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This version published online on October 31, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-0993
A more recent version of this article appeared on January 1, 2007
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*Substance via MeSH
Hazardous Substances DB
*THYROGLOBULIN
Medline Plus Health Information
*Thyroid Cancer

Submitted on May 8, 2006
Accepted on October 24, 2006

Monitoring Thyroglobulin in a Sensitive Immunoassay Has Comparable Sensitivity to Recombinant Human TSH Stimulated Thyroglobulin in Follow-Up of Thyroid Cancer Patients

Robert C. Smallridge MD*, Shon E. Meek MD, Melissa A. Morgan MD, Geoffrey S. Gates MD, Thomas P. Fox MD, Stefan Grebe MD, PhD, and Vahab Fatourechi MD

Division of Endocrinology and Metabolism; Mayo Clinic College of Medicine, Jacksonville, FL, Department of Laboratory Medicine and Pathology, and Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN

* To whom correspondence should be addressed. E-mail: smallridge.robert{at}mayo.edu.

Context: Most thyroglobulin (Tg) assays have a sensitivity of 0.5-1 ng/mL. A minority of patients with undetectable T4-suppressed Tg levels have a recombinant human TSH (rhTSH)-stimulated Tg > 2 ng/mL and identifiable residual disease.

Objective: To determine if a Tg assay with improved sensitivity could eliminate the need for rhTSH stimulation when baseline Tg is < 0.1 ng/mL.

Design: Retrospective study of two academic endocrine practices.

Population: One hundred ninety-four patients undergoing rhTSH stimulation.

Results: Of the 80 patients with Tg < 0.1 ng/mL, two (2.5%) had rhTSH stimulated Tg > 2ng/mL. One other patient with stimulation to 0.3 ng/mL and negative 123I scan had an ultrasound detected malignant lymph node resected. None had 131I/123I imaging after rhTSH stimulation suggestive of local recurrence or distant metastasis. If T4-suppressed Tg = 0.1-0.5 or 0.6-2.0 ng/mL, rhTSH Tg was > 2 ng/mL in 24.2% and 82.4%, respectively.

Conclusions: Patients with differentiated thyroid carcinoma and a T4-suppressed serum Tg < 0.1 ng/mL rarely have a rhTSH-stimulated Tg > 2 ng/mL and none of these patients had 131I or 123I imaging after rhTSH stimulation suggestive of local recurrence or distant metastasis. We recommend monitoring such patients with a T4-suppressed Tg level and periodic neck ultrasonography. An increase in T4 suppressed serum Tg to detectable level, or appearance of abnormal lymph nodes by physical or ultrasound exam, should prompt further investigation.




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eLetters:

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Is Slightly Detectable rhTSH-Tg Clinically Relevant when Undetectable onT4-Tg occured?
Luca Giovanella
JCEM Online, 13 Nov 2006 [Full text]

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