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Can ultrasensitive thyroglobulin immunoassays avoid the need for ultrasound in thyroid cancer follow-up?

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Abstract

Purpose:

Differentiated thyroid cancer (DTC) is the most common endocrine neoplasm, with a rising incidence and a long life expectancy. It has recently been suggested that patients with low- and intermediate-risk DTC with a good response to treatment at one year could be followed up using only highly sensitive immunoassays for thyroglobulin (Tg). The aim of this study was to examine the serum Tg levels in a series of DTC patients with histologically proven persistent or recurrent diseases.

Methods:

The study involved 50 consecutive patients being routinely followed up at our center, whose clinical, histological, and biochemical data were retrospectively collected.

Results:

The false-negative rate of ultrasensitive serum Tg assay was 14.3% (5/35) overall, and limited to anti-thyroglobulin autoantibodies (TgAb)-negative patients. Among them, only one patient had an excellent response to treatment at one-year follow-up and was diagnosed with a 4 mm recurrence, after more than seven years of periodic ultrasounds. The size of the neck lesion documented in the histological report was slightly larger in patients with detectable as opposed to negative Tg values (P < 0.05).

Conclusions:

Serum highly sensitive Tg is undetectable in a proportion of patients with a proven persistent or recurrent DTC. The reasons behind this phenomenon are still unknown. However, in low/intermediate-risk patients cured at one-year follow-up, highly sensitive Tg without neck US seems an appropriate strategy for patients’ management.

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Data availability

All data generated or analyzed during this study are included in this published article. Further data are available from the corresponding author on reasonable request.

Code availability

MedCalc version 19.2.1 (MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org; 2020

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Acknowledgements

We thank Frances Coburn for text editing.

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Author notes

  1. These authors contributed equally: Simona Censi, Antonio De Rosa

Authors and Affiliations

  1. Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

    Simona Censi, Jacopo Manso, Loris Bertazza, Susi Barollo & Caterina Mian

  2. Department of Oncology, Veneto Institute of Oncology IOV IRCCS, Padua, Italy

    Antonio De Rosa

  3. Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy

    Francesca Galuppini & Gianmaria Pennelli

  4. Endocrine Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy

    Isabella Merante-Boschin & Maurizio Iacobone

  5. Laboratory Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy

    Mario Plebani & Diego Faggian

  6. Department of Radiotherapy, Veneto Institute of Oncology IOV IRCCS, Padua, Italy

    Federica Vianello

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  1. Simona Censi
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Correspondence to Caterina Mian.

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Censi, S., De Rosa, A., Galuppini, F. et al. Can ultrasensitive thyroglobulin immunoassays avoid the need for ultrasound in thyroid cancer follow-up?. Endocrine 75, 837–845 (2022). https://doi.org/10.1007/s12020-021-02936-2

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