Preoperative undetectable serum thyroglobulin in differentiated thyroid carcinoma: incidence, causes and management strategy

Giovanella, Luca; Ceriani, Luca; Ghelfo, Antonella; Maffioli, Marco; Keller, Franco

doi:10.1111/j.1365-2265.2007.02922.x

Cited by 31 publications

(16 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In clinical practice it is realistically difficult to use many different assay methods in all patients who initially showed undetectable serum Tg or TgAb. However, our study and recently published studies (21,22) had shown that retesting or follow-up of Tg using different assay methods is useful in patients with initially negative Tg since some patients had demonstrated detectable Tg during follow-up indicative for recurrent disease (Table 3).…”

Section: Discussionmentioning

confidence: 70%

The follow-up of patients with differentiated thyroid cancer and undetectable thyroglobulin (Tg) and Tg antibodies during ablation

Phan

Jager

Wal

et al. 2008

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: This retrospective study describes the role of serum thyroglobulin (Tg) in relation to tumor characteristics in the prediction of persistent/recurrent disease in patients with differentiated thyroid cancer (DTC) with negative Tg at the time of ablation. Design: Between 1989 and 2006, 94 out of 346 (27%) patients with DTC had undetectable Tg at the time of 131 I ablation and were included in this evaluation. The group of 94 patients consisted of 15 males and 79 females in the age range of 16-89 years with a median follow-up of 8 years (range 1-17). All medical records and follow-up parameters of the 94 patients were evaluated for the occurrence of persistent/recurrent disease. In patients with persistent/recurrent disease hematoxylineosin-stained slides of the primary tumors and/or metastatic lesions were also reviewed for histological features including immunostains for Tg. Results: During follow-up, 8 out of 94 (8.5%) patients showed persistent/recurrent disease: in the course of the disease two patients showed Tg positivity, three showed Tg antibody (TgAb) positivity, and the other three showed persistently undetectable Tg and TgAb. Patients who developed Tg and/or TgAb positivity during follow-up had a significantly shorter disease-free survival period when compared with patients with persistently undetectable Tg and TgAb (P!0.006). Histological features were not able to predict the recurrent status. Conclusions: Follow-up of Tg and TgAb in patients with initially negative Tg and TgAb is useful since a number of patients had shown detectable Tg or TgAb during follow-up indicative for persistent/recurrent disease. Tg and TgAb negativity at the time of ablation is not a predictive determinant for future recurrent status. 158 77-83 European Journal of Endocrinology

show abstract

Section: Discussionmentioning

confidence: 70%

The follow-up of patients with differentiated thyroid cancer and undetectable thyroglobulin (Tg) and Tg antibodies during ablation

Phan

Jager

Wal

et al. 2008

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…In facts, Tg was found to be undetectable in 3% to 5% of DTC patients but using different immunoassays resulted in detectable values being found in 67% to 75% of these patients. 18 The large differences in Tg reactivity are probably related to differences in epitope number, specificity of the Tg monoclonal antibodies, and nonserum calibrator matrices. 7 Even though most Tg immunoassays are now calibrated (directly or indirectly) against the international reference preparation (CRM 457), different Tg methods show a high between-method variability and serum Tg levels that are measured by methods calibrated against CRM 457 still vary by as much as a factor of 4.…”

Section: Discussionmentioning

confidence: 99%

“…7 Even though most Tg immunoassays are now calibrated (directly or indirectly) against the international reference preparation (CRM 457), different Tg methods show a high between-method variability and serum Tg levels that are measured by methods calibrated against CRM 457 still vary by as much as a factor of 4. 8,18,19 Thyroid tumors differ in their ability to synthesize and secrete Tg and less-differentiated histotype are likely to be "poor Tg secretors." Additionally, Tg is a very large and heterogeneous thyroid prohormone and conformational changes were demonstrated in tissues and sera from patients with thyroid carcinomas compared with patients with nonmalignant thyroid diseases and healthy controls.…”

Section: Discussionmentioning

confidence: 99%

Undetectable Thyroglobulin in Patients With Differentiated Thyroid Carcinoma and Residual Radioiodine Uptake on a Postablation Whole-Body Scan

