Thyroglobulin measurement using highly sensitive assays in patients with differentiated thyroid cancer: a clinical position paper

TY - JOUR

T1 - Thyroglobulin measurement using highly sensitive assays in patients with differentiated thyroid cancer:

T2 - a clinical position paper

AU - Giovanella, Luca

AU - Clark, Penelope M

AU - Chiovato, Luca

AU - Duntas, Leonidas

AU - Elisei, Rossella

AU - Feldt-Rasmussen, Ulla

AU - Leenhardt, Laurence

AU - Luster, Markus

AU - Schalin-Jäntti, Camilla

AU - Schott, Matthias

AU - Seregni, Ettore

AU - Rimmele, Herald

AU - Smit, Jan

AU - Verburg, Frederik A

N1 - © 2014 The authors.

PY - 2014/8

Y1 - 2014/8

N2 - Differentiated thyroid cancer (DTC) is the most common endocrine cancer and its incidence has increased in recent decades. Initial treatment usually consists of total thyroidectomy followed by ablation of thyroid remnants by iodine-131. As thyroid cells are assumed to be the only source of thyroglobulin (Tg) in the human body, circulating Tg serves as a biochemical marker of persistent or recurrent disease in DTC follow-up. Currently, standard follow-up for DTC comprises Tg measurement and neck ultrasound combined, when indicated, with an additional radioiodine scan. Measurement of Tg after stimulation by endogenous or exogenous TSH is recommended by current clinical guidelines to detect occult disease with a maximum sensitivity due to the suboptimal sensitivity of older Tg assays. However, the development of new highly sensitive Tg assays with improved analytical sensitivity and precision at low concentrations now allows detection of very low Tg concentrations reflecting minimal amounts of thyroid tissue without the need for TSH stimulation. Use of these highly sensitive Tg assays has not yet been incorporated into clinical guidelines but they will, we believe, be used by physicians caring for patients with DTC. The aim of this clinical position paper is, therefore, to offer advice on the various aspects and implications of using these highly sensitive Tg assays in the clinical care of patients with DTC.

AB - Differentiated thyroid cancer (DTC) is the most common endocrine cancer and its incidence has increased in recent decades. Initial treatment usually consists of total thyroidectomy followed by ablation of thyroid remnants by iodine-131. As thyroid cells are assumed to be the only source of thyroglobulin (Tg) in the human body, circulating Tg serves as a biochemical marker of persistent or recurrent disease in DTC follow-up. Currently, standard follow-up for DTC comprises Tg measurement and neck ultrasound combined, when indicated, with an additional radioiodine scan. Measurement of Tg after stimulation by endogenous or exogenous TSH is recommended by current clinical guidelines to detect occult disease with a maximum sensitivity due to the suboptimal sensitivity of older Tg assays. However, the development of new highly sensitive Tg assays with improved analytical sensitivity and precision at low concentrations now allows detection of very low Tg concentrations reflecting minimal amounts of thyroid tissue without the need for TSH stimulation. Use of these highly sensitive Tg assays has not yet been incorporated into clinical guidelines but they will, we believe, be used by physicians caring for patients with DTC. The aim of this clinical position paper is, therefore, to offer advice on the various aspects and implications of using these highly sensitive Tg assays in the clinical care of patients with DTC.

KW - Adenocarcinoma, Follicular

KW - Carcinoma

KW - Humans

KW - Iodine Radioisotopes

KW - Neck

KW - Sensitivity and Specificity

KW - Thyroglobulin

KW - Thyroid Neoplasms

KW - Thyroidectomy

KW - Thyrotropin

U2 - 10.1530/EJE-14-0148

DO - 10.1530/EJE-14-0148

M3 - Review

C2 - 24743400

SN - 0804-4643

VL - 171

SP - R33-R46

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

IS - 2

ER -