Accuracy of Unstimulated Basal Serum Thyroglobulin Levels in Assessing the Completeness of Thyroidectomy

Gürleyik, Emin; Doğan, Sami

doi:10.14740/jocmr1873w

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…In previous studies, any functional remnant tissue was checked postoperatively by thyroid scintigraphy. The incidence of the PL remnant has been reported as 23% in a total thyroidectomy series for benign disorders, as estimated by nuclear scanning with Tc 99 m pertechnetate [ 2 ]. After a radioiodine ablation of the remnant, radioiodine neck scans have detected a remnant of thyroid tissue in 30.5% to 46% of patients who underwent thyroidectomy for differentiated thyroid cancer; nuclear scan results showed minimal residual uptake in the anterior cervical region [ 3 – 5 ].…”

Section: Discussionmentioning

confidence: 99%

Pyramidal Lobe of the Thyroid Gland: Surgical Anatomy in Patients Undergoing Total Thyroidectomy

Gürleyik

Gurleyik

Doğan

et al. 2015

Anatomy Research International

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Background. Anatomic variations, the presence of the pyramidal lobe (PL), may impact completeness of thyroidectomy and effect of surgical treatment. Method. This study included 166 patients who underwent total thyroidectomy. The anterior cervical region between the thyroid isthmus and the hyoid bone was dissected during thyroid surgery. The incidence, size, and anatomical features of the PL were established in these patients. Results. The incidence of PL was 65.7%. No gender difference was found for PL incidence. The base of the PL was located at the isthmus in 52.3%, the left lobe in 29.4%, and the right lobe in 18.3% of patients. The mean length of the PL was 22.7 (range, 5–59) mm. The PL was longer than 30 mm in 23% of patients. One-third of the patients with short PL were men whereas women accounted for 80% of patients with long PL. Conclusions. The high incidence indicates that the PL is a common part of the thyroid. The PL generally originates from the isthmus near midline and is of variable length, extending from the isthmus up to the hyoid bone. Considering that the PL is a common structure, the prelaryngeal region should be dissected to achieve the completeness of thyroidectomy.

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Section: Discussionmentioning

confidence: 99%

Pyramidal Lobe of the Thyroid Gland: Surgical Anatomy in Patients Undergoing Total Thyroidectomy

Gürleyik

Gurleyik

Doğan

et al. 2015

Anatomy Research International

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“…Interestingly, unstimulated highly sensitive Tg Assays (hsTg) have a very good functional sensitivity (0.1‐0.2 ng/mL) and allow to avoid TSH stimulation 5‐7 . However, postoperative Tg predictive value can be affected by several factors such as TSH concentration at the moment of Tg measurement, time since total thyroidectomy, and functional sensitivity of the Tg assay 8,9 . Moreover, preoperative Tg is not recommended as screening since a lot of benign disease (Grave's disease, thyroiditis, or toxic nodules) may lead to higher serum Tg levels 1…”

Section: Introductionmentioning

confidence: 99%

Comparison between a new thyroglobulin assay with the well‐established Beckman Access immunoassay: A preliminary report

Cennamo

Civita

Curci

et al. 2020

Clinical Laboratory Analysis

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Objectives Measurement of serum thyroglobulin (Tg) plays a key role in the post‐thyroidectomy management of differentiated thyroid carcinoma (DTC). In this context, the performance of new‐generation thyroglobulin assay has clinical implications in the follow‐up of DTC patients. Aim of this study was to compare the new highly sensitive Liaison Tg II (Tg‐L) with the well‐established Tg Access assay (Tg‐A). Materials and methods A total of 91 residual serum samples (23 positive and 68 negatives for Tg auto‐antibodies) were tested by the Beckman Access and Diasorin Liaison assays. Study samples were from 21 patients with pathologically proven DTC and control samples from 70 (16 patients with benign thyroid disease and 54 apparently healthy subjects). Results Our results showed that Tg‐L was highly correlated with Tg‐A for both values ranging between 0.2 and 50 ng/mL (Pearson's r = 0.933 [95%CI 0.894‐0.958], P < .001) and higher than 50 ng/mL (Pearson's r = 0.849 [95%CI 0.609‐0.946], P < .001). For Tg values lower than 0.2 ng/mL, the overall concordance rate was 92%. Moreover, we tested 7 fine‐needle aspiration washout fluids (FNA), showing an overall concordance rate in discriminating negative and positive of 100%. Finally, we found no interference by Tg auto‐antibodies (TgAbs) for both Tg‐L and Tg‐A. Conversely, rheumatoid factor (RF) interferes with Tg‐A, but not with Tg‐L in one patient with no relapsing thyroid carcinoma. Conclusions Liaison Tg II demonstrated a good correlation with Access Tg assay both for sera and FNAs. Further studies on larger population are needed to evaluate Tg‐L clinical impact on DTC patient's follow‐up.

