Serum thyroglobulin level in newly detected thyrotoxicosis and its role in differential diagnosis of thyrotoxicosis

Background: Elevated serum thyroglobulin (Tg) level is commonly observed in various forms of thyrotoxicosis; the levels vary according to different etiologies. This study aimed at identifying the value of serum Tg level in the differential diagnosis of common etiologies of thyrotoxicosis. Methods: This cross-sectional study was conducted at the endocrine outpatient department of a tertiary hospital in Bangladesh from March 2015 to May 2017. In this study, 200 subjects with newly detected untreated thyrotoxicosis were evaluated. Serum Tg was assayed by chemiluminescent immunometric assay. Results: Serum Tg level was raised in 48% of subjects. Subjects aged ≥40 years, and those having a family history of thyroid disorders had relatively higher thyroglobulin levels. The frequency of subjects with an elevated Tg was highest in subacute thyroiditis (89.5%) followed by toxic nodular goiter (77.3%) and Graves’ disease (32.9%); the difference in the frequencies was statistically significant (p<0.001). Median Tg was highest in the subjects with subacute thyroiditis (132.6 ng/ml) followed by toxic nodular goiter (99.55 ng/ml); those with Graves’ disease had the lowest Tg level (12.5 ng/ml); the differences in median Tg levels across the three groups were also statistically significant (p<0.001). Conclusions: Serum thyroglobulin level may be useful for the etiological diagnosis of thyrotoxicosis.

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Differential Diagnosis

Diagnosing and Managing Hashimoto’s Disease - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-5225-9655-4.ch012 ◽

2020 ◽

pp. 180-184

Keyword(s):

Differential Diagnosis ◽

Nodular Goiter ◽

Subacute Thyroiditis ◽

Graves Disease ◽

Polyglandular Autoimmune Syndrome ◽

Euthyroid Sick Syndrome ◽

Toxic Nodular Goiter ◽

Cytological Features ◽

Toxic Goiter ◽

Biochemical Imaging

Diseases that should be considered in the differential diagnosis of Hashimoto's thyroiditis (HT) include subacute thyroiditis and Reidle's thyroiditis, Graves' disease, euthyroid sick syndrome, goiter, hypopituitarism, lithium-induced goiter, simple (non-toxic) goiter, thyroid lymphoma, toxic nodular goiter, and types I and II polyglandular autoimmune syndrome. The characteristic diagnostic clinical, biochemical, imaging (sonographic), and histological/cytological features of HT will help make a differential diagnosis. This chapter explores the differential diagnosis of Hashimoto's disease.

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Elevated Serum Thyroglobulin and Low Iodine Intake Are Associated with Nontoxic Nodular Goiter among Adults Living near the Eastern Mediterranean Coast

Journal of Thyroid Research ◽

10.1155/2014/913672 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Yaniv S. Ovadia ◽

Dov Gefel ◽

Svetlana Turkot ◽

Dorit Aharoni ◽

Shlomo Fytlovich ◽

...

Keyword(s):

Eastern Mediterranean ◽

Medical Center ◽

Elevated Serum ◽

Nodular Goiter ◽

Cross Sectional Study ◽

Iodine Intake ◽

Mediterranean Coast ◽

Thyroid Diseases ◽

Serum Thyroglobulin ◽

Cross Sectional

Background.Information about iodine intake is crucial for preventing thyroid diseases. Inadequate iodine intake can lead to thyroid diseases, including nontoxic nodular goiter (NNG).Objective.To estimate iodine intake and explore its correlation with thyroid diseases among Israeli adults living near the Mediterranean coast, where iodine-depleted desalinated water has become a major source of drinking water.Methods.Cross-sectional study of patients attending Barzilai Medical Center Ashkelon. Participants, who were classified as either NNG (n=17), hypothyroidism (n=14), or control (n=31), provided serum thyroglobulin (Tg) and completed a semiquantitative iodine food frequency questionnaire.Results.Elevated serum Tg values (Tg > 60 ng/mL) were significantly more prevalent in the NNG group than in the other groups (29% versus 7% and 0% for hypothyroidism and controls, resp.,P<0.05). Mean estimated iodine intake was significantly lower in the NNG group (65±30 μg/d) than in controls (115±60 μg/d) (P<0.05) with intermediate intake in the hypothyroid group (73±38 μg/d).Conclusions.Elevated serum Tg values and low dietary iodine intake are associated with NNG among adult patients in Ashkelon District, Israel. Larger studies are needed in order to expand on these important initial findings.

