Disappearance of Humoral Thyroid Autoimmunity after Complete Removal of Thyroid Antigens

Chiovato, Luca; Latrofa, Francesco; Braverman, Lewis E.; Pacini, Furio; Capezzone, Marco; Masserini, Lucio; Grasso, Lucia; Pinchera, Aldo

doi:10.7326/0003-4819-139-5_part_1-200309020-00010

Cited by 327 publications

(132 citation statements)

References 9 publications

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“…Although the patients with the higher initial TgAb concentrations tended to have measurable TgAbs at the end of the study, the within-subject variability was such that no variable could be used to predict persistence of TgAbs 20. With less sensitive agglutination techniques,21 a median time to TgAb disappearance of 3.0 years (95% CI 1.9 to 4.1) was demonstrated.…”

Section: Key Analytical Issuesmentioning

confidence: 95%

Laboratory services for thyroglobulin and implications for monitoring of differentiated thyroid cancer

Clark

2009

J Clin Pathol

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Serum thyroglobulin is used as a marker for monitoring differentiated thyroid cancer. There are a number of analytical challenges: the need for stability of the assay over decades, differences in assay bias, and interference in immunoassays by endogenous thyroglobulin antibodies. Improved precision at low analyte concentrations is desirable. Approaches to identifying assay interference are discussed. No single approach is likely to be successful on all occasions. Decision limits should be assay-specific, and clinicians should be aware of the limitations of current immunoassays.

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Section: Key Analytical Issuesmentioning

confidence: 95%

Laboratory services for thyroglobulin and implications for monitoring of differentiated thyroid cancer

Clark

2009

J Clin Pathol

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“…The majority (∼75%) of DTC patients either have no TgAb detected throughout their course or become TgAb-negative in the years following successful surgery [14 ▪ ,27,37 ▪▪ ,89,92,98–100]. With RAI treatment now being limited to high-risk DTC patients [13,14 ▪ ,15], most postoperative thyroglobulin testing will be made for low-risk PTC patients with low thyroglobulin concentrations arising from postsurgical thyroid remnants.…”

Section: Postoperative Serum Thyroglobulin Monitoringmentioning

confidence: 99%

How sensitive (second-generation) thyroglobulin measurement is changing paradigms for monitoring patients with differentiated thyroid cancer, in the absence or presence of thyroglobulin autoantibodies

Spencer

LoPresti

Fatemi

2014

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewTo discuss new insights regarding how sensitive (second-generation) thyroglobulin immunometric assays (Tg2GIMAs), (functional sensitivities ≤0.10 μg/L) necessitate different approaches for postoperative thyroglobulin monitoring of patients with differentiated thyroid cancer (DTC), depending on the presence of thyroglobulin autoantibodies (TgAbs).Recent findingsReliable low-range serum thyroglobulin measurement has both enhanced clinical utility and economic advantages, provided TgAb is absent (∼75% DTC patients). Basal [nonthyroid-stimulating hormone (TSH) stimulated] Tg2GIMA measurement obviates the need for recombinant human TSH stimulation because basal Tg2GIMA below 0.20 μg/L has comparable negative predictive value (>95%) to recombinant human TSH-stimulated thyroglobulin values below the cutoff of 2 μg/L. Now that radioiodine remnant ablation is no longer considered necessary to treat low-risk DTC, the trend and doubling time of low basal thyroglobulin values arising from postsurgical thyroid remnants have recognized prognostic significance. The major limitation of Tg2GIMA testing is interference by TgAb (∼25% DTC patients), causing Tg2GIMA underestimation that can mask disease. When TgAb is present, the trend in TgAb concentrations (measured by the same method) can serve as the primary (surrogate) tumor-marker and be augmented by thyroglobulin measured by a TgAb-resistant class of method (radioimmunoassay or liquid chromatography-tandem mass spectrometry).SummaryThe growing use of Tg2GIMA measurement is changing paradigms for postoperative DTC monitoring. When TgAb is absent, it is optimal to monitor the basal Tg2GIMA trend and doubling time (using the same method) in preference to recombinant human TSH-stimulated thyroglobulin testing. When TgAb is present, interference renders Tg2GIMA testing unreliable and the trend in serum TgAb concentrations per se (same method) can serve as a (surrogate) tumor-marker.

