engleski

Serum thyroglobulin (Tg) in detection of regional DTC metastases off- and on- hormone suppression therapy

A prospective study was conducted to evaluate diagnostic significance of serum thyroglobulin (Tg) in the detection of the regional lymph node metastases (LNM) of differentiated thyroid cancer (DTC). We evaluated serum Tg data during and off L-T4 therapy in 76 patients (pts) with DTC. There were 69/76 pts (90.1%) with papillary and 7/76 pts (9.9%) with follicular DTC. Mean age at time of DTC diagnosis was 43.3 ą 14.6 yrs, with male to female ratio 1:3.2. Follow-up, after thyroidectomy and 131-I ablation of the thyroid remnant, lasted for 3 years for each pt. The presence of LNM was established by neck ultrasonography (USG) with ultrasound-guided biopsy (UGB) and 131-I whole-body scintigraphy (WBS). Serum Tg levels were determined by commercial IRMA assay. Values >5 ng/ml were considered abnormal. In pts with LNM (15/76; 19.7%), off T4, mean (ą SD) Tg level measured 19.6ą51.7 ng/ml; what was significantly higher than in pts without signs of disease (2.8ą8.8 ng/ml; p=0.001). Off L-T4, in 12/15 of LNM pts (80%) Tg levels ranged between 5.1-203 ng/ml; while 3/15 LNM pts had a Tg less than 5 ng/ml. 131-I scans were negative in 2 LNM pts with elevated Tg and in all 3 LNM pts with negative Tg. During L-T4, Tg level ranged in 14/15 of LNM pts from 0.01-3.4 ng/ml. Only one LNM pt had slightly elevated Tg (6,8 ng/ml). Mean (ą SD) Tg value, during L-T4, in LNM pts measured 1.06ą2.13 ng/ml, and was significantly decreased in comparison to the Tg value measured off L-T4 therapy (p=0,019). We conclude that Tg and 131-I WBS are complementary in the follow-up of pts with DTC, and that in most pts with LNM, Tg assay during L-T4 therapy can not be used to rule out the presence of cancer. The combined use of three diagnostic modalities (serum Tg, 131-I WBS, USG with UGB) appears to give the best results in detecting DTC lymph node metastases in the neck region.

Serum thyroglobulin (Tg) in detection of regional DTC metastases off- and on- hormone suppression therapy

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