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Giovanella L, D'Aurizio F, Algeciras-Schimnich A, Görges R, Petranovic Ovcaricek P, Tuttle RM, Visser WE, Verburg FA. Thyroglobulin and thyroglobulin antibody: an updated clinical and laboratory expert consensus. Eur J Endocrinol 2023; 189:R11-R27. [PMID: 37625447 DOI: 10.1093/ejendo/lvad109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/12/2023] [Accepted: 05/31/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Thyroglobulin measurement is the cornerstone of modern management of differentiated thyroid cancer, with clinical decisions on treatment and follow-up based on the results of such measurements. However, numerous factors need to be considered regarding measurement with and interpretation of thyroglobulin assay results. DESIGN The present document provides an integrated update to the 2013 and 2014 separate clinical position papers of our group on these issues. METHODS Issues concerning analytical and clinical aspects of highly-sensitive thyroglobulin measurement will be reviewed and discussed based on an extensive analysis of the available literature. RESULTS Thyroglobulin measurement remains a highly complex process with many pitfalls and major sources of interference, especially anti-thyroglobulin antibodies, need to be assessed, considered and, when necessary, dealt with appropriately. CONCLUSIONS Our expert consensus group formulated 53 practical, graded recommendations for guidance on highly-sensitive thyroglobulin and TgAb in laboratory and clinical practice, especially valuable where current guidelines do not offer sufficient guidance.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Federica D'Aurizio
- Institute of Clinical Pathology, Department of Laboratory Medicine, University Hospital of Udine, Udine, Italy
| | | | - Rainer Görges
- Department of Nuclear Medicine, University Hospital of Essen, Essen, Germany
| | - Petra Petranovic Ovcaricek
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - W Edward Visser
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Angelopoulos N, Paparodis RD, Androulakis I, Anagnostis P, Boniakos A, Duntas L, Karras SN, Livadas S. The clinical significance of low dose biotin supplements (<300μg/day) in the treatment of patients with hypothyroidism: crucial or overestimated? Thyroid Res 2023; 16:18. [PMID: 37455308 DOI: 10.1186/s13044-023-00162-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/07/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND In the last decade, the combination of the widespread use of streptavidin-biotin technology and biotin-containing supplements (BCS) in the daily clinical practice, have led to numerous reports of erroneous hormone immunoassay results. However, there are no studies assessing the clinical and biochemical significance of that phenomenon, when treating patients with hypothyroidism. Therefore, a prospective study was designed to investigate the potential alterations in the measurement of thyroid hormone concentrations and clinical consequences in patients with hypothyroidism using low -dose BCS containing less than 300 μg/day. METHODS Fifty-seven patients on thyroxine supplementation, as a result of hypothyroidism and concurrent use of BCS at a dose <300μg/day for 10 to 60 days were prospectively evaluated. Namely, TSH and free T4 (FT4) concentration measurements were performed, during BC supplementation and 10 days post BCS discontinuation and compared to 31 age-matched patients with supplemented hypothyroidism and without BCS. RESULTS A statistically significant increase in TSH and decline in FT4 concentrations was observed after BCS discontinuation. However, on clinical grounds, these modifications were minor and led to medication dose adjustment in only 2/57 patients (3.51%) in whom TSH was notably decreased after supplement discontinuation. CONCLUSION Our study suggests that changes in thyroid hormones profiling, due to supplements containing low dose biotin, are of minimal clinical relevance and in most cases don't occult the need to adjust the thyroxine replacement dose in patients with hypothyroidism. Larger, well-designed trials are required to further evaluate this phenomenon.
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Affiliation(s)
- Nicholas Angelopoulos
- Endocrine Unit, Athens Medical Centre, Athens, Greece.
- Private Practice, 26G Venizelou St, 65302, Kavala, Greece.
| | - Rodis D Paparodis
- Center for Diabetes and Endocrine Research, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Private Practice, Patras, Greece
| | | | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1St Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Leonidas Duntas
- Unit of Endocrinology, Diabetes and Metabolism, Evgenideion Hospital, University of Athens, 11528, Athens, Greece
| | - Spyridon N Karras
- Laboratory of Biological Chemistry, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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van Kinschot CMJ, Peeters RP, van den Berg SAA, Verburg FA, van Noord C, van Ginhoven TM, Visser WE. Thyroglobulin and thyroglobulin antibodies: assay-dependent management consequences in patients with differentiated thyroid carcinoma. Clin Chem Lab Med 2022; 60:756-765. [PMID: 35108464 DOI: 10.1515/cclm-2021-1046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES International guidelines recommend fixed cut-off values for thyroglobulin (Tg). These cut-offs do not take potential assay differences into account. This study aimed to evaluate if different assays for Tg and Tg antibodies (TgAb) affect management guidance for differentiated thyroid cancer (DTC) patients. METHODS In 793 samples derived from 413 patients with DTC, Tg and TgAb were simultaneously measured with two immunometric assays: Immulite 2000XPi and Kryptor compact plus. In addition, a qualitative measurement for TgAb interference (recovery test) was performed on the Kryptor compact plus platform. The extent to which different assays lead to different classifications of response to therapy was evaluated when applying the current cut-offs for Tg. RESULTS Mean Tg concentrations were 37.4% lower with Kryptor as compared with Immulite. Applying guideline based cut-off values for Tg, 33 (4.7%) samples had a Tg-on concentration ≥1.0 μg/L with Immulite and <1.0 μg/L with Kryptor. Of the samples tested as TgAb+ with at least one assay (n=125), 68 (54.4%) samples showed discrepancy in TgAb status. Differences between Immulite and Kryptor measurements resulted in a change in the response to therapy classification in 94 (12.0%) measurements derived from 67 (16.2%) individual patients. CONCLUSIONS A substantial portion of DTC patients were classified differently dependent on which Tg and TgAb assays are used, when applying the cut-off values as defined in clinical guidelines. Such differences can significantly affect clinical management. In the context of large between-method variation, the recommended Tg cut-offs in guidelines should be used with wisdom rather than as fixed cut-offs.
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Affiliation(s)
- Caroline M J van Kinschot
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sjoerd A A van den Berg
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frederik A Verburg
- Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Charlotte van Noord
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Tessa M van Ginhoven
- Academic Center for Thyroid Diseases, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - W Edward Visser
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Thyroglobulin and thyroid cancer. Cancer Biomark 2022. [DOI: 10.1016/b978-0-12-824302-2.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Broecker-Preuss M, Mehnert I, Gilman E, Herrmann K, Weber M, Görges R. Evaluation of a new automated assay for high-sensitivity thyroglobulin measurement and comparison with two established high-sensitivity thyroglobulin assays. Pract Lab Med 2021; 26:e00250. [PMID: 34386567 PMCID: PMC8342782 DOI: 10.1016/j.plabm.2021.e00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Thyroglobulin (Tg) is an important tumor marker for therapy control and follow-up of differentiated thyroid carcinoma (DTC). Over the past decade, assays for highly sensitive Tg measurement have become increasingly established. We evaluated a newly developed high-sensitive Tg assay running on an automated platform (LIAISON® Tg II Gen assay, DiaSorin), with a limit of quantification of 0.10 ng/ml. Design and Methods Tg values of 166 sera from subjects without thyroid diseases and of more than 500 sera of well-defined DTC patients were determined with the new LIAISON® Tg II Gen assay and compared with two established assays (Elecsys® Tg II/Roche, and Medizym® Tg REM/Medipan). Results Tg reference values from healthy subjects were up to 37.93 ng/ml (women) resp. 24.59 ng/ml (men) with the LIAISON® Tg II Gen assay. Tg values showed good correlations in healthy subjects and patients with active tumorous disease. In contrast, Tg values in the very low range from cured thyroidectomized patients were poorly comparable between the three assays, while clinical differences between the cohorts were correctly reflected by all assays. Conclusions With the new LIAISON® Tg II Gen assay, another automated assay standardized against the first International Reference Preparation CRM-457 for highly sensitive measurement of Tg values is available.
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Affiliation(s)
- Martina Broecker-Preuss
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital of Essen, Germany
| | - Irina Mehnert
- Department of Nuclear Medicine, University Hospital of Essen, Germany
| | - Elena Gilman
- Gilman Biometrics, Consultant for Data Processing and Statistics, Köln, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital of Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital of Essen, Germany
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital of Essen, Germany
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Fan L, Tian Q, Xiu C, Wang F, Yuan Z, He Q, Guo L, Sun Q, Yang X, Miao S, Sun J, Sun D. High Iodine Nutrition May Be a Risk Factor for Cervical Lymph Node Metastasis in Papillary Thyroid Cancer Patients. ANNALS OF NUTRITION AND METABOLISM 2021; 77:90-99. [PMID: 34289482 DOI: 10.1159/000513334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to retrospectively identify the effect of iodine on the papillary thyroid cancer (PTC) process and investigate the risk clinicopathologic characteristics of cervical lymph node metastasis (CLNM) for achieving a better preventive strategy of PTC. METHODS Totally 187 patients with CLNM and 279 without CLNM (NCLNM) were enrolled, and their urinary iodine concentration (UIC) and serum iodine concentration (SIC) were measured. Logistic regressions were used to reveal the effects of iodine nutrition on the CLNM status of PTC. RESULTS The levels of thyroid-stimulating hormone (TSH) and thyroglobulin (TG) were higher in the CLNM group than in the NCLNM group. UIC and SIC were positively correlated, and both of them were correlated with TSH, free thyroxine, and TG. The proportions of UIC >300 μg/L and of SIC >90 μg/L were higher in the CLNM than in the NCLNM. Logistic analysis showed that SIC >90 μg/L was an independent predictor for CLNM in PTC. Additionally, age ≥45, female, TG, multifocality, and diameter of cancer invasion >1 cm also affected CLNM status in PTC, and their logistic regression model showed a certain diagnostic accuracy (area under the receiver-operating characteristic curve = 0.72). CONCLUSIONS Relatively high iodine nutrition seemed to be a significant risk factor for the occurrence of CLNM in PTC and may promote lymphatic metastasis in PTC.