Giovanella¹,

Suriano²,

Ceriani³

et al. 2011

Clinical Nuclear Medicine

Self Cite

View full text Add to dashboard Cite

A careful assessment of interferences in Tg measurement significantly reduced the occurrence of undetectable Tg among patients with ¹³¹I uptake in PT-WBS. However, such extensive assessment is difficult in clinical practice and one-fifth of patients still had undetectable Tg in multiple assays despite an intensive laboratory work-up. A benchmark between ¹³¹I imaging and Tg measurement authenticates the interpretation of Tg measurements and, consequently, remains of pivotal value by authenticating the use of serum Tg during further follow-up of DTC patients.

show abstract

“…The sensitivity of Tg measurements after surgery will be higher if the tumor is relatively small (2 cm or smaller) and the Tg value before surgery high. If the Tg value is low before surgery, a non-detectable Tg value after surgery is not a convincing confirmation of the absence of tumor tissue, as it is not clear whether the tumor produced Tg or not (20,21). For such patients a detectable level of Tg after surgery might indicate the presence of a large tumor mass or the appearance of metastases.…”

Section: Preoperative Tg Measurementmentioning

confidence: 99%

Measuring Thyroglobulin Concentrations in Patients with Differentiated Thyroid Carcinoma

Savin¹,

Cvejić²,

Mijatović³

et al. 2010

Journal of Medical Biochemistry

View full text Add to dashboard Cite

Kratak sadr`aj: Tiroidni karcinomi su naj~e{}i maligni endo krini tumori. Tireoglobulin (Tg), specifi~ni protein {ti -ta ste `lezde, najva`niji je tumorski marker u tireoidnoj onkologiji. Kod pacijenata sa diferentovanim karcinomima tireo ideje, nakon operativnog le~enja, koncentracija Tg odre|uje se radi otkrivanja rezidualnog tumorskog tkiva ili postojanja lokalnih, odnosno udaljenih metastaza. Na koncentraciju Tg u serumu uti~u: masa prisutnog tireoidnog tkiva (benignog ili malignog), intenzitet stimulacije receptora za tireostimuli{u}i hormon (TSH) i sposobnost tumorskih }elija da sinteti{u i lu~e Tg. Savremene metode, imunometrijske (IMA) i radioimunolo{ke (RIA), kojima se odre|uje koncentracija Tg u serumu ispitanika, imaju odre|ena ograni~enja koja mogu da umanje klini~ki zna~aj dobijenih rezultata. Usled metodolo{kih razlika, koncen tra cije Tg u istim uzorcima seruma, izmerene razli~itim testo vima, mogu se razlikovati. Faktori koji mogu prouzrokovati razlike u izmerenim koncentracijama Tg su brojni: razli~iti referentni materijali, razlike u specifi~nosti primarnih i sekundarnih antitela za antigenske determinante Tg, razli ~it afinitet vezivanja tih antitela za epitope Tg, i interfe ren cija serumskih faktora. Princip testa, kao i eventualno prisu stvo TgAt u serumima ispitanika, mo `e uticati na izmerenu koncentraciju Tg. Svako odstupanje izmerenih koncentra cija Tg od stvarnih vrednosti mo`e imati ozbiljne posledice: la`no niske vrednosti Tg mogu odlo`iti neophodni tretman pacijenata, dok la`no pove}ane vrednosti Tg mogu prouzrokovati nepotrebni stres, ili ~ak tretman pacijenata. I pored ograni~enih mogu}nosti savreme nih metoda, odre|ivanje koncentracije Tg u serumu pacije nata operisa nih od diferentovanog tiroidnog karcino ma je koristan test za otkrivanje pogor{anja bolesti i za pra}enje efekata tera pije.Klju~ne re~i: diferentovani tireoidni karcinom, imunometrijski test, tireoglobulin, tireoglobulinska antitela Summary: Thyroid 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 antibo...

show abstract

Preoperative undetectable serum thyroglobulin in differentiated thyroid carcinoma: incidence, causes and management strategy

Cited by 31 publications

References 25 publications

The follow-up of patients with differentiated thyroid cancer and undetectable thyroglobulin (Tg) and Tg antibodies during ablation

The follow-up of patients with differentiated thyroid cancer and undetectable thyroglobulin (Tg) and Tg antibodies during ablation

Undetectable Thyroglobulin in Patients With Differentiated Thyroid Carcinoma and Residual Radioiodine Uptake on a Postablation Whole-Body Scan

Measuring Thyroglobulin Concentrations in Patients with Differentiated Thyroid Carcinoma

Contact Info

Product

Resources

About