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Prediction of relapse in drug-treated Graves' disease using thyroid stimulation indices

Acta Endocrinologica ◽

10.1530/acta.0.1250643 ◽

1991 ◽

Vol 125 (6) ◽

pp. 643-650 ◽

Cited By ~ 17

Author(s):

Hiroshi Ikenoue ◽

Ken Okamura ◽

Kaori Sato ◽

Takeo Kuroda ◽

Mototaka Yoshinari ◽

...

Keyword(s):

Elevated Serum ◽

Late Relapse ◽

Antithyroid Drugs ◽

Graves Disease ◽

Serum Thyroglobulin ◽

Early Relapse ◽

Thyroglobulin Level ◽

Permanent Remission ◽

Radioactive Iodine Uptake ◽

Prediction Of Relapse

Abstract. Thyroid stimulation indices such as high thyroidal radioactive iodine uptake, increased estimated thyroid weight, presence of TSH-binding inhibitor immunoglobulin or thyroid-stimulating antibody, and elevated serum thyroglobulin level, were evaluated in 148 patients with Graves' disease who had been treated with antithyroid drugs for two years or more before the drugs were withdrawn. In all 19 patients in whom three or more indices were positive, early relapse, within 12 months, occurred after reducing the dosage of antithyroid drugs. Other 129 patients were followed after the drug was withdrawn and in 77 patients with one or two positive indices, early relapse occurred in 65-71% and late relapse, after 12 months or later, occurred in 2-11%. In 52 patients in whom none of the indices were positive, 86% remained in remission, but 10% developed an early relapse, and 4% a late relapse. We conclude that a combined analysis of thyroid stimulation indices is useful in predicting relapse in Graves' disease whereas it remains difficult to predict permanent remission.

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Hypothyroidism and Thyrotoxicosis

10.2310/fm.1229 ◽

2019 ◽

Author(s):

Paul W. Ladenson

Keyword(s):

Thyroid Tissue ◽

Elevated Serum ◽

Nodular Goiter ◽

Thyroid Stimulating Hormone ◽

Graves Disease ◽

Thyroid Function Tests ◽

Toxic Nodular Goiter ◽

Total Thyroxine ◽

Characteristic Features ◽

Toxic Goiter

Thyroid disorders are the most common endocrine conditions encountered in clinical practice and can range from clinically obvious to clinically silent. This review provides the definition and epidemiology of the conditions of hypothyroidism and hyperthyroidism. Hypothyroidism can be congenital or acquired, and its pathogenesis, diagnosis, and management are presented. The three most common disorders of thyrotoxicosis (diffuse toxic goiter [Graves disease], toxic nodular goiter, and iatrogenic thyrotoxicosis in thyroid hormone–treated patients are addressed, as well as the many diseases in each of these categories. This review also discusses thyroiditis, goiter, thyroid nodules, and thyroid cancer. Tables list the causes of elevated serum thyroid-stimulating hormone (TSH) levels, the etiologic classification of thyrotoxicosis, characteristic features of thyroiditis, and causes of elevated serum total thyroxine levels. Figures show the prevalence of abnormalities in thyroid function tests in different populations, certain forms of hyperthyroidism that result from pathophysiologic activation of the TSH receptor, and inflammation of thyroid tissue in acute thyroiditis. This review contains 3 figures, 12 tables, and 61 references. Key Words: Hypothyroidism, Thyrotoxicosis, Thyrotropin, celiac disease, vitiligo, pernicious anemia, Sjögren syndrome, Graves disease, Munchausen syndrome

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Is 99mTechnetium Pertechnetate Thyroid Uptake accurate in Thyrotoxicosis Evaluation?

10.21203/rs.3.rs-34343/v1 ◽

2020 ◽

Author(s):

kusai al-muqbel ◽

Reema Tashtoush ◽

Fadia Mayyas ◽

Wael Marashdeh ◽

Amr Tashtoush ◽

...