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Affiliation(s)
- Lijun Fan
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Qiushi Tian
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Cheng Xiu
- Department of Head and Neck Oncology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fengqian Wang
- Public Health College, Harbin Medical University, Harbin, China
| | - Zhennan Yuan
- Department of Head and Neck Oncology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qian He
- Shandong First Medical University, Tai'an, China
| | - Lunhua Guo
- Department of Head and Neck Oncology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qihao Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Xianguang Yang
- Department of Head and Neck Oncology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Susheng Miao
- Department of Head and Neck Oncology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ji Sun
- Department of Head and Neck Oncology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dianjun Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
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BÍLEK R, DVOŘÁKOVÁ M, GRIMMICHOVÁ T, JISKRA J. Iodine, Thyroglobulin and Thyroid Gland. Physiol Res 2020; 69:S225-S236. [DOI: 10.33549/physiolres.934514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Iodine is essential in the biosynthesis of thyroid hormones that affect metabolic processes in the organism from the prenatal state to the elderly. The immediate indicator of iodine intake is the concentration of iodine in urine, but the indicator of iodine intake in the longer term of several months is thyroglobulin (Tg). Tg negatively correlated with increasing intake of iodine in population that do not suffer from thyroid disease, while a more than adequate to excessive iodine intake leads to an increase in Tg. The dependence of Tg on iodine can be described by a U-shaped curve. Thyroglobulin in serum is elevated in thyroid disease mainly in hyperthyroidism (diagnosis E05 of WHO ICD-10 codes) and in goiter (diagnosis E04 of WHO ICD-10 codes). Tg values decrease below 20 µg/l after effective treatment of patients with thyroid disease. Thyroglobulin may thus be an indicator of thyroid stabilization and the success of the thyroid gland treatment.
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Affiliation(s)
- R. BÍLEK
- Institute of Endocrinology, Prague, Czech Republic
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Falsely decreased thyroglobulin levels in a patient with differentiated thyroid carcinoma. Clin Chim Acta 2020; 509:217-219. [DOI: 10.1016/j.cca.2020.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/31/2020] [Accepted: 06/15/2020] [Indexed: 01/01/2023]
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Determination of thyroglobulin levels by radioimmunoassay method in anti thyroglobulin positive differentiated thyroid patients: One center clinical experience. Appl Radiat Isot 2020; 166:109400. [PMID: 32956923 DOI: 10.1016/j.apradiso.2020.109400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Abstract
It is very crucial to determine Tg accurately and precisely in thyroid cancer cases. Although there are many studies on the detection of Tg in thyroid cases in the literature, there are no sufficient clinical studies examining many cases with different features by using RIA methodology. Here, a radiometric and chromatographic method has been studied for the first time to eliminate the interference from anti-Tg positive patients. In this paper, radioimmunoassay (RIA) and immunoradiometric (IRMA) techniques were used for the analysis of 302 sera collected from patients for Tg and TgAb quantification. By the RIA technique, a reliable result was obtained by calculating the real Tg value quantitatively in 41 patients showing TgAb positivity out of 208 patients. Our findings show that the RIA assay is the most suitable approach for detection of changeable (low or undetectable) Tg value and metastases detected by post-therapeutic imaging in early-stage DTC cases showing preoperative and postoperative TgAb positivity. The new immunoradiometric method allows the real (%) Tg value to be reached in a part of TgAb-positive DTC. Even if TgAb positive in the metastatic and nonmetastatic DTC patient group. This allows the accurate clinical follow-up of patients.
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Santos-Silva R, Rosário M, Grangeia A, Costa C, Castro-Correia C, Alonso I, Leão M, Fontoura M. Genetic analyses in a cohort of Portuguese pediatric patients with congenital hypothyroidism. J Pediatr Endocrinol Metab 2019; 32:1265-1273. [PMID: 31430255 DOI: 10.1515/jpem-2019-0047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/05/2019] [Indexed: 11/15/2022]
Abstract
Background Permanent primary congenital hypothyroidism (CH) can be caused by thyroid dysgenesis or dyshormonogenesis. A molecular genetic study is recommended in dyshormonogenesis, in syndromic hypothyroidism and when there is a family history of CH. The aim of this study was to identify a monogenic etiology for CH in selected individuals from a cohort of primary permanent CH. Methods From an initial cohort of 79 patients with permanent CH (3-19 years), 11 patients were selected for molecular analyses. Nine patients with dyshormonogenesis (normal in-situ gland or goiter) were screened for causative variants, by next-generation sequencing (NGS), in 28 genes known to be responsible for CH. One patient with a family history of CH was screened for the paired-box gene 8 (PAX8) gene and another patient with a syndromic CH was screened for the NKX2-1 gene. Results We found a monogenic basis of disease in eight patients, involving the thyroid peroxidase (TPO) gene (four patients), the thyroglobulin (TG) gene (two patients), and the PAX8 and NKX2-1 genes (one patient each). Two patients were heterozygotes, one harboring a variant in the TG gene and the other in the SLC5A5 gene. In one patient, we found no potential causative variants in any of the 28 genes screened. We described five novel variants: three in the TG gene, one in the NKX2-1 and one in the SLC5A5 gene, all of them classified as pathogenic. Conclusions In eight of the 11 screened patients, a monogenic disease was found. These results highlight the advantage of using an NGS panel and provide further data regarding the molecular basis of CH.
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Affiliation(s)
- Rita Santos-Silva
- Department of Pediatrics, Pediatric Endocrinology Unit, Centro Hospitalar S. João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Marta Rosário
- Department of Pediatrics, Centro Hospitalar S. João, Porto, Portugal
| | - Ana Grangeia
- Department of Medical Genetics, Centro Hospitalar de S. João, Porto, Portugal
| | - Carla Costa
- Department of Pediatrics, Pediatric Endocrinology Unit, Centro Hospitalar S. João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Cíntia Castro-Correia
- Department of Pediatrics, Pediatric Endocrinology Unit, Centro Hospitalar S. João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Isabel Alonso
- UnIGENe and CGPP/Units at i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Miguel Leão
- Department of Medical Genetics, Centro Hospitalar de S. João, Porto, Portugal
| | - Manuel Fontoura
- Department of Pediatrics, Pediatric Endocrinology Unit, Centro Hospitalar S. João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
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Song E, Ahn J, Oh HS, Jeon MJ, Kim WG, Kim WB, Shong YK, Baek JH, Lee JH, Ryu JS, Chung KW, Hong SJ, Kim TY. Time trends of thyroglobulin antibody in ablated papillary thyroid carcinoma patients: Can we predict the rate of negative conversion? Oral Oncol 2019; 91:29-34. [PMID: 30926059 DOI: 10.1016/j.oraloncology.2019.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/22/2019] [Accepted: 02/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Persistence of thyroglobulin antibody (TgAb) in patients with papillary thyroid carcinoma (PTC) years after total thyroidectomy (TT) followed by ablation occurs even without any evidence of structural disease. Few studies have studied the natural course of TgAb positivity and factors that may influence this course. The present study evaluated the time trends of TgAb in ablated PTC patients and aimed to identify the predictive factors for the rate of negative conversion of TgAb. MATERIALS AND METHODS Overall, 1279 patients who underwent TT and subsequent ablation for PTC, with available data on thyroid peroxidase Ab (TPOAb) and TgAb prior to surgery (preop-) and ablation (abl-) were enrolled. Patients with initial distant metastasis or recurrence during follow-up were excluded. RESULTS AND CONCLUSION Preop-TgAb was positive in 24.9% of patients (n = 319), whereas abl-TgAb positivity decreased to 12.8% (n = 164). In 164 patients positive for abl-TgAb, TgAb in patients with higher abl-TgAb levels decreased more gradually than those observed in patients with lower abl-TgAb levels (p < 0.001). Furthermore, in patients within the same range of abl-TgAb levels, patients positive for abl-TPOAb had a higher rate of negative conversion of TgAb compared with negative patients for abl-TPOAb (log rank p < 0.001). TPOAb significantly increased the rate of negative conversion in multivariate analysis adjusted for abl-TgAb (odds ratio 1.59, 95% confidence interval 1.11-2.28, p = 0.011). This study clearly showed that abl-TgAb titers and abl-TPOAb status can predict the rate of negative conversion. These findings can guide the optimal timing for additional examination in patients positive for TgAb during follow-up.
