Thyroglobulin and thyroglobulin antibody measurements in the follow-up of differentiated thyroid cancer: practical implications for laboratories illustrated by means of a new highly sensitive thyroglobulin assay

Differentiated thyroid cancer (DTC) is the most common endocrine cancer and its incidence has increased in recent decades. Initial treatment usually consists of total thyroidectomy followed by ablation of thyroid remnants by iodine-131. As thyroid cells are assumed to be the only source of thyroglobulin (Tg) in the human body, circulating Tg serves as a biochemical marker of persistent or recurrent disease in DTC follow-up. Currently, standard follow-up for DTC comprises Tg measurement and neck ultrasound combined, when indicated, with an additional radioiodine scan. Measurement of Tg after stimulation by endogenous or exogenous TSH is recommended by current clinical guidelines to detect occult disease with a maximum sensitivity due to the suboptimal sensitivity of older Tg assays. However, the development of new highly sensitive Tg assays with improved analytical sensitivity and precision at low concentrations now allows detection of very low Tg concentrations reflecting minimal amounts of thyroid tissue without the need for TSH stimulation. Use of these highly sensitive Tg assays has not yet been incorporated into clinical guidelines but they will, we believe, be used by physicians caring for patients with DTC. The aim of this clinical position paper is, therefore, to offer advice on the various aspects and implications of using these highly sensitive Tg assays in the clinical care of patients with DTC.

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Anti-thyroglobulin Antibody Positivity During Follow-Up of a Patient with Differentiated Thyroid Cancer

Thyroid and Parathyroid Diseases ◽

10.1007/978-3-319-78476-2_44 ◽

2018 ◽

pp. 281-286

Author(s):

Gülin Uçmak ◽

B. Büşra Demirel

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Thyroglobulin Antibody ◽

Antibody Positivity

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Unstimulated Highly Sensitive Thyroglobulin in Follow-up of Differentiated Thyroid Cancer Patients: A Meta-Analysis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-3156 ◽

2014 ◽

Vol 99 (2) ◽

pp. 440-447 ◽

Cited By ~ 59

Author(s):

Luca Giovanella ◽

Giorgio Treglia ◽

Ramin Sadeghi ◽

Pierpaolo Trimboli ◽

Luca Ceriani ◽

...

Keyword(s):

Thyroid Cancer ◽

Cancer Patients ◽

Differentiated Thyroid Cancer ◽

Meta Analysis ◽

Highly Sensitive

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Highly Sensitive Determination of TSH in the Follow-Up of TSH-Suppressive Therapy of Patients with Differentiated Thyroid Cancer

Nuklearmedizin ◽

10.1055/s-0038-1628906 ◽

1988 ◽

Vol 27 (01) ◽

pp. 24-28 ◽

Cited By ~ 2

Author(s):

B. Sailer ◽

U. Mehl ◽

R. Hörmann ◽

E. Moser ◽

K. Mann

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Hormonal Treatment ◽

Suppressive Therapy ◽

Highly Sensitive ◽

Tsh Secretion ◽

Sensitive Determination ◽

Tsh Levels

Basal and TRH-stimulated TSH levels were determined in 72 patients with differentiated thyroid cancer on hormonal treatment, using a highly sensitive immunoradiometric assay (IRMAclon, Henning). 43 patients were under treatment with levothyroxine (T4), 29 patients with triiodothyronine (T3). In 33/43 patients (77%) under T4- and in 18/29 patients (62%) under T3-treatment basal TSH levels were below 0.1 mU/l and levels stimulated with 200 µg TRH i.v. were below 0.5 mU/l. 3 patients showed a significant response (to above 0.5 mU/l) in the TRH test despite basal values of less than 0.1 mU/l. In 2 patients with elevated basal TSH levels (0.23 and 0.60 mU/l, resp.) in the IRMAclon, total suppression of TSH secretion was suggested by a failure of TSH to rise after TRH. By retesting these samples in an own TSH IRMA, basal and stimulated TSH values were below 0.1 mU/l. In conclusion, basal and TRH-stimulated TSH levels are well correlated in most patients with thyroid cancer under hormonal treatment. However, in some cases (5/72) determination of basal TSH could not clearly define the degree of thyrotropic suppression. Thus, TRH testing is still necessary to establish definitely complete TSH suppression in patients with thyroid carcinoma under suppressive treatment.

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Outcome of differentiated thyroid cancer after initial treatment

Orvosi Hetilap ◽

10.1556/oh.2011.29227 ◽

2011 ◽

Vol 152 (43) ◽

pp. 1731-1738 ◽

Cited By ~ 1

Author(s):

András Konrády ◽

Zsuzsa Bencsik ◽

Zoltán Lőcsey ◽

Tamás Bénik

Keyword(s):

Thyroid Cancer ◽

Initial Treatment ◽

Differentiated Thyroid Cancer ◽

First Year ◽

Thyroid Hormone Withdrawal ◽

Radioiodine Ablation ◽

Thyroglobulin Antibody ◽

Ablation Success ◽

Recombinant Human Thyrotropin

Incidence of differentiated thyroid cancer has increased in the last two decades. This type of cancer is now being diagnosed at an earlier stage. Treatment strategy has been modified. Aims: The goals of this study were to analyze the outcome of differentiated thyroid cancer after initial treatment (surgery and radioiodine ablation) in patients evaluated and followed up in a single centre between l999 and 2009, to compare these results with others as well as to monitor the adoption of international recommendation. 107 patients having T1-T2 differentiated thyroid cancer were studied. Mean follow-up time was 63 months. Results: After surgery patients were prepared using thyroid hormone withdrawal or recombinant human thyrotropin, then 1.1-3.7 GBq 131-iodine was administered. First year evaluation consisted of ultrasound as well as serum thyrotropin and thyroglobulin (plus thyroglobulin antibody) determinations. Ablation success rate was 83% and the five year survival was 100%. There was not any cancer specific death. Conclusion: In the future somewhat more radical surgery and less remnant ablation is needed with unified follow-up protocol. Orv. Hetil., 2011, 152, 1731–1738.

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