Keyword(s):

Predictive Value ◽

Nodular Goiter ◽

Subacute Thyroiditis ◽

Graves Disease ◽

Radioiodine Uptake ◽

Toxic Nodular Goiter ◽

Thyroid Uptake ◽

Normal Mean ◽

Uptake Test ◽

Hyperthyroid Patients

Abstract BackgroundThis study aimed to evaluate the 99mTc thyroid uptake (TcTU) in terms of (1) normal mean and range, (2) level of uncertainty in thyrotoxic patients and (3) effectiveness of adding radioiodine uptake in patients with uncertain TcTU values.MethodsPatients referred for TcTU test were included and categorized into groups: euthyroid, Graves’ disease, toxic nodular goiter and subacute thyroiditis. Mean and range of TcTU were obtained separately for each group. Second radioiodine uptake test was performed in patients who had uncertain TcTU (overlap with normal range). Results209 patients were included (54 euthyroid, 112 Graves’ disease, 29 toxic nodules and 17 subacute thyroiditis patients). Normal mean and range of TcTU were 1.5 +/- 1.1% and 0.17-4.8%, respectively. Mean TcTU was high in hyperthyroid patients and was extremely low in subacute thyroiditis patients, however, uncertain values was noted in about 30% of the patients. TcTU was uncertain in 39 hyperthyroid patients and in 10 subacute thyroiditis patients, while second radioiodine uptake was high in the former and extremely low in the latter.Test sensitivity was 68%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 52% and accuracy was 76%. ConclusionTcTU major disadvantage is the uncertainty seen in third of patients degrading test sensitivity and accuracy. We managed to overcome this uncertainty by adding second radioiodine thyroid uptake test. Accordingly, single visit TcTU was accurate and sufficient in about two thirds of patients while the remainder required second radioiodine uptake to reach accurate diagnosis.

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Hypothyroidism and Thyrotoxicosis

10.2310/im.1229 ◽

2019 ◽

Author(s):

Paul W. Ladenson

Keyword(s):

Thyroid Tissue ◽

Elevated Serum ◽

Nodular Goiter ◽

Thyroid Stimulating Hormone ◽

Graves Disease ◽

Thyroid Function Tests ◽

Toxic Nodular Goiter ◽

Total Thyroxine ◽

Characteristic Features ◽

Toxic Goiter

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Impact of the serum thyroglobulin concentration on the diagnostics of benign and malignant thyroid diseases

Nuklearmedizin ◽

10.1055/s-0038-1632259 ◽

2000 ◽

Vol 39 (05) ◽

pp. 133-138 ◽

Cited By ~ 4

Author(s):

W. Dembowski ◽

H.-J. Schroth ◽

K. Klinger ◽

Th. Rink

Keyword(s):

Hashimoto’S Thyroiditis ◽

Thyroid Volume ◽

Nodular Goiter ◽

Thyroid Diseases ◽

Hashimoto's Thyroiditis ◽

Graves Disease ◽

Normal Range ◽

Serum Thyroglobulin ◽

Diffuse Goiter ◽

Hyperthyroid Patients

Summary Aim of this study is to evaluate new and controversially discussed indications for determining the thyroglobulin (Tg) level in different thyroid diseases to support routine diagnostics. Methods: The following groups were included: 250 healthy subjects without goiter, 50 persons with diffuse goiter, 161 patients with multinodular goiter devoid of functional disorder (108 of them underwent surgery, in 17 cases carcinomas were detected), 60 hyperthyroid patients with autonomously functioning nodular goiter, 150 patients with Hashimoto’s thyroiditis and 30 hyperthyroid patients with Graves’ disease. Results: The upper limit of the normal range of the Tg level was calculated as 30 ng Tg/ml. The evaluation of the collective with diffuse goiter showed that the figure of the Tg level can be expected in a similar magnitude as the thyroid volume in milliliters. Nodular tissue led to far higher Tg values then presumed when considering the respective thyroid volume, with a rather high variance. A formula for a rough prediction of the Tg levels in nodular goiters is described. In ten out of 17 cases with thyroid carcinoma, the Tg was lower than estimated with thyroid and nodular volumes, but two patients showed a Tg exceeding 1000 ng/ml. The collective with functional autonomy had a significantly higher average Tg level than a matched euthyroid group being under suppressive levothyroxine substitution. However, due to the high variance of the Tg values, the autonomy could not consistently be predicted with the Tg level in individual cases. The patients with Hashimoto’s thyroiditis showed slightly decreased Tg levels. In Graves’ disease, a significantly higher average Tg level was observed compared with a matched group with diffuse goiter, but 47% of all Tg values were still in the normal range (< 30 ng/ml). Conclusion: Elevated Tg levels indicate a high probability of thyroid diseases, such as malignancy, autonomy or Graves’ disease. However, as low Tg concentrations cannot exclude the respective disorder, a routine Tg determination seems not to be justified in benign thyroid diseases.