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Affiliation(s)
- Eyun Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jonghwa Ahn
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Hye-Seon Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Jeong Hyun Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Jin Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Ki Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
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Cheng X, Yu S, Jin C, Han S, Hu Y, Zhang K, Liu H, Qiu L. Comparison of three different assays for measuring thyroglobulin and thyroglobulin antibodies in patients with chronic lymphocytic thyroiditis. Clin Biochem 2017; 50:1183-1187. [DOI: 10.1016/j.clinbiochem.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/27/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
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Cho YY, Chun S, Lee SY, Chung JH, Park HD, Kim SW. Performance Evaluation of the Serum Thyroglobulin Assays With Immunochemiluminometric Assay and Immunoradiometric Assay for Differentiated Thyroid Cancer. Ann Lab Med 2017; 36:413-9. [PMID: 27374705 PMCID: PMC4940483 DOI: 10.3343/alm.2016.36.5.413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/04/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022] Open
Abstract
Background Measurement of postoperative serum thyroglobulin (Tg) is important for detecting persistent or recurrent differentiated thyroid cancer. We evaluated the analytic performance of the DxI 800 assay (Beckman Coulter, USA) for serum Tg and anti-thyroglobulin antibodies (TgAbs) in comparison with that of the GAMMA-10 assay (Shinjin Medics Inc., Korea) for serum Tg and RIA-MAT 280 assay (Stratec, Germany) for TgAb. Methods We prospectively collected blood samples from 99 patients thyroidectomized for thyroid cancer. The functional sensitivity was investigated in standards and human serum. Precision and linearity were evaluated according to the guidelines of the Clinical and Laboratory Standards Institute. The correlation between the two assays was assessed in samples with different Tg ranges. Results The functional sensitivity of the DxI 800 assay for serum Tg was between 0.0313 and 0.0625 ng/mL. The total CV was 3.9–5.6% for serum Tg and 5.3–6.9% for serum TgAb. The coefficient of determination (R2) was 1.0 and 0.99 for serum Tg and TgAb, respectively. The cut-offs for serum TgAb were 4.0 IU/mL (DxI 800) and 60.0 IU/mL (RIA-MAT 280), and the overall agreement was 68.7%. The correlation between the two assays was excellent; the correlation coefficient was 0.99 and 0.88 for serum Tg and TgAb, respectively. Conclusions The DxI 800 is a sensitive assay for serum Tg and TgAb, and the results correlated well with those from the immunoradiometric assays (IRMA). This assay has several advantages over the IRMA and could be considered an alternative test for Tg measurement.
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Affiliation(s)
- Yoon Young Cho
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sejong Chun
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Youn Lee
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Doo Park
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sun Wook Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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14
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Rössing RM, Jentzen W, Nagarajah J, Bockisch A, Görges R. Serum Thyroglobulin Doubling Time in Progressive Thyroid Cancer. Thyroid 2016; 26:1712-1718. [PMID: 27750024 DOI: 10.1089/thy.2016.0031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tumor marker doubling time (DT) has been proposed as a prognostic marker for various types of cancer. The present study analyzed the DT of the thyroid-specific tumor marker thyroglobulin (Tg), focusing on patients with progressive differentiated thyroid cancer (DTC). METHODS A total of 144 Tg courses of 99 patients with progressive or recurrent DTC were included (median observation period 19 months, 3-11 Tg measurements per course) in this retrospective study. The distribution of Tg-DT was determined for both a highly sensitive assay (functional working range 0.03-3 ng/mL) and a routine assay. Tg-DT and other prognostic markers were used to perform uni- and multivariate statistical analyses for survival predictors. RESULTS The median Tg-DT was 212 days (95% percentile: 49-961 days). No significant differences were observed between DT derived from Tg values in the very low range using a highly sensitive assay and DT calculated from Tg values measured by a conventional Tg assay. Multivariate analysis yielded no simple correlation between Tg-DT and survival rate, but the mortality risk of patients with a Tg-DT <5 months was more than twice as high as compared with a Tg-DT of >14 months. Highly significant differences on survival rates were only observed in patients with a high tumor load (Tg >100 ng/mL). CONCLUSIONS Tg-DT alone is not an independent survival predictor in all patients with progressive DTC; however, analyzing only patients with a high tumor load, we found highly significant differences in survival rates.
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Affiliation(s)
| | - Walter Jentzen
- 1 Klinik für Nuklearmedizin, Universitätsklinikum Essen , Essen, Germany
| | - James Nagarajah
- 2 Human Oncology and Pathogenesis Program, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center , New York, New York
| | - Andreas Bockisch
- 1 Klinik für Nuklearmedizin, Universitätsklinikum Essen , Essen, Germany
| | - Rainer Görges
- 1 Klinik für Nuklearmedizin, Universitätsklinikum Essen , Essen, Germany
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15
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Wang Z, Zhang H, Zhang X, Sun J, Han C, Li C, Li Y, Teng X, Fan C, Liu A, Shan Z, Liu C, Weng J, Teng W. Serum thyroglobulin reference intervals in regions with adequate and more than adequate iodine intake. Medicine (Baltimore) 2016; 95:e5273. [PMID: 27902589 PMCID: PMC5134814 DOI: 10.1097/md.0000000000005273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to establish normal thyroglobulin (Tg) reference intervals (RIs) in regions with adequate and more than adequate iodine intake according to the National Academy of Clinical Biochemistry (NACB) guidelines and to investigate the relationships between Tg and other factors.A total of 1317 thyroid disease-free adult subjects (578 men, 739 nonpregnant women) from 2 cities (Guangzhou and Nanjing) were enrolled in this retrospective, observational study. Each subject completed a questionnaire and underwent physical and ultrasonic examination. Serum Tg, thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), Tg antibody (TgAb), and urinary iodine concentration (UIC) were measured. Reference groups were established on the basis of TSH levels: 0.5 to 2.0 and 0.27 to 4.2 mIU/L.The Tg RIs for Guangzhou and Nanjing were 1.6 to 30.0 and 1.9 to 25.8 ng/mL, respectively. No significant differences in Tg were found between genders or among different reference groups. Stepwise linear regression analyses showed that TgAb, thyroid volume, goiter, gender, age, and TSH levels were correlated with Tg.In adults from regions with adequate and more than adequate iodine intake, we found that Tg may be a suitable marker of iodine status; gender-specific Tg RI was unnecessary; there was no difference between Tg RIs in regions with adequate and more than adequate iodine intake; and the TSH criterion for selecting the Tg reference population could follow the local TSH reference rather than 0.5 to 2.0 mIU/L.
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Affiliation(s)
- Zhaojun Wang
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Hanyi Zhang
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Xiaowen Zhang
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Jie Sun
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Cheng Han
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Chenyan Li
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Yongze Li
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Xiaochun Teng
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Chenling Fan
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Aihua Liu
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Zhongyan Shan
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
| | - Chao Liu
- Department of Endocrinology and Metabolism, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu
| | - Jianping Weng
- Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology and Metabolic Disease, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China
| | - Weiping Teng
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Liaoning
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16
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Kim M, Jeon MJ, Kim WG, Lee JJ, Ryu JS, Cho EJ, Ko DH, Lee W, Chun S, Min WK, Kim TY, Shong YK, Kim WB. Comparison of Thyroglobulin Measurements Using Three Different Immunoassay Kits: A BRAMHS Tg-Plus RIA Kit, a BRAMHS hTg Sensitive Kryptor Kit, and a Beckman Coulter ACCESS Immunoassay Kit. Endocrinol Metab (Seoul) 2016; 31:462-468. [PMID: 27491718 PMCID: PMC5053060 DOI: 10.3803/enm.2016.31.3.462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/09/2016] [Accepted: 07/05/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Second-generation thyroglobulin immunometric assays (Tg-IMAs) have been developed with improved sensitivity. Our aim was to compare the diagnostic value of Tg-IMA measurements using a Kryptor (BRAHMS AG) kit (Tg-K) and an ACCESS (Beckman Coulter) kit (Tg-A) with that of the first-generation Tg measurement using a Tg-plus (BRAHMS AG) kit (Tg+). METHODS We enrolled 82 differentiated thyroid cancer patients who underwent total thyroidectomy with radioactive iodine remnant ablation and who underwent diagnostic whole body scan using recombinant human thyroid stimulating hormone (rhTSH). The Tg+, Tg-K, and Tg-A were measured before rhTSH administration during levothyroxine treatment (suppressed Tg) from the same sample. Serum Tg+ was measured after rhTSH stimulation (stimulated Tg). RESULTS Suppressed Tg+ was more significantly correlated with suppressed Tg-K (R²=0.919, P<0.001) than with suppressed Tg-A (R²=0.536, P<0.001). The optimal cut-off values of suppressed Tg+, Tg-K, and Tg-A for predicting stimulated Tg+ of 1 ng/mL were 0.3, 0.2, and 0.2 ng/mL, respectively. The sensitivity, specificity, and accuracy of suppressed Tg+ were 67%, 100%, and 90%, respectively; those of suppressed Tg-K were 83%, 90%, and 88%; those of suppressed Tg-A were 96%, 82%, and 87%, respectively. The positive predictive and negative predictive values of Tg+ were 100% and 87%, respectively; those of Tg-K were 79% and 92%; and those of Tg-A were 73% and 98%. CONCLUSION We could not clearly demonstrate which kit had better diagnostic performance after comparison of first-generation Tg measurements with Tg-IMA measurements. Also, there were kit-to-kit variations between Tg-IMA kits. Suppressed Tg measured by Tg-IMA was insufficient to completely substitute for a stimulated Tg measurement.
