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Horm Metab Res 2013; 45(09): 664-668
DOI: 10.1055/s-0033-1345185
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

High Sensitive Thyroglobulin Assay on Thyroxine Therapy: Can it Avoid Stimulation Test in Low and High Risk Differentiated Thyroid Carcinoma Patients?

P. Trimboli
1   Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy
,
D. La Torre
1   Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy
,
L. Ceriani
2   Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
,
E. Condorelli
1   Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy
,
O. Laurenti
1   Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy
,
F. Romanelli
3   Department of Experimental Medicine, Sapienza University, Rome, Italy
,
C. Ventura
1   Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy
,
A. Signore
4   Nuclear Medicine Unit, Department of Medical-Surgical and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
,
S. Valabrega
5   Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy
,
L. Giovanella
2   Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
› Author Affiliations
Further Information

Publication History

received 06 December 2012

accepted 22 April 2013

Publication Date:
29 May 2013 (online)

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Abstract

Thyroglobulin (Tg) is a key marker in the follow-up of differentiated thyroid cancer (DTC). Diagnostic accuracy of serum Tg is higher after TSH stimulation than during thyroxine treatment. However, some studies suggest that TSH stimulation could be not necessary in a large part of patients, if Tg is measured by high sensitive assay under replacement therapy. The aim of this study was to evaluate the need of Tg stimulation test in DTC followed-up by sensitive Tg assay. In a prospective multicenter explorative study, 68 low or high risk patients underwent Tg measurement on thyroxine (ON-LT4-Tg) and after LT4 withdrawal (OFF-LT4-Tg). Undetectable ON-LT4-Tg and OFF-LT4-Tg values (i. e.,<0.15 ng/ml) were found in 56/68 patients, all with negative imaging workup. Twelve subjects had skewed OFF-LT4-Tg: 8 cases had increased ON-LT4-Tg and local recurrence (n=6), distant metastasis (n=1), or benign thyroglossal duct (n=1); the remaining 4 patients had undetectable ON-T4-Tg but detectable OFF-LT4-Tg and neck metastasis was recorded in one of these. By ROC analysis, the most accurate cutoff for ON-LT4-Tg and OFF-LT4-Tg were set at 0.23 ng/ml and 0.70 ng/ml, respectively. A positive ON-LT4-Tg value accurately predicts a positive stimulation test and confers an Odds Ratio of 464 (95% CI from 26.3 to 8 173.2, p<0.0001) to have persistent/recurrent disease. This study shows that DTC patients with ON-LT4-Tg below 0.23 ng/ml by our high sensitive assay should be considered disease free and they can avoid Tg stimulation test. High sensitive Tg assays should be used to better manage DTC patients.

Key words

thyroid carcinoma - thyroglobulin - ultrasound - whole body scan
 

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