An evaluation of the value of first thyroglobulin determination in the diagnostics of metastases immediately following differentiated thyroid carcinoma surgery
2006
Introduction : Evaluation of the differential value of the first
thyroglobulin (Tg) concentration, measured after thyroidectomy
(Tx) but before thyroid remnant ablation, in patients
with differentiated thyroid carcinoma (DTC) as a marker of
either metastases or residual cancer (M).
Material and methods : Data from 517 patients with DTC
after Tx, with follow-up > 1.5 year were analysed retrospectively.
Patients in whom either the course of the disease was
unclear or interference in the Tg test was possible (a-TgAb
[+], Tg recovery up24 ), thyroid remnant volume (V) and
Tg in patients with diagnosed M (group M1; n = 35) were
compared with the same parameters in patients with remission
> 1.5 year (group M0; n = 212). The area under the
ROC curve was calculated. The clinical decision limit of Tg
level to be suggestive of metastases was determined by
means of efficiency curve.
Results : Groups M0 and M1 did not differ from each other
with respect to TSH concentration (median 49.7 mIU/l vs
44.3; p = 0.16) or thyroid remnant volume (1.4 vs 1.1 ml;
p = 0.79). However, they did differ with respect to T up24 (7.6 vs 3.2%; p = 0.01) and Tg (4.5 vs 96.7 ng/ml;
p = 0.000000). Area under ROC for Tg was 0.78 ± 0.05 (mean ± s.e.m.). The decision limit of Tg for suspected M was determined
at 38.1 ng/ml, Tg sensitivity was 0.57 (95%CI 0.39-0.74) and specificity 0.96 (95%CI 0.92-0.98).
Conclusions : First thyroglobulin concentration, determined
after thyroidectomy but before other treatment, is higher
in patients with metastatic DTC than in patients without
such metastases. This indicates that Tg level may be used as
an early marker of either residual or metastatic DTC (even
if thyroid remnants are present).
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