Preoperative Serum Thyroglobulin and Its Correlation with the Burden and Extent of Differentiated Thyroid Cancer

Abstract

Lymph node metastasis (LNM) in differentiated thyroid cancer (DTC) is usually detected with preoperative ultrasonography; however, this has limited sensitivity for small metastases, and there is currently no predictive biomarker that can help to inform the extent of surgery required. We evaluated whether preoperative serum thyroglobulin levels can predict tumor burden and extent. We retrospectively reviewed the clinical records of 4029 DTC cases diagnosed and treated at a Samsung Medical Center between 1994 and 2016. We reviewed primary tumor size, number and location of LNM, and presence of distant metastases to reveal relationships between tumor burden and extent and preoperative serum thyroglobulin levels. We found a linear association between increasing preoperative thyroglobulin levels, the size of the primary tumor, and the number of LNM (r = 0.34, p < 0.001, r = 0.20, p < 0.001, respectively). Tumor extent also increased with each decile of increasing preoperative thyroglobulin level (r = 0.18, p < 0.001). Preoperative thyroglobulin levels of 13.15 ng/mL, 30.05 ng/mL, and 62.9 ng/mL were associated with the presence of ipsilateral lateral LNM, contralateral lateral LNM, and distant metastasis, respectively. Our results suggest that preoperative measurement of serum thyroglobulin may help to predict LNM and help to tailor surgery.

Preoperatively Predicting the Central Lymph Node Metastasis for Papillary Thyroid Cancer Patients With Hashimoto’s Thyroiditis

“…On the other hand, the raised level of Tg was frequently used for predicting the recurrence of PTC patients with reasonable sensitivity and specificity during the postoperative follow-up. But some recent studies (28,29) have proved that serum Tg level was markedly related to distant lymph node metastasis and skip metastasis in PTC patients. However, we did not include this factor in the further analysis as a result of it could be impaired by the HT condition, especially in the presence of TgAb.…”

Prognostic Value of Serum Thyroglobulin and Anti-Thyroglobulin Antibody in Thyroid Carcinoma Patients following Thyroidectomy

“…The initial and follow-up evaluation entails the measurement of TSH, serum TG levels, and neck sonogram, before RAI for diagnostic or therapeutic purposes was recommended by the American Thyroid Association (ATA) guidelines [7,8]. The ATA task force guidelines for the evaluation of thyroid cancer have evolved and recommend that patients with WDTC should be classified accordingly into low-, intermediate-, and high-risk groups It should be stressed that a universal increase in the prevalence of WDTC in thyroidectomized patients requires monitoring of these patients for recurrent or permanent disease through periodic (6-12 months) serum thyroglobulin (TG) estimation and anatomic imaging [9,10]. Patient management is then guided on this stratification according to the recurrence of the disease [11].…”

<p>The Blood Biomarkers of Thyroid Cancer</p>

“…16 Although thyroglobulin does not distinguish thyroid cancer from normal thyroid tissue, some studies 17,18 have shown that preoperative detection of thyroglobulin may help predict the tumor burden and lymph node metastasis of patients. A study in South Korea 19 believes that patients with preoperative thyroid globulin above 13.15ng/mL can be considered to have ipsilateral cervical lymph node metastasis, while above 30.05ng/mL may also have contralateral cervical lymph node metastasis, if higher than 62.9 ng/mL is at risk for distant metastases. Therefore, although thyroglobulin cannot be used as a marker for the diagnosis of thyroid cancer, it has a pivotal position in the management of thyroid cancer.…”