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Affiliation(s)
- Mijin Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Jin Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jung Cho
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Hyun Ko
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woochang Lee
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sail Chun
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Ki Min
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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17
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The role of 18F-FDG PET/CT in the follow-up of well-differentiated thyroid cancer with negative thyroglobulin but positive and/or elevated antithyroglobulin antibody. Nucl Med Commun 2016; 37:577-82. [DOI: 10.1097/mnm.0000000000000480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Stinca S, Andersson M, Erhardt J, Zimmermann MB. Development and Validation of a New Low-Cost Enzyme-Linked Immunoassay for Serum and Dried Blood Spot Thyroglobulin. Thyroid 2015; 25:1297-305. [PMID: 26528830 DOI: 10.1089/thy.2015.0428] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thyroglobulin (Tg), a biomarker of iodine nutrition, can be measured on dried blood spots (DBS), which simplifies collection and transport in surveys. The World Health Organization recommends DBS-Tg for monitoring iodine status in children. It could also be a useful iodine biomarker during pregnancy. However, the Tg antibody (Ab) used in earlier DBS-Tg assays is no longer commercially available. The aims of the present study were: (i) to develop a new low-cost serum and DBS-Tg sandwich enzyme-linked immunosorbent assay for assessment of Tg in population studies; (ii) to check the stability of DBS-Tg during long-term storage; and (iii) to assess within-subject variability in DBS-Tg. METHODS Serum and DBS samples were measured from healthy pregnant women (n = 424) with the new assays, as well as the Immulite 2000 (Siemens), including TgAb positive (n = 150) and TgAb negative (n = 274) women. DBS-Tg stability was tested over 15 weeks of storage at -20 °C. Within-subject variability was evaluated over four weeks in four healthy adults. RESULTS Intra-assay and interassay variability was 4.4-7.3% and 10.1-12.9% for the new serum Tg assay, and 7.6-12.3% and 7.6-16.5% for the DBS-Tg assay. Correlation between the two serum methods was high (r = 0.68, p < 0.01). Assay performance in all women and those TgAb negative was comparable. Correlation between the new serum Tg assay and the DBS-Tg assay was high (r = 0.78, p < 0.01), and agreement expressed as a function of the average Tg concentration for the two methods (X) was 0.59X -4.59 μg/L. DBS-Tg was stable for 15 weeks stored at -20 °C. Within-subject variability in DBS-Tg was 21.1%. Reagents and antibodies costs for the new serum and DBS assays are ∼ US$1. CONCLUSIONS These new low-cost serum and DBS-Tg assays perform well over a wide range of Tg concentrations, and the field-friendly DBS assay may be particularly useful in population studies of iodine nutrition.
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Affiliation(s)
- Sara Stinca
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
| | - Jürgen Erhardt
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
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19
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BÍLEK R, ČEŘOVSKÁ J, ZAMRAZIL V. The Relationship Between Iodine Intake and Serum Thyroglobulin in the General Population. Physiol Res 2015; 64:345-53. [DOI: 10.33549/physiolres.932840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The relationship is shown between a concentration of urinary iodine and serum thyroglobulin in population studies carried out on a general population that was randomly selected from the registry of the General Health Insurance Company (individuals aged 6-98 years, 1751 males, 2420 females). The individuals were divided into subgroups with a urinary iodine concentration of <50, 50-99, 100-199, 200-299 and ≥300 μg/l. The mean and median of thyroglobulin were calculated in these subgroups. Tg concentrations were dependent on gender (males<females), age (thyroglobulin increased with age) and statistically significant negative relationship was observed between thyroglobulin and urinary iodine in individuals with urinary iodine <300 μg/l and the age under 65 years. Upper nonparametric tolerance limits of thyroglobulin in relation to iodine intake were calculated in subgroup of normal individuals (n=1858, thyroglobulin, urinary iodine, thyrotropin and free thyroxine were within the normal reference range). Upper limits were dependent on gender and age. The total value of upper limits is 44 μg/l; for individuals aged 6-17 years it is 39.1 μg/l; 18-65 years = 51.4 μg/l and 66-98 years = 60.6 μg/l. In general, thyroglobulin serum concentrations higher than 40 μg/l should be an indicator for determining urinary iodine.
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Affiliation(s)
- R. BÍLEK
- Institute of Endocrinology, Prague, Czech Republic
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20
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Thyroglobulin in differentiated thyroid cancer. Clin Chim Acta 2015; 444:310-7. [DOI: 10.1016/j.cca.2014.10.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/21/2014] [Accepted: 10/24/2014] [Indexed: 12/17/2022]
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21
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The role of FDG-PET/CT in differentiated thyroid cancer patients with negative iodine-131 whole-body scan and elevated anti-Tg level. Ann Nucl Med 2014; 28:970-9. [PMID: 25120245 DOI: 10.1007/s12149-014-0897-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022]
Abstract
AIM In the follow-up of differentiated thyroid cancer (DTC) after a successful total-near total thyroidectomy and I-131 ablation therapy, anti-thyroglobulin antibodies (anti-Tg) may be persistently or progressively increased in the patients with an undetectable serum thyroglobulin (Tg) level. In these cases, further investigation was performed to search for recurrence/metastases. The aim of our study was clarifying the role of FDG-PET/CT in detecting recurrence/metastasis in patients with DTC with negative serum Tg and elevated anti-Tg level. MATERIALS AND METHODS A total of 40 patients (32 female, 8 male; mean age: 43.15 years (22-65); mean age at diagnosis: 39.08 (16-64)) with DTC who had undetectable serum Tg and elevated anti-Tg level after a successful initial therapy were included in the study. All of the patients had serum anti-Tg of >40 IU/ml and underwent FDG-PET/CT to search for recurrence/metastasis. RESULTS Twenty patients (50 %) had recurrence/metastasis on FDG-PET/CT while the other 20 had no pathologic findings. Of the 20 patients who had positive FDG-PET/CT, 12 had a histopathological final diagnosis of which 11 were true positive (TP) and 1 was false positive (FP). On the other hand, 16 of the 40 patients had a histopathological final diagnosis of which 11/16 had TP, 1/16 FP, 3/16 false negative (FN) and 1/16 true negative (TN) findings by PET/CT. The final diagnosis was made by clinical follow-up in the remaining 24 patients. Of these, 8 patients were PET positive, and in 1 (12.5 %) of 8 patients a decrease in serum anti-Tg level, in 2 (25 %) patients a saw-toothed pattern and in 5 (62.5 %) a progressive increase in the serum anti-Tg level were noted during the follow-up. Of the 16 of 24 patients who were diagnosed by clinical follow-up, in 8 a (50 %) decrease in serum anti-Tg level, in 6 (37.5 %) a saw-toothed pattern, and in 2 (12.5 %) a progressively increased anti-Tg level was seen. Of the 40 patients, 14 (35 %) had a diagnosis of recurrence/metastasis finally, with PET/CT detecting 11 (78.6 %) of them. CONCLUSION The value of a persistently or progressively increased serum anti-Tg level in the follow-up of DTC in the prediction of recurrence/metastasis is controversial. However, it is reported that FDG-PET can be useful in the detection of recurrence/metastasis. We conclude from the available data that PET/CT can be effectively used in the detection of recurrence/metastasis in the follow-up of patients with DTC and negative serum Tg and a persistently/progressively increased anti-Tg level. Besides, one half of the patients were FDG negative, meaning that further studies are needed to assess the prognostic-clinical value of PET negativity.
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22
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Giovanella L, Clark PM, Chiovato L, Duntas L, Elisei R, Feldt-Rasmussen U, Leenhardt L, Luster M, Schalin-Jäntti C, Schott M, Seregni E, Rimmele H, Smit J, Verburg FA. Thyroglobulin measurement using highly sensitive assays in patients with differentiated thyroid cancer: a clinical position paper. Eur J Endocrinol 2014; 171:R33-46. [PMID: 24743400 PMCID: PMC4076114 DOI: 10.1530/eje-14-0148] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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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Affiliation(s)
- Luca Giovanella
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Penelope M Clark
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Luca Chiovato
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Leonidas Duntas
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Rossella Elisei
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Ulla Feldt-Rasmussen
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Laurence Leenhardt
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Markus Luster
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Camilla Schalin-Jäntti
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Matthias Schott
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Ettore Seregni
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Herald Rimmele
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Jan Smit
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Frederik A Verburg
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
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Abstract
BACKGROUND Thyroglobulin, produced exclusively by the thyroid gland, has been proposed to be a more sensitive biomarker of iodine status than thyrotropin or the thyroid hormones triiodothyronine and thyroxine. However, evidence on the usefulness of thyroglobulin (Tg) to assess iodine status has not been extensively reviewed, particularly in pregnant women and adults. SUMMARY An electronic literature search was conducted using the Cochrane CENTRAL, Web of Science, PubMed, and Medline to locate relevant studies on Tg as a biomarker of iodine status. Since urinary iodine concentration (UIC) is the recommended method to assess iodine status in populations, only studies that clearly reported both Tg and UIC were included. For the purpose of this review, a median Tg <13 μg/L and a median UIC ≥100 μg/L (UIC ≥150 μg/L for pregnant women) were used to indicate adequate iodine status. We excluded studies conducted in subjects with either known thyroid disease or those with thyroglobulin antibodies. The search strategy and selection criteria yielded 34 articles of which nine were intervention studies. The majority of studies (six of eight) reported that iodine-deficient pregnant women had a median Tg ≥13 μg/L. However, large observational studies of pregnant women, including women with adequate and inadequate iodine status, as well as well-designed intervention trials that include both Tg and UIC, are needed. In adults, the results were equivocal because iodine-deficient adults were reported to have median Tg values of either <13 or ≥13 μg/L. Only studies in school-aged children showed that iodine-sufficient children typically had a median Tg <13 μg/L. Some of the inconsistent results may be partially explained by the use of different methodological assays and failure to assess assay accuracy using a certified reference material. CONCLUSIONS These data suggest that Tg does hold promise as a biomarker of iodine deficiency. However, it is associated with limitations. A median Tg cutoff of 13 μg/L warrants further investigation, particularly in adults or pregnant women, as there is a lack of both observational and intervention studies in these groups.
