Document Detail

Unstimulated high sensitive thyroglobulin measurement predicts outcome of differentiated thyroid carcinoma.
MedLine Citation:
PMID:  19589104     Owner:  NLM     Status:  MEDLINE    
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.
Luca Giovanella; Marco Maffioli; Luca Ceriani; Diego De Palma; Giuseppe Spriano
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical chemistry and laboratory medicine : CCLM / FESCC     Volume:  47     ISSN:  1434-6621     ISO Abbreviation:  Clin. Chem. Lab. Med.     Publication Date:  2009  
Date Detail:
Created Date:  2009-07-31     Completed Date:  2009-10-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9806306     Medline TA:  Clin Chem Lab Med     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1001-4     Citation Subset:  IM    
Department of Nuclear Medicine, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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MeSH Terms
Carcinoma / blood*,  radiotherapy,  surgery
Immunoradiometric Assay
Middle Aged
Neoplasm Recurrence, Local / blood,  diagnosis*
Prospective Studies
Thyroglobulin / blood*
Thyroid Neoplasms / blood*,  radiotherapy,  surgery
Thyrotropin / administration & dosage
Thyroxine / therapeutic use
Reg. No./Substance:
7488-70-2/Thyroxine; 9002-71-5/Thyrotropin; 9010-34-8/Thyroglobulin

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