Abstract
Thyroglobulin (Tg) is fundamental for differentiated thyroid cancer (DTC) monitoring. Tg detection can be enhanced using recombinant human thyroid-stimulating hormone (TSH) (rhTSH). This study is aimed to evaluate the use of the rhTSH stimulation test when using a high-sensitivity Tg assay. We retrospectively studied 181 rhTSH tests from 114 patients with DTC and negative for antithyroglobulin antibodies (anti-TgAb). Image studies were performed in all cases. Serum Tg and anti-TgAb were measured using specific immunoassays. rhTSH stimulation in patients with basal serum Tg (b-Tg) concentrations lower than 0.2ng/mL always resulted in rhTSH-stimulated serum Tg (s-Tg) concentrations lower than 1.0ng/mL and negative structural disease. In patients with b-Tg concentration between 0.2 and 1.0ng/mL, s-Tg detected one patient (1/30) who showed biochemical incomplete response. Patients with negative images had lower s-Tg than those with nonspecific or abnormal findings (p<0.05). Receiver operating characteristic curve analysis of the s-Tg to detect altered images showed an area under the curve of 0.763 (p<0.05). With an s-Tg cutoff of 0.85ng/mL, the sensitivity was 100%, decreasing to 96.15% with an s-Tg cutoff of 2ng/mL. Patients with DTC with b-Tg concentrations equal or higher than 0.2ng/mL can benefit from the rhTSH stimulation test.
Highlights
Differentiated thyroid cancer (DTC) comprises less than 1% of malignant neoplasia, it represents the most prevalent endocrine cancer, with an increasing incidence worldwide, being more frequent in middle-aged women [1]
Stimulation with recombinant human TSH (rhTSH) in group A patients always resulted in serum Tg (s-Tg) concentrations lower than 1.0 ng/mL (Tables 1 and 2), which corresponds to excellent response in accordance with the dynamic stratification assessment of the American Thyroid Association (ATA)
In patients with differentiated thyroid cancer (DTC) treated by total thyroidectomy in addition to radioactive iodine ablation (RAI), the rhTSH stimulation test has been used rhTSH stimulated Thyroglobulin
Summary
Differentiated thyroid cancer (DTC) comprises less than 1% of malignant neoplasia, it represents the most prevalent endocrine cancer, with an increasing incidence worldwide, being more frequent in middle-aged women [1]. Tg becomes the fundamental biomarker in DTC monitoring [2, 4] and a key factor in the assessment of the dynamic stratification of response to treatment [5]. The 2015 American Thyroid Association (ATA) guidelines classified patients’ response in accordance with basal serum Tg (b-Tg) and stimulated (s-Tg) serum Tg concentrations [2]. Thyroglobulin (Tg) is fundamental for differentiated thyroid cancer (DTC) monitoring. This study is aimed to evaluate the use of the rhTSH stimulation test when using a high-sensitivity Tg assay. Methods: We retrospectively studied 181 rhTSH tests from 114 patients with DTC and negative for antithyroglobulin antibodies (anti-TgAb). Results: rhTSH stimulation in patients with basal serum Tg (b-Tg) concentrations lower than 0.2 ng/mL always resulted in rhTSH-stimulated serum Tg (s-Tg) concentrations lower than 1.0 ng/mL and negative structural disease.
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