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“…According to the American Thyroid Association (ATA) guidelines [4], postoperative serum TG (on thyroid hormone therapy or after TSH stimulation) can help in assessing the persistence of disease or thyroid remnant and in predicting potential disease recurrence, is useful in decisions regarding additional radioactive iodine (RAI) I-131 therapy, and quantifies response to therapy. The predictive value of the postoperative TG, however, can be significantly influenced by a wide variety of factors including the amount of residual thyroid cancer and/or normal thyroid tissue, TSH level at the time of TG measurement, functional sensitivity of the TG assay, TG cutoff levels used for analysis, individual risk of having radioiodine avid locoregional or distant metastasis, timing and dose of RAI therapy, and time elapsed since total thyroidectomy [6, 7]. The National Comprehensive Cancer Network (NCN) guidelines recommend checking TG 6-12 weeks post thyroidectomy [8], while ATA guidelines state TG should reach its nadir by 3-4 weeks postoperatively in most patients and that the optimal time to check postoperatively is unknown [4].…”

Section: Introductionmentioning

confidence: 99%

Serum Thyroglobulin: Preoperative Levels and Factors Affecting Postoperative Optimal Timing following Total Thyroidectomy

Patel

Shostrom

Treude

et al. 2019

International Journal of Endocrinology

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Objective. We evaluated if preoperative TG levels affected postoperative levels and if other factors may influence the optimal time to check postoperative TG. Methods. This is a prospective, observational pilot study. We approved and enrolled 50 subjects≥19 years scheduled for total thyroidectomy and measured serum TG, thyroglobulin antibody (TG ab), and TSH preoperatively and post thyroidectomy at 7-14 days, 4 and 6 weeks, and 3 months in subjects with benign pathology, with additional 6- and 12-month measurements in subjects with thyroid cancer. Results. Preoperative TG was significantly higher in the benign (median 167.5 ng/mL vs 30.8 ng/mL) than in the malignant (p=0.0006) group. In the benign group, 76.5% (13/17) of subjects had an undetectable TG<0.2 ng/mL by 12 weeks postoperatively. In the malignant group, 70.6% (12/17) of those who did not receive RAI therapy and 25% (1/4) of those who did receive RAI had undetectable TG<0.2 ng/mL by 12 weeks. Subset analysis showed 94.1% (16/17) of the benign, 70.6% of the malignant without RAI, and 50% (2/4) of the malignant with RAI achieved TG<1.0 ng/mL by 6 weeks postoperatively. Four subjects in the malignant group reached undetectable TG levels as early as 7-14 days postoperatively. Conclusion. Preoperative TG levels did not predict the risk of malignancy nor time to TG nadir postoperatively. We did not find a difference in TG elimination half-life between the benign and malignant groups. The median time to reach undetectable TG levels in both benign and malignant groups who did not receive RAI therapy was 12 weeks. However, those with preexisting hypothyroidism and hyperthyroidism had lower levels of TG overall in the malignant group which can be taken into consideration besides other known factors that can affect TG levels post thyroidectomy. This trial is registered with Clinicaltrials.gov NCT02347683.

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Accuracy of Unstimulated Basal Serum Thyroglobulin Levels in Assessing the Completeness of Thyroidectomy

Cited by 9 publications

References 13 publications

Pyramidal Lobe of the Thyroid Gland: Surgical Anatomy in Patients Undergoing Total Thyroidectomy

Pyramidal Lobe of the Thyroid Gland: Surgical Anatomy in Patients Undergoing Total Thyroidectomy

Comparison between a new thyroglobulin assay with the well‐established Beckman Access immunoassay: A preliminary report

Serum Thyroglobulin: Preoperative Levels and Factors Affecting Postoperative Optimal Timing following Total Thyroidectomy

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