Establishing Serum Thyroglobulin Reference Values and Predictors of Its Variability in an Iodine-Sufficient...

Serum thyroglobulin (Tg) is a key biomarker for various thyroid conditions. However, population-specific reference values (RVs) are missing, and clinical practice relies on manufacturer-provided RVs. This study aimed to establish Tg RVs in an iodine-sufficient population using the strict National Academy of Clinical Biochemistry (NACB) criteria and to identify determinants of serum Tg levels.

We screened 420 volunteers through history, physical examination, thyroid function tests, urine iodine excretion, and thyroid ultrasonography. Thyroid volume (TTV) was estimated in a subset of the study population. We selected 140 subjects for NACB criteria-based Tg RVs determination (Cohort 1) and 154 for Tg determinant analysis (Cohort 2). Redundancy Analysis and Variation Partition were performed to quantify the explained variance of Tg from 5 variables -smoking, age, gender, thyrotropin, and TTV.

The RVs for Tg, calculated as mean ± 2 standard deviations on log-transformed data (as per the NACB criteria), were 2.95-56.23 ng/mL, whereas those suggested by our Tg assay manufacturer are 3.5-77 ng/mL. A model including all 5 predictors explained only 7.5% of Tg variability, with smoking (4.8%) and TTV (2.7%) as the only significant contributors. Subgroup analysis showed that thyrotropin had a minor impact only in men, while age and gender were not significant contributors.

Population-specific RVs for Tg are essential in clinical decision-making. Known clinical/biochemical variables explained only a small proportion of Tg variability. Our findings underscore the need to identify additional determinants of Tg levels.