Prognostic value of serial serum thyroglobulin determinations after total thyroidectomy for differentiated thyroid cancer

Abstract

Serial weekly serum samples (for 3 weeks) were obtained from 42 patients with differentiated thyroid cancer (DTC, papillary no.=35, follicular no.=6, Hürthle cell no.=1) for serum thyroid hormone, TSH and TG before and after total thyroidectomy. Serum specimens were also obtained one month after radioiodine (¹³¹I) therapy followed by suppressive dose of L-thyroxine (L-T₄, 2.5 μg/kg). The patients were subdivided into four groups: group I: the DTC was confined to a single solid nodule (no.=12); group II: thyroid malignancy invaded local cervical structures but there were no lymph node metastases (no.=8); group III: DTC with lymph node metastases (no.=6); and group IV: DTC with distant metastases (no.=16). In all group I patients serum TG remained undetectable in spite of elevated serum TSH levels at the 3rd week post-surgery (PS). Only one of group II patients had a detectable serum TG value of 5.2 ng/ml (3^rd week PS). By contrast, 37.5% of group III patients had detectable serum TG levels, ranging from 3.4 to 16.8 ng/ml (3^rd week PS). Lymph node metastases were detected in 5 of these patients by whole body scan (WBS) and removed surgically in 3. As expected, group IV patients had elevated serum TG values ranging 33.0–958.0 ng/ml and distant metastases were confirmed in all of them by WBS. From the calculations through univariate logistic regression comparing TG concentrations at the 3^rd week PS from groups I and II vs groups III and IV, we obtained a cut-off value of 2.3 ng/ml with the following efficacy features: sensitivity= 74.5%; specificity=95%; positive predictive value=92.3%; negative predictive value= 65.5%; and accuracy=73.8%. After ¹³¹I and L-T₄ suppressive therapy, only 5 out of 36 patients of groups I, II and III had detectable serum TG levels (3.1–7.0 ng/ml) whereas serum TG was detectable in all group IV patients (ranging 2.5–8.6 ng/ml). We concluded that serum TG concentrations above 2.3 ng/ml at the 3^rd week PS could be suggestive of lymph node or distant metastases in patients with DTC. Patients with serum TG above this limit could be considered at risk for metastatic disease and higher doses of diagnostic iodine-131 (¹³¹I) may be indicated for actinic ablation.