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      Use of thyroglobulin as a tumour marker

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          Abstract

          It is worthwhile to measure serum thyroglobulin (TG) level in thyroid cancer before subjecting patients to surgery for two reasons. Firstly, if the level is high, it may give a clue to the local and metastatic tumour burden at presentation; secondly, if the level is normal, it identifies the patients who are unlikely to show rising TG levels in the presence of thyroid cancer. Those who have high serum TG before surgery will show up recurrence as rising serum TG during the postoperative period. Those who do not have high serum TG before surgery will not show up rising serum TG in the presence of recurrent disease. In the latter situation, normal TG level gives only a false reassurance regarding recurrence of disease. Nevertheless, rising serum TG during the postoperative period must be interpreted cautiously because this could be due to the enlargement of non-cancerous residual thyroid tissue inadvertently left behind during surgery.

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          Serum Tg--a sensitive marker of thyroid abnormalities and iodine deficiency in epidemiological studies.

          H Perrild, I Bülow, N Knudsen … (2001)
          Serum Tg is widely used in the control of thyroid cancer but also in the diagnosis of certain other thyroid diseases. Serum Tg may be useful in the characterization of the iodine status of a population, but little is known about determinants of serum Tg levels. We examined a random selection of 4,649 subjects from 2 regions in Denmark with different iodine status. Thyroid volume and structure were determined with ultrasonography, and thyroid function tests and Tg analysis were performed. The factor with the closest association with serum Tg levels was thyroid volume at ultrasonography (P < 0.001). Also thyroid nodularity (P < 0.001) and iodine excretion (P < 0.001) had close associations to serum Tg, even after adjusting for the influence of the other parameters. Thyroid dysfunction had a less pronounced but still highly significant association with serum Tg (P < 0.001), but no relation was found to serum TSH in general. The association with age seemed to rely on differences in the prevalence of thyroid abnormalities, and men had lower Tg levels than women of the same age. There was a marked difference in serum Tg between the two regions with slightly different iodine excretion also after adjusting for the other factors. In conclusion, serum Tg reflects thyroid abnormalities and thyroid function and is a sensitive marker of iodine deficiency in a population.
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            Approach to follow-up of the patient with differentiated thyroid cancer and positive anti-thyroglobulin antibodies.

            Matthew Ringel, Fadi Nabhan (2013)
            Anti-thyroglobulin antibodies are commonly identified in patients with differentiated follicular cell-derived thyroid cancer. When present, they interfere with the measurement of thyroglobulin (Tg), which is the primary biochemical marker used for disease surveillance, creating challenges in monitoring patients for residual or recurrent disease. Moreover, there is variability in measuring anti-Tg antibodies according to the different assays, such that not all patients with anti-Tg antibodies are identifiable on a single assay system. The persistence of anti-Tg antibodies, especially if levels are rising, may indicate persistent, recurrent, or progressive thyroid cancer. In contrast, declining anti-Tg antibody levels may indicate reduced tumor burden or the absence of disease. In this review, we will explore in a case-based manner the data supporting monitoring and treatment paradigms for patients with anti-Tg antibodies and will stress areas where more evidence is needed to better inform clinicians regarding the management of patients with this challenging situation.
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              Value of preoperative diagnostic modalities in patients with recurrent thyroid carcinoma.

              Andrea Frilling, Rainer Görges, Karsten Tecklenborg … (2000)
              Patients with well-differentiated thyroid cancer (WDTC) regularly have an excellent prognosis. However, tumor recurrence either involving the thyroid bed or the regional lymph nodes, or both, can be associated with significant morbidity and even mortality. The aim of the follow-up after primary surgery is to detect recurrent disease at its earliest stage. We assessed the value of different diagnostic methods in detecting locoregional recurrence in patients with WDTC. We prospectively identified 150 patients with WDTC. Of those, 43 (28.7%) presented with recurrent disease. Ultrasonography-guided fine needle biopsy (US-FNB), iodine 131 ((131)I) wholebody scintigraphy, thyroglobulin (Tg) measurement, and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) were carried out. Ultrasonography detected malignant lesions in 95.3% of the patients. The true positive rate of US-FNB was 95.3%. (131)I scanning had true positive, false negative, and false positive results in 54.2%, 40.0%, and 5.7% of the cases, respectively. In 85.7% of the patients, Tg levels were within pathologic range. Among the 13 patients who underwent FDG-PET, 84.6% showed pathologic uptake indicating malignancy. US and US-FNB provided the highest specificity for detecting recurrence (P <.001). In patients with WDTC and locoregional recurrence, US and US-FNB are the most sensitive methods in detecting local recurrence or regional lymph node metastases. FDG-PET is valuable in case of negative (131)I scanning results and elevated serum Tg levels. The method has limitations in finding minimal disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Biol Chem
                Journal ID (publisher-id): WJBC
                Title: World Journal of Biological Chemistry
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 1949-8454
                Publication date (Print): 26 February 2017
                Publication date (Electronic): 26 February 2017
                Volume: 8
                Issue: 1
                Pages: 81-85
                Affiliations
                Buddhike Sri Harsha Indrasena, Consultant General and Endocrine Surgeon, Kandy General Hospital (Teaching), Kandy 20000, Sri Lanka
                Author notes

                Author contributions: Indrasena BSH performed the whole of the writing.

                Correspondence to: Buddhike Sri Harsha Indrasena, MBBS (Hons), MS (Surgery), MSc (Statistics), MRCS(Ed), Consultant General and Endocrine Surgeon, Kandy General Hospital (Teaching), William Gopallawa Mawatha, Kandy 20000, Sri Lanka. indrasenaharsha@ 123456gmail.com

                Telephone: +94-718-713457 Fax: +94-812-233343

                Article
                Other ID: jWJBC.v8.i1.pg81
                DOI: 10.4331/wjbc.v8.i1.81
                PMC ID: 5329716
                PubMed ID: 28289520
                SO-VID: 9895ead0-c567-49e9-baa1-3a71a94b9dfb
                Copyright © ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 28 September 2016
                Date revision received : 28 December 2016
                Date accepted : 11 January 2017
                Categories
                Subject: Minireviews

                Keywords: thyroglobulin,thyroid cancer,recurrent thyroid cancer,anti-thyroglobulin antibodies,tumour marker
                Data availability:
                Keywords: thyroglobulin, thyroid cancer, recurrent thyroid cancer, anti-thyroglobulin antibodies, tumour marker

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