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Unstimulated high sensitive thyroglobulin measurement predicts outcome of differentiated thyroid carcinoma

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Published/Copyright: July 10, 2009
Clinical Chemistry and Laboratory Medicine
From the journal Clinical Chemistry and Laboratory Medicine Volume 47 Issue 8

Abstract

Background: Thyroglobulin (Tg) measurement following thyrotropin (TSH) stimulation is used in the follow-up of patients with differentiated thyroid carcinoma (DTC). However, high-sensitive assays allow accurate measurement of serum Tg even without TSH stimulation. Here, we prospectively evaluated the impact of unstimulated high-sensitive Tg measurement in early and long-term outcome of patients with DTC.

Methods: One hundred and ninety five patients affected with DTC were evaluated. Six months after thyroid ablation (i.e., thyroidectomy plus radioiodine) serum Tg was measured during TSH-suppressive thyroxine (T4) treatment (onT4-Tg). Patients with undetectable onT4-Tg and negative neck ultrasound (US) were considered disease free and onT4-Tg was measured every 12 months for a mean follow-up of 6.8 (4.7–8.9) years. Patients with an increase in onT4-Tg underwent specific diagnostic work-up and appropriate treatment if necessary.

Results: Four patients showed recurrence at first follow-up visit with a corresponding increase in onT4-Tg concentrations (sensitivity 100%). Three patients had false positive onT4-Tg measurement (specificity 98%) with a spontaneous decrease within 3–6 months in all cases (specificity 100%). Three of 188 patients with undetectable serum onT4-Tg at first follow-up showed recurrence later with an increase in onT4-Tg as the first (n=2) or unique (n=1) sign of relapse (sensitivity 100%). Among 185 disease-free patients in a prolonged follow-up, 12 had a transient increase in onT4-Tg (specificity 91.6%). However, a spontaneous reduction within 3–6 months occurred in all cases (specificity 100%).

Conclusions: Undetectable serum onT4-Tg using a high-sensitivity immunoradiometric assay 6 months after thyroid ablation predicts low-risk of DTC recurrence. When onT4-Tg became detectable during follow-up, the evaluation of Tg slope in a 3–6 months period accurately discriminated patients with DTC recurrence from those without recurrence. This helped avoid unnecessary diagnostic or therapeutic procedures.

Clin Chem Lab Med 2009;47:1001–4.

Keywords: differentiated thyroid carcinoma (DTC); follow-up; thyroglobulin (Tg); thyroid
Corresponding author: PD Dr. med. Luca Giovanella, Nuclear Medicine and Thyroid Center, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland Phone: +41-91-8118672, Fax: +41-91-8118250,
Received: 2008-11-27
Accepted: 2009-4-29
Published Online: 2009-07-10
Published in Print: 2009-08-01

©2009 by Walter de Gruyter Berlin New York

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  3. Review
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  10. Multicenter evaluation of the hemolysis index in automated clinical chemistry systems
  11. Haemolysis index – an estimate of preanalytical quality in primary health care
  12. Evaluation of the Innovance D-DIMER analytical performance
  13. Heterophile antibodies may falsely increase or decrease thyroglobulin measurement in patients with differentiated thyroid carcinoma
  14. Variation of barrier permeability for albumin and immunoglobulin G influx into cerebrospinal fluid
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  21. Comparison of fifteen immunoassays for the measurement of serum MUC-1/CA 15-3 in breast cancer patients
  22. Serum levels of matrix metalloproteinase-2 and -9 and conventional tumor markers (CEA and CA 19-9) in patients with colorectal and gastric cancers
  23. Unstimulated high sensitive thyroglobulin measurement predicts outcome of differentiated thyroid carcinoma
  24. Relationship of serum antioxidant micronutrients and sociodemographic factors to cervical neoplasia: a case-control study
  25. Letters to the Editor
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https://doi.org/10.1515/CCLM.2009.216
Keywords for this article
differentiated thyroid carcinoma (DTC); follow-up; thyroglobulin (Tg); thyroid

Articles in the same Issue

  1. Editorial
  2. Hemolysis index: quality indicator or criterion for sample rejection?
  3. Review
  4. Neutrophil CD64: a diagnostic marker for infection and sepsis
  5. Genetics and Molecular Diagnostics
  6. Chromosome 9p21 polymorphism is associated with myocardial infarction but not with clinical outcome in Han Chinese
  7. Differential expression of microRNAs in the placentae of Chinese patients with severe pre-eclampsia
  8. Clinical, biochemical, and genetic analysis of a Korean neonate with hereditary tyrosinemia type 1
  9. General Clinical Chemistry and Laboratory Medicine
  10. Multicenter evaluation of the hemolysis index in automated clinical chemistry systems
  11. Haemolysis index – an estimate of preanalytical quality in primary health care
  12. Evaluation of the Innovance D-DIMER analytical performance
  13. Heterophile antibodies may falsely increase or decrease thyroglobulin measurement in patients with differentiated thyroid carcinoma
  14. Variation of barrier permeability for albumin and immunoglobulin G influx into cerebrospinal fluid
  15. Anti-citrullinated protein antibody and rheumatoid factor in patients with end-stage renal disease
  16. Reference Values and Biological Variations
  17. Quality of interpretative commenting on common clinical chemistry results in the Asia-Pacific region and Africa
  18. Analysis and interpretation of drug testing results from patients on chronic pain therapy: a clinical laboratory perspective
  19. Cancer Diagnostics
  20. HER1-4 protein concentrations in normal breast tissue from breast cancer patients are expressed by the same profile as in the malignant tissue
  21. Comparison of fifteen immunoassays for the measurement of serum MUC-1/CA 15-3 in breast cancer patients
  22. Serum levels of matrix metalloproteinase-2 and -9 and conventional tumor markers (CEA and CA 19-9) in patients with colorectal and gastric cancers
  23. Unstimulated high sensitive thyroglobulin measurement predicts outcome of differentiated thyroid carcinoma
  24. Relationship of serum antioxidant micronutrients and sociodemographic factors to cervical neoplasia: a case-control study
  25. Letters to the Editor
  26. Clinical efficacy of two cardiac troponin I assays
  27. Impeded centrifugation in plasmocytoma serum
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