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Evidence for autonomous thyroglobulin release from euthyroid and hyperthyroid nodular goiter — thyroglobulin, a possible helpful parameter in diagnosis of non-malignant thyroid disorders

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Summary

Thyroglobulin (Tg) levels in serum of patients with diffuse goiter, “cold” nodules and autonomous adenomas were determined before and during TSH-suppressive therapy with thyroid hormones and antithyroid therapy with carbimazole, respectively.

In normal controls, Tg was found to be 14.5 ng/ml (median), with a range from <10−34 ng/ml (n=27). Tg-levels were significantly elevated in untreated diffuse goiter (median 48 ng/ml, range <10−193 ng/ml,n=68,p≦0.001), as well as in goiters with solid cold nodules (median 72.5 ng/ml, range 14−1,183 ng/ml,n=32,p≦0.001). In these cuthyroid disorders there was no difference in basal or stimulated TSH after TRH. The Tg-levels were unsuppressible in most patients with solid “cold” nodules (median 68.5 ng/ml, range ≦10−569,n=13) and in 25% of the patients with diffuse goiter during effective suppression of TSH with thyroid hormone therapy.

In autonomous adenomas, Tg-levels were also significantly elevated, irrespective of anti-thyroid treatment.

From these data we conclude:

  1. 1.

    The Tg-release is independent from the TSH-stimulation of the thyroid gland in “cold” nodules and autonomous adenomas.

  2. 2.

    Palpatory and scintigraphically defined diffuse goiters are heterogeneous, concerning the Tg-suppressibility in thyroid hormone treatment. This indicates TSH-independent Tg-release and corresponding to solid nodules may indicate autonomously functioning thyroid tissue or leakage of Tg from necrotic follicles, undetectable with conventional diagnostic procedures in vivo.

  3. 3.

    Tg-release seems to be independent from the release of thyroid hormones.

The possible diagnostic vlaue to the Tg-determination in euthyroid diffuse goiters during TSH-suppressive therapy may be the indication for partially autonomous or necrotic thyroid tissue.

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Authors and Affiliations

  1. Medizinische Klinik Innenstadt der Universität München, Germany

    R. Gärtner, A. Hainzinger, K. Horn & R. C. Pickardt

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  1. R. Gärtner
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  2. A. Hainzinger
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  3. K. Horn
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  4. R. C. Pickardt
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Supported by Deutsche Forschungsgesellschaft (DFG), Ga272/1-1

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Gärtner, R., Hainzinger, A., Horn, K. et al. Evidence for autonomous thyroglobulin release from euthyroid and hyperthyroid nodular goiter — thyroglobulin, a possible helpful parameter in diagnosis of non-malignant thyroid disorders. Klin Wochenschr 61, 737–741 (1983). https://doi.org/10.1007/BF01497400

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