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Affiliation(s)
- Zheng Feei Ma
- Department of Human Nutrition, University of Otago , Dunedin, New Zealand
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24
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Owen WE, Bunker AM, Straseski JA. Pediatric reference intervals for thyroglobulin using the Beckman Coulter Access 2 immunoassay. Clin Chim Acta 2014; 435:40-1. [PMID: 24780579 DOI: 10.1016/j.cca.2014.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 11/17/2022]
Affiliation(s)
- William E Owen
- ARUP Institute for Clinical & Experimental Pathology, Salt Lake City, UT, United States
| | - Ashley M Bunker
- ARUP Institute for Clinical & Experimental Pathology, Salt Lake City, UT, United States
| | - Joely A Straseski
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT, United States.
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25
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Spencer C, Fatemi S. Thyroglobulin antibody (TgAb) methods - Strengths, pitfalls and clinical utility for monitoring TgAb-positive patients with differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2013; 27:701-12. [PMID: 24094640 DOI: 10.1016/j.beem.2013.07.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Thyroglobulin autoantibodies (TgAb) are detected at diagnosis or during treatment in approximately 25% of patients with differentiated thyroid cancer (DTC). When present, TgAb interferes with thyroglobulin (Tg) measurement causing falsely low or undetectable Tg immunometric assay (IMA) values that can mask disease. Guidelines mandate that every Tg test have TgAb measured simultaneously and quantitatively by immunoassay and not a recovery test. The propensity and magnitude of TgAb-Tg interference relates to both Tg and TgAb concentrations and the class of Tg method used. Because the TgAb trend reflects changes in thyroid tissue mass, TgAb concentrations serve as a surrogate post-operative DTC tumor marker. A rising, or de novo appearance of TgAb may indicate recurrence, whereas a progressive decline suggests successful treatment. This review focuses on the technical limitations of current TgAb methods, characteristics of TgAb interference with different classes of Tg method, and the clinical value of monitoring TgAb trends as a surrogate DTC tumor marker.
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Affiliation(s)
- Carole Spencer
- University of Southern California, Los Angeles, CA, USA.
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26
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Verburg FA, Luster M, Cupini C, Chiovato L, Duntas L, Elisei R, Feldt-Rasmussen U, Rimmele H, Seregni E, Smit JWA, Theimer C, Giovanella L. Implications of thyroglobulin antibody positivity in patients with differentiated thyroid cancer: a clinical position statement. Thyroid 2013; 23:1211-25. [PMID: 23692026 DOI: 10.1089/thy.2012.0606] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Even though the presence of antithyroglobulin antibodies (TgAbs) represents a significant problem in the follow-up of patients with differentiated thyroid cancer (DTC), the current guidelines on the management of DTC that have been published in recent years contain no text concerning the methods to be used for detecting such antibody-related interference in thyroglobulin (Tg) measurement or how to manage TgAb-positive patients in whom Tg cannot be used reliably as a tumor marker. AIM An international group of experts from the European Thyroid Association Cancer Research Network who are involved in the care of DTC patients met twice to form a consensus opinion on how to proceed with treatment and follow-up in TgAb-positive DTC patients based on the available evidence in the literature. Here we will report on the consensus opinions that were reached regarding technical and clinical issues. RESULTS This clinical opinion article provides an overview of the available evidence and the resulting consensus recommendations. The current literature does not provide sufficient data for giving evidence-based answers to many questions arising in the care of TgAb-positive DTC patients. Where insufficient evidence was available, a thorough discussion by a group of physician-scientists, all of whom have a distinguished track record in thyroid cancer care, was held to arrive at a consensus expert opinion. The questions and answers discussed were then summarized into an algorithm for the management of TgAb-positive patients. CONCLUSION We were able to define 26 consensus expert recommendations and a resulting algorithm for the care of TgAb-positive DTC patients.
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Affiliation(s)
- Frederik A Verburg
- 1 Department of Nuclear Medicine, University Hospital Aachen , Aachen, Germany
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27
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Crane MS, Strachan MWJ, Toft AD, Beckett GJ. Discordance in thyroglobulin measurements by radioimmunoassay and immunometric assay: a useful means of identifying thyroglobulin assay interference. Ann Clin Biochem 2013; 50:421-32. [DOI: 10.1177/0004563213480492] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Serum thyroglobulin (Tg) is useful for monitoring patients with differentiated thyroid cancer (DTC) but is limited by interference from anti-Tg antibodies (TgAb). We determined Tg assay discordance between a radioimmunoassay (RIA) and one of two immunometric assays (IMA) in DTC patients over a 9-year period to gauge assay performance against evidence of recurrent/progressive DTC. Methods Patients with DTC monitored for >1 year attending local clinics between September 2000 and January 2010 were included. All samples were analysed for Tg using both RIA and IMA. TgAb were measured on all Tg requests made after May 2006. Bias plots comparing RIA against IMA were established to calculate a 2-SD outlier limit. Clinical records were viewed to compare discordant Tg results against clinical evidence of recurrent/progressive DTC. Results Discordant Tg results were observed in 53/433 patients (12.2%). Four were discordant owing to a higher IMA result, one of which demonstrated recurrence. The remaining 49 patients demonstrated a disproportionately higher RIA result, of which four had recurrent/persistent disease. Twelve patients with a higher RIA result but no evidence of recurrence underwent thyrogen stimulation testing, which was negative in all 12. In many cases, assay discordance appeared more sensitive at indicating interference than direct measurement of TgAb. Conclusions Interference was evident with both Tg assays, such that neither could be solely relied upon to provide the correct result in the presence of TgAb. The concomitant measurement of Tg by RIA and IMA methods should be considered as an alternative to monitoring TgAb status.
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Affiliation(s)
- Michael S Crane
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mark WJ Strachan
- Edinburgh Centre for Endocrinology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anthony D Toft
- Edinburgh Centre for Endocrinology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Geoffrey J Beckett
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
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28
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Pitoia F, Bueno MF, Abelleira E, Salvai ME, Bergoglio L, Luster M, Niepomniszcze H. Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems. ACTA ACUST UNITED AC 2013; 57:300-6. [PMID: 23828434 DOI: 10.1590/s0004-27302013000400004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 11/01/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To establish the frequency of U Tg (undetectable pre-ablation thyroglobulin) in TgAb- negative patients and to evaluate the outcome in the follow-up. SUBJECTS AND METHODS We retrospectively reviewed 335 patients' records. Twenty eight patients (9%) had U Tg. Mean follow-up was 42 ± 38 months. All subjects had undergone total thyroidectomy, and lymph nodes were positive in 13 (46%) patients. Tg and TgAb levels were measured 4 weeks after surgery by IMA technology in hypothyroid state. No evidence of disease (NED) status was defined as undetectable (< 1 ng/mL) stimulated Tg and negative Tg-Ab and/or negative WBS, together with normal imaging studies. RESULTS Seventeen patients (61%) were considered with NED. Four patients (14%) had persistent disease (mediastinum, n = 1, lung n = 2, unknown n = 1), and 7 (25%) had detectable TgAb by other method during their follow-up. CONCLUSIONS U Tg levels usually is associated to a complete surgery. However, in a low percentage of patients, this may be related to false negative Tg or TgAb measurement.
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Affiliation(s)
- Fabián Pitoia
- Division of Endocrinology, Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina.
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29
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Ruan M, Shen Y, Chen L, Li M. RECIST 1.1 and serum thyroglobulin measurements in the evaluation of responses to sorafenib in patients with radioactive iodine-refractory differentiated thyroid carcinoma. Oncol Lett 2013; 6:480-486. [PMID: 24137351 PMCID: PMC3789091 DOI: 10.3892/ol.2013.1424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 06/02/2013] [Indexed: 12/15/2022] Open
Abstract
The present study was designed to investigate the association between response evaluation criteria in solid tumors (RECIST) 1.1 and 1.0, and to explore the utility of thyroglobulin (Tg) measurements in assessing tumor responses to sorafenib in patients with radioactive iodine (RAI)-refractory differentiated thyroid carcinoma (DTC). In total, 23 patients with RAI-refractory DTC were enrolled. A comparison of RECIST 1.1 and 1.0 was performed in all patients with measurable disease. Following the exclusion of patients who were positive for anti-Tg antibody, the correlation between RECIST 1.1 and Tg was investigated in patients with measurable disease, and the concordance of the change in Tg between these patients and the patients with non-measurable disease only was analyzed over time. Tumor responses, assessed by RECIST 1.1 and 1.0, were concordant in 96% of the 23 records. However, the number of target lesions, according to RECIST 1.1, was significantly lower than when using RECIST 1.0. Progressive disease (PD) was identified in one of the five patients who underwent fluorodeoxyglucose-positron emission tomography (FDG-PET)/computed tomography (CT) scanning. A correlation between the Tg levels and the sum of the diameters of the target lesions was verified, with the percentage decrease in Tg levels significantly greater than that in the radiograph, demonstrating shrinkage. Furthermore, the percentage change in Tg levels was consistent between the patients with measurable disease and the subjects with non-measurable disease only. In conclusion, in patients with RAI-refractory DTC, RECIST 1.1 is highly concordant with RECIST 1.0 in the assessment of responses to sorafenib treatment, with the advantage of simplified procedures and the complementary use of FDG-PET. Tg measurements, in concordance with RECIST 1.1, are valuable in the evaluation of tumor responses.