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The outcome of radioiodine therapy of hyperthyroidism: comparison of patients with a toxic nodular goiter and with Graves' disease

Annales UMCS Medicina ◽

10.2478/v10079-008-0053-8 ◽

2008 ◽

Vol 63 (2) ◽

pp. 74-78

Author(s):

Jolanta Kijek ◽

Jerzy S. Tarach ◽

Maria Kurowska ◽

Bożena Szymanek

Keyword(s):

Radioiodine Therapy ◽

Nodular Goiter ◽

Graves Disease ◽

Toxic Nodular Goiter

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Elevated Serum Thyroglobulin Level in Congenital Thyroxine-Binding Globulin Deficiency*

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem-57-3-665 ◽

1983 ◽

Vol 57 (3) ◽

pp. 665-667 ◽

Cited By ~ 4

Author(s):

DAVID SARNE ◽

KIMBERLY BAROKAS ◽

NEAL H. SCHERBERG ◽

REFETOFF REFETOFF

Keyword(s):

Elevated Serum ◽

Serum Thyroglobulin ◽

Thyroxine Binding Globulin ◽

Thyroglobulin Level

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Radioiodine Treatment of Hyperthyroidism—Prognostic Factors for Outcome

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.86.8.7781 ◽

2001 ◽

Vol 86 (8) ◽

pp. 3611-3617 ◽

Cited By ~ 2

Author(s):

Amit Allahabadia ◽

Jacquie Daykin ◽

Michael C. Sheppard ◽

Stephen C. L. Gough ◽

Jayne A. Franklyn

Keyword(s):

Single Dose ◽

Prognostic Factors ◽

Nodular Goiter ◽

Fixed Dose ◽

Graves Disease ◽

Cure Rate ◽

Toxic Nodular Goiter ◽

Large Size ◽

Lower Cure Rate ◽

Lower Cure

There is little consensus regarding the most appropriate dose regimen for radioiodine (131I) in the treatment of hyperthyroidism. We audited 813 consecutive hyperthyroid patients treated with radioiodine to compare the efficacy of 2 fixed-dose regimens used within our center (185 megabequerels, 370 megabequerels) and to explore factors that may predict outcome. Patients were categorized into 3 diagnostic groups: Graves’ disease, toxic nodular goiter, and hyperthyroidism of indeterminate etiology. Cure after a single dose of 131I was investigated and defined as euthyroid off all treatment for 6 months or T4 replacement for biochemical hypothyroidism in all groups. As expected, patients given a single dose of 370 megabequerels had a higher cure rate than those given 185 megabequerels, (84.6% vs. 66.6%, P < 0.0001) but an increase in hypothyroidism incidence at 1 yr (60.8% vs. 41.3%, P < 0.0001). There was no difference in cure rate between the groups with Graves’ disease and those with toxic nodular goiter (69.5% vs. 71.4%; P, not significant), but Graves’ patients had a higher incidence of hypothyroidism (54.5% vs. 31.7%, P< 0.0001). Males had a lower cure rate than females (67.6% vs. 76.7%, P = 0.02), whereas younger patients (<40 yr) had a lower cure rate than patients over 40 yr old (68.9% vs. 79.3%, P < 0.001). Patients with more severe hyperthyroidism (P < 0.0001) and with goiters of medium or large size (P < 0.0001) were less likely to be cured after a single dose of 131I. The use of antithyroid drugs, during a period 2 wk before or after 131I, resulted in a significant reduction in cure rate in patients given 185 megabequerels 131I (P < 0.01) but not 370 megabequerels. Logistic regression analysis showed dose, gender, goiters of medium or large size, and severity of hyperthyroidism to be significant independent prognostic factors for cure after a single dose of 131I. We have demonstrated that a single fixed dose of 370 megabequerels 131I is highly effective in curing toxic nodular hyperthyroidism as well as Graves’ hyperthyroidism. Because male patients and those with more severe hyperthyroidism and medium or large-sized goiters are less likely to respond to a single dose of radioiodine, we suggest that the value of higher fixed initial doses of radioiodine should be evaluated in these patient categories with lower cure rates.

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