Consideration of Serum Thyrotropin When Interpreting Serum Thyroglobulin Level in Patients with Differentiated Thyroid Cancer
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (25)
- Budak A, "Lack of influence of pregnancy on the prognosis of survivors of thyroid cancer", Asian Pac J Cancer Prev, 14(11), pp.6941~6943 (2013)
- Lin Y, "Predictive value of preablation stimulated thyroglobulin and thyroglobulin", thyroid-stimulating hormone ratio in differentiated thyroid cancer, 2011, pp.36(12), 1102~1105
- Mazzaferri EL, "An overview of the management of papillary and follicular thyroid carcinoma", Thyroid, 9(5), pp.421~427 (1999)
- Mazzaferri EL, "Clinical review 128: Current approaches to primary therapy for papillary and follicular thyroid cancer", J Clin Endocrinol Metab, 86(4), pp.1447~1463 (2001)
- Cooper DS, "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 19(11), pp.1167~1214 (2009)
- Mazzaferri EL, "A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma", J Clin Endocrinol Metab, 88(4), pp.1433~1441 (2003)
- Schlumberger MJ, "Papillary and follicular thyroid carcinoma", N Engl J Med, 338(5), pp.297~306 (1998)
- Brassard M, "Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients", J Clin Endocrinol Metab, 96(5), pp.1352~1359 (2011)
- Haugen BR, "A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer", J Clin Endocrinol Metab, 84(11), pp.3877~3885 (1999)
- Kloos RT, "Thyroid cancer recurrence in patients clinically free of disease with undetectable or very low serum thyroglobulin values", J Clin Endocrinol Metab, 95(12), pp.5241~5248 (2010)
- Kloos RT, "A single recombinant human thyrotropin-stimulated serum thyroglobulin measurement predicts differentiated thyroid carcinoma metastases three to five years later", J Clin Endocrinol Metab, 90(9), pp.5047~5057 (2005)
- Mazzaferri EL, "Is diagnostic iodine-131 scanning with recombinant human TSH useful in the follow-up of differentiated thyroid cancer after thyroid ablation?", J Clin Endocrinol Metab, 87(4), pp.1490~1498 (2002)
- Edmonds CJ, "Measurement of serum TSH and thyroid hormones in the management of treatment of thyroid carcinoma with radioiodine", Br J Radiol, 50(599), pp.799~807 (1977)
- Goldman JM, "Influence of triiodothyronine withdrawal time on 131I uptake postthyroidectomy for thyroid cancer", J Clin Endocrinol Metab, 50(4), pp.734~739 (1980)
- Hershman JM, "Serum thyrotropin (TSH) levels after thyroid ablation compared with TSH levels after exogenous bovine TSH: implications for 131-I treatment of thyroid carcinoma", J Clin Endocrinol Metab, 34(5), pp.814~818 (1972)
- Hilts SV, "Serial TSH determination after T3withdrawal or thyroidectomy in the therapy of thyroid carcinoma", J Nucl Med, 20(9), pp.928~932 (1979)
- Tamai H, "Alterations in circulating thyroid hormones and thyrotropin after complete thyroidectomy", J Clin Endocrinol Metab, 48(1), pp.54~58 (1979)
- Valle LA, "In thyroidectomized patients with thyroid cancer, a serum thyrotropin of 30 muU", mL after thyroxine withdrawal is not always adequate for detecting an elevated stimulated serum thyroglobulin, 2013, pp.23(2), 185~193
- Kendler DB, "Preablation stimulated thyroglobulin is a good predictor of successful ablation in patients with differentiated thyroid cancer", Clin Nucl Med, 37(6), pp.545~549 (2012)
- Tamilia M, "Serum thyroglobulin predicts thyroid remnant ablation failure with 30 mCi iodine-131 treatment in patients with papillary thyroid carcinoma", Nucl Med Commun, 32(3), pp.212~220 (2011)
- Eustatia-Rutten CF, "Diagnostic value of serum thyroglobulin measurements in the follow-up of differentiated thyroid carcinoma, a structured meta-analysis", Clin Endocrinol (Oxf), 61(1), pp.61~74 (2004)
- Pelttari H, "Post-ablative serum thyroglobulin is an independent predictor of recurrence in low-risk differentiated thyroid carcinoma: a 16-year follow-up study", Eur J Endocrinol, 163(5), pp.757~763 (2010)
- Toubeau M, "Predictive value for disease progression of serum thyroglobulin levels measured in the postoperative period and after (131)I ablation therapy in patients with differentiated thyroid cancer", J Nucl Med, 45(6), pp.988~994 (2004)
- Lin JD, "Significance of postoperative serum thyroglobulin levels in patients with papillary and follicular thyroid carcinomas", J Surg Oncol, 80(1), pp.45~51 (2002)
- Webb RC, "The utility of serum thyroglobulin measurement at the time of remnant ablation for predicting disease-free status in patients with differentiated thyroid cancer:a meta-analysis involving 3947 patients", J Clin Endocrinol Metab, 97(8), pp.2754~2763 (2012)