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Affiliation(s)
- Maomei Ruan
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233
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30
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Hoofnagle AN, Roth MY. Clinical review: improving the measurement of serum thyroglobulin with mass spectrometry. J Clin Endocrinol Metab 2013; 98:1343-52. [PMID: 23450057 PMCID: PMC3615194 DOI: 10.1210/jc.2012-4172] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT Serum thyroglobulin (Tg) measurements are central to the management of patients treated for differentiated thyroid carcinoma. For decades, Tg measurements have relied on methods that are subject to interference by commonly found substances in human serum and plasma, such as Tg autoantibodies. As a result, many patients need additional imaging studies to rule out cancer persistence or recurrence that could be avoided with more sensitive and specific testing methods. OBJECTIVES The aims of this review are to: 1) briefly review the interferences common to Tg immunoassays; 2) introduce readers to liquid chromatography-tandem mass spectrometry as a method for quantifying proteins in human serum/plasma; and 3) discuss the potential benefits and limitations of the method in the quantification of serum Tg. RESULTS Mass spectrometric methods have traditionally lacked the sensitivity, robustness, and throughput to be useful clinical assays. These methods failed to meet the necessary clinical benchmarks due to the nature of the mass spectrometry workflow and instrumentation. Over the past few years, there have been major advances in reagents, automation, and instrumentation for the quantification of proteins using mass spectrometry. More recently, methods using mass spectrometry to detect and quantify Tg have been developed and are of sufficient quality to be used in the management of patients. CONCLUSIONS Novel serum Tg assays that use mass spectrometry may avoid the issue of autoantibody interference and other problems with currently available immunoassays for Tg. Prospective studies are needed to fully understand the potential benefits of novel Tg assays to patients and care providers.
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Affiliation(s)
- Andrew N Hoofnagle
- Departments of Laboratory Medicine, University of Washington, Seattle, WA 98195-7110, USA.
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The additive clinical value of 18F-FDG PET/CT in defining the recurrence of disease in patients with differentiated thyroid cancer who have isolated increased antithyroglobulin antibody levels. Clin Nucl Med 2012; 37:755-8. [PMID: 22785502 DOI: 10.1097/rlu.0b013e31825ae77b] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The aim of this study was to investigate the additive clinical value of 18F-FDG PET/CT in defining the recurrence of disease in patients with differentiated thyroid cancer (DTC) who have isolated increased antithyroglobulin antibody (TgAb) levels with undetectable thyroglobulin (Tg) levels and negative 131I whole-body scintigraphy (wbs). MATERIALS AND METHODS Clinical follow-up data of 231 patients with DTC who underwent 18F-FDG PET/CT between June 2006 and March 2011 were evaluated retrospectively. There were a total of 48 patients who underwent 18F-FDG PET/CT for isolated increased serum TgAb levels. When 17 patients who have lymphocytic thyroiditis were excluded, the remaining 31 patients [27 women and 4 men; mean (SD) age, 50.29 (15.2) y] were included in this study. The inclusion criteria were undetectable serum Tg and increased TgAb levels under the condition of thyroid-stimulating hormone greater than 30 IU/mL with negative 131I wbs and absence of pathologic findings in neck ultrasound and thoracic CT if performed. Findings from the 18F-FDG PET/CT were compared with the clinical follow-up data and the results of histopathologic examinations. RESULTS Results of 18F-FDG PET/CT were negative in 15 and positive in 16 patients. Sixteen FDG-positive sites (15 lymph nodes and 1 bone) were seen in 16 patients who had positive findings in 18F-FDG PET/CT. In the comparison with 18F-FDG PET/CT findings and clinical follow-up data and histopathologic examination results, 4, 12, 2, and 13 patients were false-positive, true-positive, false-negative and true-negative retrospectively. In the receiver operating characteristic analysis, a 5.4 cutoff SUVmax value was calculated with 82% sensitivity and 81% specificity in distinguishing malignant and benign lesions. As a result, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG PET/CT in the detection of recurrent disease were calculated as 75%, 76%, 75%, 86%, and 80%, respectively. CONCLUSIONS Isolated increased TgAb levels might be a predictor of the recurrent DTC and 18F-FDG PET/CT might be an additive imaging method in detecting the recurrent disease in patients with DTC who have increased TgAb levels with undetectable Tg levels and negative 131I wbs.
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32
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Wong H, Wong KP, Yau T, Tang V, Leung R, Chiu J, Lang BHH. Is there a role for unstimulated thyroglobulin velocity in predicting recurrence in papillary thyroid carcinoma patients with detectable thyroglobulin after radioiodine ablation? Ann Surg Oncol 2012; 19:3479-85. [PMID: 22576067 PMCID: PMC3442160 DOI: 10.1245/s10434-012-2391-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Indexed: 01/15/2023]
Abstract
Background In the follow-up of papillary thyroid cancer (PTC) patients treated with curative thyroidectomy and radioiodine ablation, raised thyroglobulin (Tg) predicts recurrence with reasonable sensitivity and specificity. However, a proportion of patients present with raised Tg level but no other clinical evidence of disease. Only limited data on Tg kinetics have been reported to date. Here we aim to evaluate the prognostic and predictive significance of nonstimulated serum Tg velocity (TgV). Methods Consecutive PTC patients treated with curative thyroidectomy and radioiodine ablation between 2003 and 2010 were analyzed. Patients with at least one detectable Tg measurement (>0.2 ng/mL) were included. TgV was defined as the annualized rate of Tg change. Logistic regression analyses were performed to evaluate the role of TgV in the prediction of disease recurrence. The optimal TgV cutoff was assigned by receiver–operating characteristic curve analysis. Overall survival of patients above versus below the TgV cutoff were determined by the Kaplan–Meier method and compared. Results Of a total of 501 patients, 87 had at least one Tg value >0.2 ng/mL; in these latter patients, 29 (33.3 %) developed recurrence. TgV was an independent predictor of the recurrence. TgV ≥0.3 ng/mL per year predicted recurrence with a sensitivity of 83.3 % and specificity of 94.4 %. Patients with TgV below the cutoff had a significantly better overall survival (p = 0.038). Conclusions TgV predicts recurrence with high sensitivity and specificity, and is a prognosticator of survival in postthyroidectomy and postablation PTC patients with raised Tg. Electronic supplementary material The online version of this article (doi:10.1245/s10434-012-2391-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hilda Wong
- Department of Medicine, Division of Hematology and Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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Andersen S, Kleinschmidt K, Hvingel B, Laurberg P. Thyroid hyperactivity with high thyroglobulin in serum despite sufficient iodine intake in chronic cold adaptation in an Arctic Inuit hunter population. Eur J Endocrinol 2012; 166:433-40. [PMID: 22170797 DOI: 10.1530/eje-11-0888] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adult man hosts brown adipose tissue with the capacity to consume energy and dissipate heat. This is essential for non-shivering thermogenesis and its activation depends on sympathetic activity and thyroid hormones. This led us to evaluate the impact of chronic cold exposure on thyroid activity and thyroid hormones in serum in Arctic residents. DESIGN Comparative, population-based study (n = 535) performed in Greenland. METHODS Hunters were compared with other men, and Inuit in remote settlements in East Greenland with no modern housing facilities were compared with the residents of the capital city in West Greenland and residents of a major town in East Greenland in a cross-sectional study. We used interview-based questionnaires, measured TSH, free thyroxine, free triiodothyronine (fT(3)), thyroglobulin (TG) antibody and TG (a measure of thyroid activity) in serum, and iodine and creatinine in spot urine samples. RESULTS Serum TG was the highest among hunters (P = 0.009) and settlement dwellers (P = 0.001), who were most markedly exposed to cold, even though they had the highest urinary iodine excretion (hunters, P < 0.001; settlement dwellers, P < 0.001). Hunters and settlement dwellers also had the lowest fT(3) (hunters, P < 0.001; settlement dwellers, P < 0.001) after adjusting for gender, age, smoking habits, alcohol intake and iodine excretion in multivariate linear regression models. TSH was not influenced by measures of cold exposure (hunter, P = 0.36; residence, P = 0.91). CONCLUSIONS Cold exposure influenced thyroid hormones and TG in serum in Arctic populations consistent with consumption of thyroid hormone and higher thyroid hormone turnover. Findings emphasise that changes in thyroid activity are essential in cold adaptation in Arctic residents.
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Affiliation(s)
- Stig Andersen
- Arctic Health Research Centre, Aalborg University Hospital, Hobrovej 42D, 9000 Aalborg, Denmark.
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Sztefko K, Szybowska P. Interpretation of hormone levels in older patients: points for consideration. Int J Endocrinol 2012; 2012:712425. [PMID: 22666247 PMCID: PMC3359804 DOI: 10.1155/2012/712425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/20/2012] [Accepted: 03/09/2012] [Indexed: 11/17/2022] Open
Abstract
Blood hormone and tumor marker concentrations are usually determined by immunochemical methods which are based on an unique reaction between antigen and assay capture antibody. Despite the speed and simplicity of assays performance on automatic immunochemistry platforms, the interpretation of final results requires a deep knowledge of method fallibility. General lack of immunoassays standardization, presence of cross-reacting substances in patient's sample, limitation of free hormones measurement due to abnormal analyte binding protein concentrations, assay interferences due to patient's autoantibodies, and heterophilic antibodies, as well as proper interpretation of very low- and very high-sample analyte levels, are the main points discussed in respect to hormones and tumor markers measurement in geriatric population.
