J Korean Thyroid Assoc.  2012 Nov;5(2):148-156. 10.11106/jkta.2012.5.2.148.

Serial Measurements of Off-Thyroxine Serum TSH and Thyroglobulin Levels to Predict Local and/or Systemic Metastasis of Papillary Thyroid Cancer after Total Thyroidectomy

• Lee JW
• Kim SH
• Lee SA
• Koh GP
• Lee SM
• Lee DH

• KMID: 2095105
• DOI: http://doi.org/10.11106/jkta.2012.5.2.148

Abstract

BACKGROUND AND OBJECTIVES
Off-thyroxine serum thyroglobulin (Tg) level is important to predict metastatic disease (MD) in papillary thyroid cancer (PTC); however, it is unclear whether a single off-thyroxine Tg level is sufficient for predicting MD. In this study, we determined whether serial measurement of off-thyroxine serum Tg level can predict metastasis in PTC patients after total thyroidectomy.
MATERIALS AND METHODS
We enrolled 140 PTC patients in whom serum thyroid-stimulating hormone (TSH) and Tg levels were measured 7 days before radio-iodine (RAI) treatment (TSHA and TgA) and on the day of RAI treatment (TSHB and TgB) with withholding L-thyroxine for 4 weeks before RAI treatment. The values of TSHinc (TSHB-TSHA) and Tginc (TgB-TgA), Tgratio (TgB/TgA), Tginc/TSHinc and Tgratio/TSHinc were calculated. Tginc/TSHinc and Tgratio/TSHinc were tested if those parameters can predict MD in patients with TSHA>30 microIU/mL and TgA<10 ng/mL.
RESULTS
Forty-four patients had MD and 96 had no evidence of MD (non-MD). MD group showed higher levels of TgA, TgB, Tginc, Tginc/TSHinc and Tgratio/TSHinc compared with non-MD group. A significant correlation was found between TSHinc and Tgratio (r=0.669) in MD group. In 43 patients with TSHA>30 microIU/mL and TgA<10 ng/mL (MD, 9; non-MD, 34), both Tginc/TSHinc (100%) and Tgratio/TSHinc (89%) had higher sensitivities for predicting MD than TgB (78%).
CONCLUSION
With the increment in serum Tg corrected for the increment in serum TSH, serial measurements of off-thyroxine serum TSH and Tg levels can help predict PTC metastasis.

Keyword

Thyroid cancer; Thyroglobulin; TSH

MeSH Terms

Factor IX
Humans
Neoplasm Metastasis
Thyroglobulin
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy
Thyrotropin
Thyroxine
Factor IX
Thyroglobulin
Thyrotropin
Thyroxine

Figure

• 

  Fig. 1 Scatter plot showing the correlation between TSHinc and Tgratio in the MD group (A) and the non-MD group (B). A moderate correlation was observed in the MD group (A, p<0.001; r=0.669) and a weak correlation was observed in the non-MD group (B, p<0.0001; r=0.419).

• 

  Fig. 2 A 41-year-old female with PTC underwent 5.6 GBq radio-iodine (RAI) treatment after surgical resection of neck lymph node recurrence. TSHA, TgA, TSHB, and TgB levels were 34.7 µIU/mL, 5.4 ng/mL, 100 µIU/mL, and 25.4 ng/mL, respectively. The Tginc/TSHinc and Tgratio/TSHinc were 0.31 and 0.07, respectively, which were higher than our cut-off values. A post-therapeutic RAI scan (A) did not show abnormal RAI uptake; however, FDG PET/CT (B) performed on the day of RAI treatment showed focal intense 18F-FDG uptake in the left neck area (arrows), which was histopathologically confirmed as metastatic PTC.

• 

  Fig. 3 ROC curves of Tginc/TSHinc (A) and Tgratio/TSHinc (B) for detecting patients with MD in a subgroup of patients with TSHA>30 µIU/mL and TgA<10 ng/mL.

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