Recurrence of papillary thyroid cancer suspected by high anti-thyroglobulin antibody levels and detection of peripheral blood thyroglobulin mRNA

Abstract

The amplifi cation of thyroglobulin (TG) mRNA in peripheral blood of patients with thyroid cancer has been studied for almost one decade, but its real contribution for diagnosis of cancer relapse has not yet been established. In the present paper we report the case of a patient with papillary thyroid cancer with undetectable stimulated serum thyrogobulin levels after thyroid ablation. Follow-up showed the presence of high titers of anti-thyroglobulin antibodies and the presence of TG mRNA in a peripheral blood sample, while cervical ultrasound and thorax and cervical computerized tomography were negative. Reinvestigation confi rmed lymph node metastases. Anti-TG antibodies progressively decreased after surgery for metastatic lymph nodes resection followed by radioiodine therapy. Although our recent fi ndings show that patients with positive TG mRNA do not have increased risk of cancer recurrence after 24 months of follow-up, the presence of TG mRNA along with high anti-TG antibodies were important indicators that determined further extensive investigation of tumour relapse in this patient, since positron emission tomography scan was not available at our Institution. A methodological standardization that can distinguish specifi c from non-specifi c TG mRNA amplifi cation might be of great interest for the follow-up of differentiated thyroid cancer, especially in patients with high levels of anti-TG antibodies. A amplifi cação de mRNA de tireoglobulina (TG) no sangue periférico de pacientes com câncer de tireóide tem sido estudada por quase uma década, mas a sua real contribuição para o diagnóstico do câncer ainda não foi estabelecida. No presente trabalho, relatamos o caso de uma paciente com carcinoma papilífero de tireóide com níveis séricos de TG indetectáveis após ablação com radioiodo. No seguimento apresentou títulos elevados de anticorpos anti-TG e a presença de mRNA TG em uma amostra de sangue periférico, enquanto a ultra-sonografi a e as tomografi as computorizadas de tórax e cervical foram negativas. Os níveis de anticorpos anti-TG diminuíram progressivamente após ressecção cirúrgica dos linfonodos seguida de terapia com radioiodo. Embora nossos achados recentes mostrem que pacientes com mRNA TG não apresentam risco aumentado de recorrência do câncer após 24 meses de seguimento, a presença de mRNA TG associada a altos títulos de anticorpos anti-TG foram importantes indicadores que determinaram o prosseguimento da investigação para recorrência tumoral nesta paciente, uma vez que não dispunhamos, na ocasião, e PET-Scan em nossa

Thyroid tumor marker genomics and proteomics: Diagnostic and clinical implications

“…Patients operated for differentiated thyroid cancer and then found to be free of thyroid remnant tumor are expected to have Tg levels less than 0.1 mg/L with suppression therapy. When periodic measurement shows progressively increasing serum Tg levels or anti‐Tg levels (Aras et al, 2007; Coelho et al, 2008; Kim et al, 2008; Pedrazzini et al, 2009), cancer metastases or relapse must be sought using anatomical and/or functional imaging techniques. Neck ultrasounds and RAI whole body scans (WBS) are performed; if they are negative, 18‐FDG‐PET scanning is recommended.…”

Bioinformatics identify the role of chordin-like 1 in thyroid cancer

“…[5,6] Although chemoradiation is the main treatment for anaplastic thyroid cancer, [7] there was still a risk of recurrence for patients accompanied by the chemoresistant, [8] which was closely related to the early detection of THCA. [9] Thus, it is essential to explore the molecular mechanisms and identified the key biomarkers of THCA.…”