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Assessing the utility of preoperative serum thyroglobulin in differentiated thyroid cancer: a retrospective cohort study

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Abstract

Purpose

Serum thyroglobulin (TG) is used to monitor for recurrence or progression of differentiated thyroid cancer (DTC). The role of preoperative TG measurement is more ambiguous, yet still being used in some centers. We aimed to determine whether preoperative TG correlates with disease stage or metastatic burden.

Methods

A retrospective review of patients with TG measured before thyroidectomy was conducted. Data collected included demographics, preoperative TG, pathology, and cancer stage. Associations between preoperative TG levels and size of largest malignant nodule, thyroid gland size, stage of cancer, and presence of metastasis using Wilcoxon rank sum tests and Spearman correlations were performed. Receiver operator curve (ROC) was generated for metastasis status.

Results

Of 598 patients, we excluded those with positive TG antibodies (n = 176); 422 patients were included in the final analysis. Median age was 55 years and 76% were female. Of 78% with malignancy, papillary thyroid cancer was the most frequent (92%). 18% had TG levels >500 ng/mL and 29% <45 ng/mL. 4% had distant metastasis and 18% had lymph node metastasis. Median follow-up was 52 months. Significant positive correlations between preoperative TG and thyroid size (rho 0.49, p < 0.001), and malignant nodule size (rho 0.27, p < 0.001). Using a cut-off of 500 ng/mL, sensitivity to detect metastasis was 10.3% (95% CI 2.5–18.2), specificity 90.0% (95% CI 86.0–93.9). The area under curve for ROC (0.46, 95% CI 0.38–0.54) indicated poor diagnostic ability for metastasis.

Conclusion

Although preoperative TG correlated significantly with the size of the gland and T stage, there was no correlation with metastasis. Preoperative TG is of limited utility in today’s value-based healthcare environment.

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Acknowledgements

We would like to thank Ahmet Bahadir Ergin, MD, for the study design and Pumima Tripathy, MD, for helping with data collection.

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Authors and Affiliations

  1. Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA

    Rushad Patell

  2. Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Alexandra Mikhael

  3. University of Vermont, Burlington, VT, 05405, USA

    Michael Tabet

  4. Quantitative Health Sciences Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    James Bena

  5. Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Eren Berber & Christian Nasr

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  1. Rushad Patell
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  2. Alexandra Mikhael
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  3. Michael Tabet
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  5. Eren Berber
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Correspondence to Alexandra Mikhael.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Patell, R., Mikhael, A., Tabet, M. et al. Assessing the utility of preoperative serum thyroglobulin in differentiated thyroid cancer: a retrospective cohort study. Endocrine 61, 506–510 (2018). https://doi.org/10.1007/s12020-018-1643-z

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  • DOI: https://doi.org/10.1007/s12020-018-1643-z

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