Serum Thyroglobulin Monitoring after Thyroid Lobectomy for Differentiated Thyroid Carcinoma: a Narrative Review and Contemporary Guidelines
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Thyroid lobectomy has become increasingly common for low-risk differentiated thyroid carcinoma (DTC), yet the role of serum thyroglobulin (Tg) monitoring in this setting remains unclear. This narrative review synthesizes evidence from longitudinal cohort studies and systematic reviews published through January 2025, focusing on the diagnostic performance and clinical utility of serum Tg measurement after thyroid lobectomy. After lobectomy, the residual thyroid lobe continues to produce Tg physiologically, leading to measurable serum levels that often increase gradually over time even in the absence of recurrence. Multiple longitudinal studies demonstrate that Tg measurements have limited sensitivity and specificity for detecting recurrent disease after lobectomy, with considerable overlap between patients with and without structural progression. The presence of anti-Tg antibodies in a substantial proportion of patients further complicates reliable interpretation. Recent systematic reviews and meta-analyses consistently report limited diagnostic performance of serial Tg monitoring in post-lobectomy surveillance. Current international guidelines do not endorse routine serial serum Tg testing after lobectomy and prioritize ultrasound-anchored surveillance. An early postoperative nonstimulated Tg may be obtained to screen for unexpectedly high values. Selective remeasurement of Tg can be considered if levels remain elevated or rise over time, particularly when ultrasound is negative. However, imaging with cytologic or histologic confirmation remains the cornerstone of clinical decision-making, with Tg serving as a selective adjunct only in specific clinical contexts.
Abstract
Thyroid lobectomy has become increasingly common for low-risk differentiated thyroid carcinoma (DTC), yet the role of serum thyroglobulin (Tg) monitoring in this setting remains unclear. This narrative review synthesizes evidence from longitudinal cohort studies and systematic reviews published through January 2025, focusing on the diagnostic performance and clinical utility of serum Tg measurement after thyroid lobectomy. After lobectomy, the residual thyroid lobe continues to produce Tg physiologically, leading to measurable serum levels that often increase gradually over time even in the absence of recurrence. Multiple longitudinal studies demonstrate that Tg measurements have limited sensitivity and specificity for detecting recurrent disease after lobectomy, with considerable overlap between patients with and without structural progression. The presence of anti-Tg antibodies in a substantial proportion of patients further complicates reliable interpretation. Recent systematic reviews and meta-analyses consistently report limited diagnostic performance of serial Tg monitoring in post-lobectomy surveillance. Current international guidelines do not endorse routine serial serum Tg testing after lobectomy and prioritize ultrasound-anchored surveillance. An early postoperative nonstimulated Tg may be obtained to screen for unexpectedly high values. Selective remeasurement of Tg can be considered if levels remain elevated or rise over time, particularly when ultrasound is negative. However, imaging with cytologic or histologic confirmation remains the cornerstone of clinical decision-making, with Tg serving as a selective adjunct only in specific clinical contexts.