Int J Thyroidol.  2017 May;10(1):5-13. 10.11106/ijt.2017.10.1.5.

Consideration of Serum Thyrotropin When Interpreting Serum Thyroglobulin Level in Patients with Differentiated Thyroid Cancer

• Son SH
• Lee CH
• Jung JH
• Kim CY
• Jeong JH
• Jeong SY
• Lee SW
• Lee J
• Ahn BC

• KMID: 2379356
• DOI: http://doi.org/10.11106/ijt.2017.10.1.5

Abstract

BACKGROUND AND OBJECTIVES
The level of thyroid-stimulating hormone (TSH)-stimulated thyroglobulin (Tg) after thyroid hormone withdrawal (THW) is the most sensitive marker for detecting recurrence of differentiated thyroid cancer (DTC). In DTC, Tg production is regulated by TSH; however, TSH values after THW are never identical, even in the same patient. The objective of this study was to evaluate the influence of TSH on Tg levels after THW.
MATERIALS AND METHODS
TSH and Tg concentrations were measured twice at 2 and 3 weeks after THW in 309 patients with DTC. TSH and Tg levels at these time points were compared. The percent change in TSH (ΔTSH) and change in Tg level (%ΔTg) from 2 to 3 weeks after THW were calculated, and Pearson's correlation coefficients were calculated to determine whether ΔTSH could affect %ΔTg. Tg cutoff value for diagnostic imaging was 2 ng/mL.
RESULTS
The TSH and Tg values at 3 weeks were significantly higher than those at 2 weeks after THW. Tg values increased significantly to >2 ng/mL after 1 week in 38.5% of the patients with Tg values of 0.2-2 ng/mL at 2 weeks after THW. In patients with Tg values ≥2 ng/mL at 2 weeks after THW, Tg values increased significantly after an additional week of THW. ΔTSH correlated significantly with %ΔTg.
CONCLUSION
TSH values differed according to time after THW, and Tg values differed significantly according to TSH values. Therefore, TSH values should be considered carefully when interpreting the meaning of Tg levels in patients with DTC.

Keyword

Thyroid-stimulating hormone; Thyroid function test; Thyroglobulin; Thyroid cancer

MeSH Terms

Diagnostic Imaging
Humans
Recurrence
Thyroglobulin*
Thyroid Function Tests
Thyroid Gland*
Thyroid Neoplasms*
Thyrotropin*
Thyroglobulin
Thyrotropin

Figure

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  Fig. 1 Diagram of the study protocol. Tg: thyroglobulin, TSH: thyroid-stimulating hormone

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  Fig. 2 Flowchart for patients with application of exclusion criteria. Tg: thyroglobulin, THW: thyroid hormone withdrawal, TSH: thyroid-stimulating hormone

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  Fig. 3 Changes in serum thyroglobulin (Tg) values from 2 to 3 weeks after thyroid hormone withdrawal (THW) in all 309 patients.

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  Fig. 4 Pattern of changes in Tg values in accordance with the increase in the thyroid-stimulating hormone values in 53 patients with Tg values of >2 ng/mL at 2 weeks after thyroid hormone withdrawal (THW).

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  Fig. 5 Relationship between thyroglobulin (Tg) and thyroid-stimulating hormone (TSH) in 53 patients with a Tg value of >2 ng/mL at 2 weeks after thyroid hormone withdrawal.

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