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Affiliation(s)
- Krystyna Sztefko
- Clinical Biochemistry Department, College of Medicine, Jagiellonian University, Wielicka Street 265, 30-663 Kracow, Poland
- *Krystyna Sztefko:
| | - Patrycja Szybowska
- Clinical Biochemistry Department, College of Medicine, Jagiellonian University, Wielicka Street 265, 30-663 Kracow, Poland
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Lõcsei Z, Horváth D, Rácz K, Toldy E. [Significance of simultaneous measurement of serum thyroglobulin and thyroglobulin antibody during the follow-up of patients with differentiated thyroid carcinoma]. Orv Hetil 2011; 152:743-52. [PMID: 21498164 DOI: 10.1556/oh.2011.29104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Serum thyroglobulin is an essential marker during the follow-up of patients with differentiated thyroid carcinoma. Demonstration of the total absence of thyroglobulin is not possible by immunoanalytic methods if thyroglobulin antibody is present in serum samples that occur in almost 20% of patients with differentiated thyroid carcinoma. Therefore, current guidelines recommend estimation of thyroglobulin levels only if quantitative level of thyroglobulin antibody is known. However, normal thyroglobulin antibody level fails to exclude interference with the antibody, because antibody concentration within the normal range may interfere with the thyroglobulin assay. In this respect recommendations are not consistent because they distinguish only occasionally cases with normal and those with non-detectable serum thyroglobulin level. In addition, the possible impact of normal thyroglobulin antibody level on the thyroglobulin assay has not been entirely explored. Authors review literature data and current guidelines on the analytical and preanalytical limitations of the thyroglobulin and thyroglobulin antibody measurements. On the basis of their own studies, authors make recommendation for improvement of the diagnostic accuracy of the thyroglobulin measurement.
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Affiliation(s)
- Zoltán Lõcsei
- Vas Megyei Markusovszky Lajos Általános, Rehabilitációs és Gyógyfürdő Kórház, Egyetemi Oktató Kórház Általános Belgyógyászati Osztály Szombathely
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Vrndic OB, Savin SB, Mijatovic LC, Djukic AA, Jeftic ID, Zivancevic Simonovic ST. Concentration of Thyroglobulin and Thyroglobulin-Specific Autoantibodies in Patients With Differentiated Thyroid Cancer After Treatment With Radioactive Iodine 131. Lab Med 2011. [DOI: 10.1309/lmnc7i58jnjmcpkw] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
Measuring Thyroglobulin Concentrations in Patients with Differentiated Thyroid CarcinomaThyroid carcinomas are the most common malignant endocrine tumors. Thyroglobulin (Tg), a specific thyroid protein, is the most important tumor marker in thyroid oncology. After total thyroidectomy or radioiodine therapy, detectable or increasing serum Tg levels in patients with differentiated thyroid carcinoma indicate persistence of active thyroid tissue or cancer recurrence. Serum Tg concentration primarily reflects three variables: the mass of differentiated thyroid tissue present; the degree of thyrotropin receptor stimulation and the intrinsic ability of the tumor to synthesize and secrete Tg. Measurement of serum Tg by current immunometric (IMA) and radioimmunological (RIA) assays encounters some methodological problems which can diminish its clinical importance. Discrepancy between the results for Tg using different methods may be caused by: different reference materials, specific properties of the primary and secondary antibodies for antigenic determinants on Tg and diverse binding affinities of these epitopes, together with interference by serum factors (usually antibodies to Tg (TgAb)) with the primary and secondary Tg antibodies from the diagnostic set. In the presence of endogenous TgAb, Tg values measured by immunoradiometric assay (IRMA) and similar assays are usually lower than the real concentrations, while in RIA apparently lower or higher results can be obtained. Falsely low values may lead to delay in necessary treatment, while an inappropriately high Tg value can cause patient anxiety and unnecessary scans. Despite current methodological limitations, serum Tg measurement is a useful test for determining worsening disease and monitoring the effects of therapy in patients who have undergone surgery for differentiated thyroid carcinoma.
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Stanojevic M, Savin S, Cvejic D, Djukic A, Jeremic M, Zivancević Simonovic S. Comparison of the influence of thyroglobulin antibodies on serum thyroglobulin values from two different immunoassays in post surgical differentiated thyroid carcinoma patients. J Clin Lab Anal 2010; 23:341-6. [PMID: 19774624 DOI: 10.1002/jcla.20339] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Measurement of serum thyroglobulin (Tg) is a highly specific test in the management of patients with differentiated thyroid cancer (DTC) after surgical treatment. The aim of our study was to evaluate and compare Tg levels in these patients found by radioimmunoassay (RIA) and immunoradiometric assay (IRMA) and to assess the influence of Tg antibodies (TgAbs) on the values obtained for Tg concentration. Both Tg and TgAb were determined postoperatively in the serum of 71 DTC patients using RIA Tg-PEG (INEP) and Tg IRMA (CIS) for Tg, together with TgAb (CIS) for circulating endogenous anti-TgAbs. The obtained concentrations were evaluated statistically. We found a significant difference of Tg concentrations between paired samples from the IRMA and RIA, although the intermethod comparison yielded satisfactory concordance of the two assays (Spearman correlation coefficient -0.792). Positive TgAb was found in 28.2% of the serum samples analyzed. Spearman rank correlation analysis revealed a significant negative relationship between serum TgAb and Tg level measured by IRMA (P=0.02), but not by RIA (P=0.417). On the other hand, our clinical data revealed that 1/18 and 3/18 patients with proven lymph node metastasis had Tg values below the detection limit by RIA and IRMA assay, respectively. Their sera were TgAb positive. We concluded that RIA was less prone to influence of TgAb than IRMA. As the presence of TgAbs may interfere in Tg measurement irrespective of the method selected for determination, this should be considered during the clinical management of these patients.
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Rosenbaum MA, McHenry CR. Contemporary management of papillary carcinoma of the thyroid gland. Expert Rev Anticancer Ther 2009; 9:317-29. [PMID: 19275510 DOI: 10.1586/14737140.9.3.317] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The incidence of thyroid cancer is increasing by 4% per year. Thyroid cancer has become the eighth most common malignancy diagnosed in women. Papillary cancer accounts for 80% of all thyroid cancer. The management of papillary thyroid cancer is challenging, primarily because there have been no prospective randomized trials to help guide therapeutic decision making. The purpose of this article is to discuss the contemporary management of papillary thyroid cancer, including the diagnosis and pre-operative evaluation, surgical management, postoperative thyroid hormone and radioiodine therapy, long-term follow-up, prognosis and management of recurrent and metastatic disease. The role of molecular markers to enhance the cytological diagnosis of papillary cancer and new molecular-based therapies will also be reviewed.
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Affiliation(s)
- Michael A Rosenbaum
- Department of Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
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40
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Stanojević M, Savin S, Cvejić D, Đukić A, Živančević Simonović S. Correlation of Thyroglobulin Concentrations Measured by Radioimmunoassay and Immunoradiometric Assay and the Influence of Thyroglobulin Antibody. J Immunoassay Immunochem 2009; 30:197-207. [DOI: 10.1080/15321810902782897] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Thyroglobulin and anti-thyroglobulin assays in thyroid cancer monitoring. Clin Biochem 2009; 42:416-9. [DOI: 10.1016/j.clinbiochem.2008.12.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 12/07/2008] [Accepted: 12/22/2008] [Indexed: 11/21/2022]
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Ma C, Kuang A, Xie J. Radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases. Cochrane Database Syst Rev 2009; 2009:CD006988. [PMID: 19160311 PMCID: PMC7212000 DOI: 10.1002/14651858.cd006988.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases has been observed in follow-up studies. The management of this condition remains controversial. Most studies support blind radioactive iodine treatment while others negate this approach. OBJECTIVES To assess the effects of radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases. SEARCH STRATEGY Studies were obtained from computerised searches of MEDLINE, EMBASE, The Cochrane Library, China National Infrastructure (CNKI) and paper collections of conferences held in Chinese. SELECTION CRITERIA Randomised controlled clinical trials and prospective controlled clinical trials. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and interviewed authors of all potentially relevant studies by electronic mail to verify randomisation procedures. One author entered data into a data extraction form and the second one verified the results of this procedure. MAIN RESULTS Because of the absence of any suitable randomised or prospective controlled trial in this area, results currently cannot be presented. AUTHORS' CONCLUSIONS The currently available evidence is insufficient to reliably assess the potential of radioiodine treatment for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases.
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Affiliation(s)
- Chao Ma
- Department of Nuclear Medicine, Affiliated Hospital of Medical College Qingdao University, Jiangsu Road 16, Qingdao, Shandong Province, China, 266003.
