assay (rhTSH-TG), 131I scanning and neck ultrasound (US) with fine-needle aspiration biopsy.
Methods: We enrolled 117 patients with histologically proven DTC treated by total thyroidectomy and radioiodine. Inclusion criteria were: complete tumour excision, no radioiodine uptake outside of the thyroid bed at post-treatment scan and undetectable onT4-TG 3months after primary treatment. At 1year after radioiodine treatment, all patients underwent onT4-TG assay, rhTSH-stimulated TG assay, 131I scanning and neck US. Based on histology, clinical data and long-term follow-up, persistent/relapsing disease was confirmed in 14 patients.
Results: onT4- and rhTSH-TG were positive in 10 and 12 patients, respectively and two patients converted from undetectable to detectable TG after rhTSH administration. Neck US was positive in 10 patients and a combination of US with onT4- and rhTSH-TG assays showed positivity in 13 and 14 out 14 patients, respectively. A radioiodine scan was positive in six patients, all with positive onT4- and rhTSH-TG levels. Globally, the negative predictive value of the onT4- and rhTSH-TG assays was 99% and 100%, respectively, and 104 rhTSH stimulations had to be performed to detect one local recurrence with negative onT4-TG.
Conclusions: Our preliminary data need further confirmation on larger groups of patients, but seem to indicate that onT4-TG assay by a high-sensitivity method combined with neck US may avoid rhTSH stimulation in low-risk DTC patients after surgery and radioiodine thyroid ablation.
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©2006 by Walter de Gruyter Berlin New York
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Articles in the same Issue
- CCLM: Expanding the science worldwide
- Factor V Leiden, prothrombin G20210A substitution and hormone therapy: indications for molecular screening
- Immunochemical quantification of free immunoglobulin light chains from an analytical perspective
- De novo deletion removes a conserved motif in the C-terminus of ABCA4 and results in cone-rod dystrophy
- Molecular detection of squamous cell carcinoma antigen transcripts in peripheral blood of cancer patients
- Influence of human haptoglobin polymorphism on oxidative stress induced by free hemoglobin on red blood cells
- Real-time RT-PCR quantification of PRAME gene expression for monitoring minimal residual disease in acute myeloblastic leukaemia
- Association of high-sensitive C-reactive protein with advanced stage β-cell dysfunction and insulin resistance in patients with type 2 diabetes mellitus
- A longitudinal evaluation of urinary glycosaminoglycan excretion in normoalbuminuric type 1 diabetic patients
- National survey on the execution of the oral glucose tolerance test (OGTT) in a representative cohort of Italian laboratories
- The reduction of cholesteryl linoleate in lipoproteins: an index of clinical severity in β-thalassemia/Hb E
- Alterations in serum glycosaminoglycan profiles in Graves' patients
- Alterations in anti-oxidative defence enzymes in erythrocytes from sporadic amyotrophic lateral sclerosis (SALS) and familial ALS patients
- Sandwich ELISAs for soluble immunoglobulin superfamily receptor translocation-associated 2 (IRTA2)/FcRH5 (CD307) proteins in human sera
- Utilizing ultrafiltration to remove alkaline phosphatase from clinical analyzer water
- Measurement of serum monoclonal components: comparison between densitometry and capillary zone electrophoresis
- Salivary aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase: possible markers in periodontal diseases?
- Reticulocyte count, mean reticulocyte volume, immature reticulocyte fraction, and mean sphered cell volume in elite athletes: reference values and comparison with the general population
- Serum homocysteine levels and paraoxonase 1 activity in preschool aged children in Greece
- The effects of adrenocorticotrophic hormone and cortisol on homocysteine and vitamin B concentrations
- Plasma, salivary and urinary cotinine in non-smoker Italian women exposed and unexposed to environmental tobacco smoking (SEASD study)
- Cut-off values for total serum immunoglobulin E between non-atopic and atopic children in north-west Croatia
- Thyroglobulin assay during thyroxine treatment in low-risk differentiated thyroid cancer management: comparison with recombinant human thyrotropin-stimulated assay and imaging procedures
- Evaluation of serum levels of p53 in hepatocellular carcinoma in Egypt
- Insufficient filling of vacuum tubes as a cause of microhemolysis and elevated serum lactate dehydrogenase levels. Use of a data-mining technique in evaluation of questionable laboratory test results
- Evaluation of three different specimen types (serum, plasma lithium heparin and serum gel separator) for analysis of certain analytes: clinical significance of differences in results and efficiency in use
- Comparative evaluation of a new immunoradiometric assay for corticotropin
- Mast cells in atherosclerosis as a source of the cytokine RANKL
- Falsely increased total serum protein due to dextran interference
