For evaluating the clinical significance of thyroglobulin measurements for the follow-up of patients with differentiated thyroid carcinoma, thyroglobulin was determined radioimmunologically during the past 2 years (up to 12 times) in 40 patients after withdrawal of thyroid hormone. Thyroglobulin values were compared with whole-body scintigrams after radioiodine. Thyroglobulin antibodies, which may interfere in the radioimmunoassay for thyroglobulin, were also estimated by a radioimmunologic method. In the majority of cases, thyroglobulin levels corresponded to the scintigrams, however, the thyroglobulin level appeared to be a more precise index for changes in tumor tissue mass. In one patient the scintigram was negative, whereas considerable amounts of thyroglobulin were measured in the serum: X-ray tomography revealed a lung metastase in this case. On the other hand, thyroglobulin was undetectable in the sera of patients who exhibited distinct metastases in the scintigram. Thyroglobulin can be regarded as a tumor marker in patients thyroidectomized for differentiated thyroid carcinoma. However, its determination can certainly not replace whole-body scintigraphy as postulated by several authors, although thyroglobulin measurement appears to be superior to scanning in some cases. A combined application of iodine scanning and thyroglobulin radioimmunoassay is thus advisable in the follow-up of patients with differentiated thyroid carcinoma.
Osteocalcin is synthesized by osteoblasts and its concentration in serum is increased when bone metabolism is raised. Radioimmunoassay of serum from 88 healthy adults gave a mean osteocalcin value for the whole group of 4.11 +/- 1.43 ng/ml. The level rose with age. In seven patients with primary hyperparathyroidism the mean value was markedly raised to 19.37 +/- 9.2 ng/ml, in 23 with metastasizing carcinoma of the breast it was elevated to 6.57 +/- 2.98 ng/ml. Serial measurements in 14 female patients over seven months revealed different changes in osteocalcin and alkaline phosphatase in some of them. In patients with breast cancer and soft-tissue metastases or without metastases both osteocalcin and alkaline phosphatase levels were normal. Three of 17 patients with multiple myeloma had increased osteocalcin levels. These results indicate that it is clinically helpful to know osteocalcin levels in primary hyperparathyroidism. Determination of osteocalcin concentration, in addition to that of alkaline phosphatase, can be of value in the postmastectomy management of patients with breast cancer, especially in the early recognition of bone metastases. The diagnostic value of osteocalcin levels in multiple myeloma remains undecided.
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