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Gao Y, Lu H, Yuan Z, Zhu R. Tumor Markers in Thyroid Carcinoma With Pulmonary Metastases After Thyroidectomy. Lab Med 2009. [DOI: 10.1309/lm8fzxw08brjsjsr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Kim WG, Yoon JH, Kim WB, Kim TY, Kim EY, Kim JM, Ryu JS, Gong G, Hong SJ, Shong YK. Change of serum antithyroglobulin antibody levels is useful for prediction of clinical recurrence in thyroglobulin-negative patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 2008; 93:4683-9. [PMID: 18812478 DOI: 10.1210/jc.2008-0962] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate the usefulness of the antithyroglobulin autoantibody (TgAb) value at 6-12 months after remnant ablation in predicting recurrence in differentiated thyroid carcinoma patients who had undetectable thyroglobulin (Tg) values. The change in TgAb concentration measured between the time of remnant ablation (TgAb1) and 6-12 months thereafter (TgAb2) was also evaluated as a possible prognostic indicator. PATIENTS AND METHODS Patients with differentiated thyroid carcinoma who underwent total thyroidectomy followed by (131)I remnant ablation between 1995 and 2003 at the Asan Medical Center (Seoul, Korea) were enrolled. Of these, 824 patients with undetectable Tg at 6-12 months after remnant ablation during thyroid hormone withdrawal were the subjects of this study. RESULTS TgAb2 was positive in 56 patients. Ten of 56 patients (18%) with positive TgAb2 had recurrence, whereas only 10 of 768 patients (1%) with negative TgAb2 had recurrence during 73.6 months of follow-up (P < 0.001). The change between TgAb1 and TgAb2 levels was evaluated in patients with positive TgAb2. TgAb concentration decreased by more than 50% in 21 patients (group 1) and by less than 50% in 16 patients (group 2), and it increased in 19 patients (group 3). The recurrence rates in groups 1, 2, and 3 were 0, 19, and 37%, respectively (P = 0.016). CONCLUSIONS Serum TgAb levels measured at 6-12 months after remnant ablation could predict recurrence in patients with undetectable Tg values. In patients with undetectable Tg and positive TgAb values, a change in TgAb concentration during the early postoperative period may be a prognostic indicator of recurrence.
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Affiliation(s)
- Won Gu Kim
- Department of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea
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The additive clinical value of combined thyroglobulin and antithyroglobulin antibody measurements to define persistent and recurrent disease in patients with differentiated thyroid cancer. Nucl Med Commun 2008; 29:880-4. [DOI: 10.1097/mnm.0b013e328308e079] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Lombardi CP, Bossola M, Princi P, Boscherini M, La Torre G, Raffaelli M, Traini E, Salvatori M, Pontecorvi A, Bellantone R. Circulating thyroglobulin mRNA does not predict early and midterm recurrences in patients undergoing thyroidectomy for cancer. Am J Surg 2008; 196:326-32. [PMID: 18614150 DOI: 10.1016/j.amjsurg.2007.09.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 09/17/2007] [Accepted: 09/17/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate if serum Tg mRNA assay predicts recurrence in patients undergoing thyroidectomy for cancer. METHODS Sixty-four consecutive patients undergoing surgery between April 1997 and July 1999 were studied. One year after surgery, blood samples were taken for serum thyroglobulin (Tg) immunoassay and for Tg mRNA assay by reverse transcription-polymerase chain reaction (RT-PCR). All patients underwent periodical clinical examination, including laboratory tests for serum Tg immunoassay, neck ultrasound, radioiodine scans, and treatment if indicated. Kaplan-Meier estimates of survival were calculated according to the presence or absence of circulating Tg mRNA and according to baseline Tg levels. RESULTS Tg mRNA was detected in 14 (21.8%) of 64 patients with thyroid carcinoma. After a median follow-up of 110 months, 8 patients (12.5%) relapsed. Among patients with detectable Tg mRNA (n. 14), only 1 distant metastasis occurred (7%), whereas lymph node metastases (n = 3) or distant metastases (n = 4) were detected in 7 of 50 patients (14%) with undetectable Tg mRNA. Tumor relapse occurred in all 7 patients with increased serum Tg and only in 1 out of 57 patients (1.7%) with normal or undetectable serum Tg. The disease-free interval of patients positive at baseline for Tg mRNA was similar to that of patients with undetectable Tg mRNA at baseline. Similar results were obtained when we limited the analysis to only patients who received postsurgical radioiodine ablation. CONCLUSIONS The results of present study suggest that detection of circulating Tg mRNA 1 year after thyroidectomy for cancer might be of no utility in predicting early and midterm local and distant recurrences.
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Affiliation(s)
- Celestino Pio Lombardi
- Divisione di Chirurgia Endocrina, Dipartimento di Scienze Chirurgiche, Università Cattolica del Sacro Cuore, Rome, Italy
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Rosario PW, Purisch S. Does a highly sensitive thyroglobulin (Tg) assay change the clinical management of low-risk patients with thyroid cancer with Tg on T4 < 1 ng/ml determined by traditional assays? Clin Endocrinol (Oxf) 2008; 68:338-42. [PMID: 17850379 DOI: 10.1111/j.1365-2265.2007.03043.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate a highly sensitive thyroglobulin (Tg) assay [functional sensitivity (FS): 0.1 ng/ml] (Tg-ICMA) in low-risk patients with known Tg on T4 < or = 1 ng/ml measured by a traditional assay (FS: 1 ng/ml) (Tg-IRMA). METHODS Tg-ICMA was measured in serum samples stored at -70 degrees C. Samples were obtained 6 months or more after total thyroidectomy and remnant ablation with (131)I, during L-T4 therapy (TSH < 0.4 mIU/l). All patients had well-differentiated and completely resected tumours, no ectopic uptake on post-therapy whole-body scans and were considered to be at low risk for recurrence. On the occasion of collection and retesting for this study, Tg-IRMA was < or = 1 ng/ml in all samples and no antibody interference was observed. RESULTS Tg-ICMA < or = 0.1 ng/ml was observed in 130/178 (73%) patients and recurrence was diagnosed in only 1/130 (0.8%). Tg-IRMA measured after L-T4 withdrawal was > 1 ng/ml in 5/130 (3.8%) patients. Forty-eight (27%) patients had Tg-ICMA > 0.1 ng/ml (0.12-1.6 ng/ml) and recurrence was diagnosed in 5/48 (10.5%). Tg-IRMA measured after L-T4 withdrawal was > 1 ng/ml in 20/48 (41.6%) patients. A negative predictive value of 100% was achieved with Tg-ICMA on T4 < or = 0.1 ng/ml combined with neck ultrasonography (US) or with stimulated Tg-IRMA < or = 1 ng/ml. CONCLUSIONS Patients at low risk for recurrence with undetectable Tg on T4 measured by a highly sensitive assay (FS: 0.1 ng/ml) in the absence of antibody interference and with a negative sensitive neck US do not need to be submitted to Tg stimulation. Recurrence is rare in these cases and only a minority of patients convert to stimulated Tg > 1-2 ng/ml.
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Affiliation(s)
- P W Rosario
- Department of Thyroid, Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil.
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Spencer CA, Lopresti JS. Measuring thyroglobulin and thyroglobulin autoantibody in patients with differentiated thyroid cancer. ACTA ACUST UNITED AC 2008; 4:223-33. [PMID: 18268520 DOI: 10.1038/ncpendmet0757] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 01/02/2008] [Indexed: 11/10/2022]
Abstract
Measurement of serum thyroglobulin is primarily used as a tumor marker in the postoperative management of patients with differentiated thyroid cancer. Unfortunately, the technical quality of current thyroglobulin assay methods varies and influences the clinical utility of this test. Two different methodologic approaches are used to measure serum thyroglobulin: the original competitive radioimmunoassay methodology and noncompetitive immunometric assay methods. Although the newer immunometric assays offer the technical benefits of eliminating the use of isotopes, using smaller specimen volumes, and having higher sensitivity potential, shorter turnaround times and the convenience of automation, immunometric assays also have a higher propensity for interference from both thyroglobulin autoantibodies and heterophilic antibodies, if present in the specimen. It is critical that physicians understand the technical limitations inherent in thyroglobulin measurement in order to effectively use this test for the postoperative management of patients with differentiated thyroid cancers.
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Affiliation(s)
- Carole A Spencer
- University of Southern California, Edmondson Building, Room 111, 1840 North Soto Street, Los Angeles, CA 90032, USA.
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Madureira D, Prazeres S, Pedro MS, Pereira T, Font AP, Bugalho MJ. In vitro assays to test the interference of anti-thyroglobulin antibodies on thyroglobulin measurement. Endocrine 2008; 33:40-4. [PMID: 18373225 DOI: 10.1007/s12020-008-9053-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 01/18/2008] [Accepted: 03/04/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the interference of anti-thyroglobulin antibodies (TgAb) on serum thyroglobulin (Tg) measurement by in vitro experiments. Design Re-evaluation of Tg concentration after dilution with different TgAb-positive sera. On a first step, dilutions of the same Tg with different TgAb sera were performed and on a second step, different Tgs were diluted with the same TgAb serum. METHODS Tg measurements were performed using an immunometric (IMA) chemiluminescence assay. TgAb measurements were performed using two methods: immunoflurimetric assay (UNICAP 100) and IMA chemiluminescent assay (IMMULITE 2000). RESULTS Dilution of a known concentration of Tg with different TgAb-positive sera resulted in a variation of the final concentration of Tg ranging from -24 to -79%. A weak correlation was observed between the TgAb concentration and the percentage of the Tg deviation. Dilution of different Tgs with the same TgAb-positive serum illustrated how the same TgAb positive serum may determine a high interference or a neutral effect. CONCLUSIONS Present results suggest that the interference on Tg measurement observed in the presence of TgAb may result not only from the anti-thyroglobulin antibodies, but also from the thyroglobulin itself.
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Affiliation(s)
- Deolinda Madureira
- Laboratório de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil E.P.E., Rua Professor Lima Basto, 1099-023, Lisbon, Portugal.
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50
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Giovanella L. Highly sensitive thyroglobulin measurements in differentiated thyroid carcinoma management. Clin Chem Lab Med 2008; 46:1067-73. [DOI: 10.1515/cclm.2008.212] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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