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Submitted on March 8, 2005
Accepted on June 13, 2005
Associate Professor of Internal Medicine and Radiology; Divisions of Endocrinology, Diabetes and Metabolism & Nuclear Medicine; Thyroid Cancer Unit co-director, The Ohio State University; Emeritus Professor & Chairman of Medicine, The Ohio State University, and Professor of Medicine, University of Florida
* To whom correspondence should be addressed. E-mail: mazz01{at}bellsouth.net.
Context: Testing for residual differentiated thyroid carcinoma (DTC) relies heavily upon rhTSH-stimulated serum thyroglobulin (Tg) levels, but the positive predictive value (PPV) is often low.
Objective: Determine the accuracy of a single rhTSH-Tg measurement over time.
Design: Prospective follow-up study.
Setting: University referral center.
Patients: 107 DTC patients stratified according to their initial rhTSH-Tg (1): Group1 Tg <0.5 (n = 68), Group2 Tg 0.6-2.0 (n = 19) and Group3 Tg >2ng/mL (n = 20).
Intervention: Clinical evaluations over 0.9-5.2 yr: Tg during thyroid hormone suppression (n = 27,THST), after rhTSH (n = 59), and/or thyroid hormone withdrawal (n = 15,THW).
Main Outcome: Tumor was identified in 1 patient each of Groups1 (1.6%) and 2 (5.5%), and 16 in Group3 (80%), comprising 19 tumor locations: 11 locoregional, 2 mediastinal, 5 lung and 1 brain. Tumor was found in 81% with an initial or follow-up rhTSH-Tg >2ng/mL. TSH-stimulated Tg fell spontaneously to <0.5ng/mL in 50% of Group2 and 5% of Group3 over 1.7-5.0 yr. The PPV of the initial rhTSH-Tg >2ng/mL was 80% and the NPV 98%. After re-treatment, 100% of Group1, 74% of Group2, and 55% of Group3 had no evidence of tumor (P = 0.0001).
Conclusions: 1) A single rhTSH-Tg >2ng/mL predicts persistent tumor, while no value entirely excludes future recurrence. 2) Repeated TSH-stimulated studies are appropriate for patients at risk of recurrence, especially those with an rhTSH-Tg >1ng/mL. 3) A single rhTSH-Tg <0.5ng/mL without TgAb has 
98% likelihood of identifying patients completely free of tumor, a large group in which TSH suppression to <0.1mIU/L and frequent imaging and TSH-stimulated Tg testing are unnecessary.
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