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Role of thyroglobulin in the management of patients with differentiated thyroid cancer

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Abstract

Purpose

To discuss the role and limitations of serum thyroglobulin (Tg) assay in management of differentiated thyroid cancer (DTC) from the perspective of nuclear medicine (NM) physicians.

Methods

We performed a literature search in electronic databases PubMed, Embase, and the Cochrane Library up to January 2019 using the following key words: thyroid, cancer/carcinoma/neoplasm, and thyroglobulin. We included prospective and retrospective original and recent studies written in English regarding Tg in DTC.

Results

Serum Tg level can reflect disease status. It is a tumor marker of DTC. Many studies have confirmed the clinical roles of Tg in monitoring thyroid remnant, locoregional, and distant metastatic disease, tailoring radioactive iodine (RAI) therapy, and predicting persistence or recurrence as well as response to treatment. Most NM physicians in Asia are actively involved in the management of DTC. They are actively using serologic markers such as Tg, anti-Tg antibody, and thyroid stimulating hormone as well as imaging studies including neck ultrasound and RAI whole body scan. Authors suggest an algorithm for the use of serum Tg assay as an indicator of RAI therapy. Pitfalls of interpretation and complementary roles of Tg and imaging studies are discussed.

Conclusions

Serum Tg is a useful biomarker for risk stratification and decision-making in the management of DTC. It is expected to be used more widely in NM practice.

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Abbreviations

ATA:

American Thyroid Association

DTC:

Differentiated thyroid cancer

FDG:

Fluorodeoxyglucose

FNA:

Fine needle aspiration

HAb:

Heterophile antibody

IRMA:

Immunoradiometric assay

LC–MS/MS:

Liquid chromatography–tandem mass spectrometry

NM:

Nuclear medicine

PET/CT:

Positron emission tomography/computed tomography

RAI:

Radioactive iodine

rhTSH:

Recombinant human thyroid stimulating hormone

RIA:

Radioimmunoassay

SPECT/CT:

Single photon emission computed tomography/computed tomography

SUVmax:

Maximum standardized uptake value

THW:

Thyroid hormone withdrawal

Tg:

Thyroglobulin

TgAb:

Anti-thyroglobulin antibody

US:

Ultrasound

WBS:

Whole body scan

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Acknowledgements

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2016R1D1A3B01006631).

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Author notes

  1. Seong Young Kwon and Yingjie Zhang contributed equally to this work as co-first authors.

Authors and Affiliations

  1. Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128, Republic of Korea

    Seong Young Kwon & Hee-Seung Bom

  2. Department of Nuclear Medicine, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China

    Yingjie Zhang

  3. Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing, China

    Yansong Lin

  4. Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea

    Byeong-Cheol Ahn

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  1. Seong Young Kwon
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  2. Yingjie Zhang
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Contributions

SYK: Literature search and review, manuscript writing, and editing. YJZ: Literature search and review, manuscript writing, and editing. YSL: Manuscript writing, editing, and content planning. BCA: Manuscript writing and editing. HSB: Literature search and review, manuscript writing and editing, and content planning.

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Correspondence to Hee-Seung Bom.

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Seong Young Kwon, Yingjie Zhang, Yansong Lin, Byeong-Cheol Ahn, and Hee-Seung Bom declare that they have no conflict of interest.

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Kwon, S.Y., Zhang, Y., Lin, Y. et al. Role of thyroglobulin in the management of patients with differentiated thyroid cancer. Clin Transl Imaging 7, 209–217 (2019). https://doi.org/10.1007/s40336-019-00325-4

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