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“…Some investigations have presented higher frequencies of recurrent or persistent disease related to persistent TgAb (5,8,9,10), but some studies have not demonstrated such correlations (11,12,13). The later prospective investigations have reported that TgAb levels did not affect disease aggravation, and that TgAb diminished gradually after surgery in most cases throughout a three-year follow-up (13,14). …”

Section: Introductionmentioning

confidence: 95%

Prognostic Value of Basal Serum Thyroglobulin Levels, but Not Basal Antithyroglobulin Antibody (TgAb) Levels, in Patients with Differentiated Thyroid Cancer

Asli¹,

Siahkali²,

Shafie³

et al. 2014

Mirt

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Objective: The prognostic values of serum thyroglobulin (Tg) and antithyroglobulin antibody (TgAb) levels, measured immediately before I-131remnant ablation in patients with differentiated thyroid cancer (DTC), have been advocated by some researchers; however, it had controversial outcomes. This study was carried out to examine this dilemma and to check the clinical significance of basal serum Tg and TgAb levels and postablation iodine 131whole body scan(WBS) findings in DTC patients. Methods: In this retrospective study, the records of 500 patients with differentiated thyroid cancer, who had undergone treatment between 2003 and 2010, were assessed. Of those, 149 patients with results of basal serum thyroglobulin concentration and whole body scan using radioactive iodine were included. Age, sex, tumour histology, basal thyroglobulin (Tg), anti-thyroglobulin (TgAb) and TSH concentration, radioactive iodine doses in each hospitalization, numbers of hospitalization, and results of whole body scans were recorded. The relationship among basal Tg, TgAb, TSH, and whole body scan with hospitalization number and total radioactive iodine doses were assessed. Results: A total of 149 patients, including 123 (83%) females and 26 (17%) males, with a mean age of 40±15 years, took part in the study. The mean (SD) basal Tg, TgAb, and TSH were 91.7±169.2 ng/mL (0.1-1000 ng/mL), 250±893 U/mL (0-9000 U/m L), and 64.8±61.5 µU/mL (30-689 U/mLµ), respectively. A total of 52 (34.9%) cases had TgAb levels greater than 100 U/mL. The mean basal Tg in patients who were admitted three or more times was significantly greater than that of patients with one hospitalization (p=0.026). In addition, the mean of Tg in patients who received 7.4 GBq radioactive iodine or less was significantly lower than the others (p=0.003). The mean of TgAb and TSH were not different between these groups. In the results of the whole body scans, patients with metastasis had higher frequency of hospitalization (p=0.010) and received higher radioactive iodine levels (p<0.001). Conclusions: The findings of this study showed that, in differentiated thyroid cancer, lower basal serum Tg levels and absence of metastasis in radioiodine scan after ablation treatment were correlated with fewer hospitalizations and lower doses of radioactive iodine. Basal TgAb and TSH had no relation. Therefore, it seems that basal Tg could help us in determining which patients need aggressive treatment.

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Disappearance of Humoral Thyroid Autoimmunity after Complete Removal of Thyroid Antigens

Abstract: Complete ablation of thyroid tissue with its antigenic components results in the disappearance of antibodies to all major thyroid antigens, thus supporting the concept that continued antibody production depends on the persistence of autoantigen in the body.

Cited by 327 publications

References 9 publications

Laboratory services for thyroglobulin and implications for monitoring of differentiated thyroid cancer

Laboratory services for thyroglobulin and implications for monitoring of differentiated thyroid cancer

How sensitive (second-generation) thyroglobulin measurement is changing paradigms for monitoring patients with differentiated thyroid cancer, in the absence or presence of thyroglobulin autoantibodies

Prognostic Value of Basal Serum Thyroglobulin Levels, but Not Basal Antithyroglobulin Antibody (TgAb) Levels, in Patients with Differentiated Thyroid Cancer

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