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Practical Management of Thyroid Cancer pp 155–186Cite as

Thyroglobulin

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Abstract

Thyroglobulin (Tg) is the large (660 kDa) glycoprotein that is synthesized exclusively by thyroid follicular cells and serves as the scaffold for thyroid hormonogenesis. Since thyroid tissue is the only source of circulating Tg, serum Tg measurement is the cornerstone of post-operative biochemical monitoring for recurrence in patients with follicular-derived (differentiated) thyroid cancer (DTC). However, technical limitations negatively impact the clinical utility and interpretation of Tg measurements, irrespective of whether the Radioimmunoassay, (RIA), Immunometric assay, (IMA) or Liquid Chromatography Tandem Mass Spectrometry, (LC-MS/MS) class of method is used. There are intrinsic sensitivity differences between the different methodologies as well as between assays from the same methodologic class. Methods also differ in specificity for detecting the heterogeneous Tg isoforms in serum, resulting in wide between-method discordances that preclude changing methods while monitoring DTC patients. The Tg autoantibodies (TgAb) that are present in approximately 25% of DTC patients remain a persistent problem, causing interference with primarily the IMA class of methods, but also potentially influencing the clinical utility of RIA and LC-MS/MS measurements by in-vitro and/or in-vivo mechanisms. This chapter will discuss the biological factors and technical limitations that impact the clinical utility of serial Tg monitoring of DTC patients with and without TgAb present.

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Abbreviations

CRM-457:

Certified reference material

CV:

Coefficient of variation

DTC:

Differentiated thyroid cancer

FNA:

Fine needle aspiration

FNAB:

Fine needle aspiration biopsy

FS:

Functional sensitivity

HAb:

Heterophile antibody

HAMA:

Human anti-mouse antibody

hCG:

Human chorionic gonadotropin

IMA:

Immunometric assay

LC-MS/MS:

Liquid chromatography tandem mass spectrometry

LOQ:

Limit of quantitation

L-T4:

Levothyroxine

Lx:

Lobectomy

MAb:

Monoclonal antibody

MCO:

Manufacturer cutoff

NPV:

Negative predictive value

PAb:

Polyclonal antibody

PPV:

Positive predictive value

PTC:

Papillary thyroid cancer

PTH:

Parathyroid hormone

RAI:

Radioiodine

RF:

Rheumatoid factor

rhTSH:

Recombinant human TSH

RIA:

Radioimmunoassay

Tg:

Thyroglobulin

TgAb:

Thyroglobulin autoantibodies

TRAb:

TSH receptor antibodies

TSH:

Thyroid stimulating hormone

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Authors and Affiliations

  1. Kaiser Permanente, Panorama City, CA, USA

    Shireen Fatemi

  2. University of Southern California, USC Endocrine Laboratory, Pasadena, CA, USA

    Carole Spencer

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  1. Shireen Fatemi
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Correspondence to Carole Spencer .

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  1. Consultant (Hon), Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK

    Ujjal K. Mallick

  2. London, UK

    Clive Harmer

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Fatemi, S., Spencer, C. (2018). Thyroglobulin. In: Mallick, U.K., Harmer, C. (eds) Practical Management of Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-91725-2_15

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