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Long-term predictive value of highly sensitive thyroglobulin measurement.

Larissa R Bögershausen1, Luca Giovanella2, Thomas Stief3

  • 1Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany.

Clinical Endocrinology
|October 20, 2022
PubMed
Summary

An undetectable nonstimulated highly sensitive thyroglobulin (hsTg) measurement in differentiated thyroid cancer (DTC) patients predicts a good prognosis, even with anti-Tg-antibodies (TgAbs). This finding allows for omitting further diagnostic procedures in many cases.

Keywords:
assayautoantibodiespatient careprognosisthyroglobulinthyroid cancerthyroid gland

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Area of Science:

  • Endocrinology
  • Oncology
  • Nuclear Medicine

Background:

  • Differentiated thyroid cancer (DTC) management relies on monitoring thyroglobulin (Tg) levels.
  • Distinguishing between stimulated and nonstimulated Tg measurements, and the influence of anti-Tg-antibodies (TgAbs), is crucial for accurate prognosis.
  • Highly sensitive Tg (hsTg) assays offer improved detection capabilities.

Purpose of the Study:

  • To evaluate the predictive capability of nonstimulated hsTg levels for stimulated Tg measurements, diagnostic imaging, recurrence, and DTC-related mortality.
  • To assess the prognostic value of hsTg in DTC patients, both with and without TgAbs.

Main Methods:

  • Retrospective analysis of 461 DTC patients treated and followed from 2004 onwards.
  • Inclusion of patients with at least one post-treatment Tg measurement at least 3 months after I-131 ablation.
  • Stratification of patients based on the presence or absence of TgAbs.

Main Results:

  • In TgAb-negative patients, an unstimulated hsTg < 0.1 ng/ml had a 97.6% negative predictive value for a stimulated Tg ≥ 1.0 ng/ml.
  • An unstimulated hsTg ≥ 0.1 ng/ml showed high sensitivity (90.0%) and specificity (94.1%) for detecting stimulated Tg ≥ 1.0 ng/ml.
  • While unstimulated Tg ≥ 0.1 ng/ml did not significantly predict DTC-related death, higher levels (≥ 1.0 ng/ml) and stimulated Tg ≥ 1.0 ng/ml did, though this significance was lost when excluding patients with distant metastases.

Conclusions:

  • Undetectable nonstimulated hsTg measurements indicate a very good prognosis in both TgAb-negative and TgAb-positive DTC patients, excluding those with distant metastases.
  • The high negative predictive value of unstimulated hsTg testing supports its use in potentially obviating further diagnostic investigations.