Factors Influencing the Basal and Recombinant Human Thyrotropin-Stimulated Serum Thyroglobulin in Patients with Metastatic Thyroid Carcinoma
Richard J. Robbins,
Shefali Srivastava,
Ashok Shaha,
Ronald Ghossein,
Steven M. Larson,
Martin Fleisher and
R. Michael Tuttle
Endocrinology, Head and Neck Surgery, Molecular Pathology, Nuclear Medicine, and Clinical Chemistry Services, Departments of Medicine, Surgery, Pathology, Radiology, and Clinical Laboratories, Memorial Hospital for Cancer and Allied Diseases, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
Address all correspondence and requests for reprints to: Dr. Richard J. Robbins, Endocrine Service, Box 296, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021. E-mail: robbinsr{at}mskcc.org.
The serum thyroglobulin (Tg) level is the most sensitive markerfor detecting residual thyroid carcinoma. We hypothesized thatthe basal and TSH-stimulated Tg levels in patients with metastaticthyroid carcinoma would reflect tumor volume, histological subtype,and location of metastatic lesions. A retrospective review of417 thyroid cancer survivors undergoing evaluation for residualdisease with the assistance of recombinant human TSH (rhTSH)was performed. In 169 patients with metastatic disease, we foundthat the basal Tg level directly correlated with the numberof lesions, and that it was highest in patients with follicularand lowest in those with papillary thyroid carcinoma. The basalTg level was highest in patients with bone metastases and lowestin those with cervical metastases. The fold increase in theserum Tg after rhTSH treatment was highest in papillary thyroidcarcinoma and lowest in Hurthle cell carcinoma. The fold increasein Tg was not influenced by tumor volume or by the site of metastaticlesions. Multivariate analysis showed multiple interactionsbetween factors, but did not identify one factor that significantlyinfluenced basal Tg or fold increase. We conclude that the locationand volume of metastases influence basal Tg, but not its responsivenessto rhTSH, whereas the histological type of carcinoma influencesboth basal Tg and responsiveness to rhTSH.
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