Serum thyroglobulin determinations in the differential diagnosis of congenital hypothyroidism

Pacini, Furio; Lari, Riccardo; Ricca, P. La; Grasso, Lucia; Bartolo, F. Di; Fenzi, Gianfranco; Ciampi, M.; Gragnani, S. G.; Baschieri, L; Pinchera, Aldo

doi:10.1007/bf03348372

Cited by 15 publications

(9 citation statements)

References 18 publications

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“…Some causes are clearly related to potentially heritable abnormalities because thyroid dysgenesis and others are heritable and may result from a spectrum of genetic defects. The Tg serum level associated with other imaging parameters is important for establishing the etiology of congenital hypothyroidismspecifically, newborns having dyshormonogenesis (19)(20)(21)(22)(23)(24)(25)(26)30). The Tg concentration may also be important for the molecular characterization of congenital hypothyroidism and for counseling in the future.…”

Section: Discussionmentioning

confidence: 99%

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Thyroglobulin Reference Values in a Pediatric Infant Population

Sobrero

Muñoz

Bazzara

et al. 2007

Thyroid

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Few reports have addressed normal serum thyroglobulin (Tg) values in newborns and infants. In the present study, serum Tg was measured in 228 normal children (110 females and 118 males) aged from 3 to 180 days of life, all presenting normal age-related serum thyrotropin (thyroid-stimulating hormone [TSH]) values and negative anti-Tg and antithyroperoxidase antibodies. Serum Tg was measured by Radioimmunoassay (RIA) (two methods) and Immunometricassay (IMA) (three methods). Mean Tg values measured by the five methods exhibited among-method biases, although a significant positive correlation was observed. Serum Tg levels measured by the five methods showed a correlation with age, but not with TSH or gender. During the first days of life, relatively high mean Tg levels were observed, which progressively decreased until they reached a plateau. Therefore, with the aim of establishing reference values, the population was separated into two age groups: from 3 to 15 days of life (group A) and from 16 to 180 days of life (group B). Mean Tg concentration in group A was statistically higher than in group B. Tg centile distributions were calculated with the aim of establishing the normal levels of serum Tg for each method. We conclude that for a correct interpretation of serum Tg levels, the age and the methods used should be considered.

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Section: Discussionmentioning

confidence: 99%

“…Tg evaluation along with imaging studies is a powerful tool for the etiologic diagnosis of congenital hypothyroidism and for the elucidation of the molecular disturbance involved (19)(20)(21)(22)(23)(24)(25)(26). Scant studies reporting Tg reference ranges measured by current methods are available for the first months of life.…”

Section: Introductionmentioning

confidence: 99%

Thyroglobulin Reference Values in a Pediatric Infant Population

Sobrero

Muñoz

Bazzara

et al. 2007

Thyroid

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“…complete absence of thyroid tissue, is very rare in the Swedish CH population. Various frequencies of aplasia have been reported by other authors (8)(9)16). Determination of the Tg concentration can be used as a substitute for scintigraphy in CH patients for detecting total aplasia of the thyroid gland.…”

Section: Discussionmentioning

confidence: 90%

The Value of Neonatal Serum Thyroglobulin Determinations in the Follow‐up of Patients with Congenital Hypothyroidism

et al. 1990

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Serum thyroglobulin was determined in 68 newborn infants with positive screening tests for congenital hypothyroidism. In 38 infants the diagnosis was confirmed (patients), but the remaining 30 were euthyroid at follow-up (controls). The mean thyroglobulin concentration at the age of 2 weeks did not differ significantly between the patients and the controls (179 vs. 125 micrograms/l). Thyroid scintigraphy was performed in 15 patients. All seven with thyroid aplasia, based on 99mTc pertechnetate scintigraphy, had measurable thyroglobulin (greater than 2 micrograms/l) and thyroid hormones in their serum. This indicates that total absence of thyroid tissue is very rare in Swedish patients with congenital hypothyroidism. Scintigraphy based on 99mTc does not permit detection of small amounts of thyroid tissue. The neonatal concentrations of thyroglobulin did not correlate with the results of Griffiths test at 3 years and are therefore not useful for prognosis of psychomotor development. We conclude that neonatal measurement of thyroglobulin is of limited value in the follow-up of patients with congenital hypothyroidism.

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“…It has been shown that many patients with permanent CH have measurable Tg levels in serum [18][19][20][21][22][23]. These Tg values are believed to be due to secretion from residual thyroid tissue.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Thyroglobulin Levels in Monitoring the Treatment of Congenital Hypothyroidism

Sack¹,

Kaiserman²,

Eidlitz‐Markus³

1995

Horm Res

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We have previously reported on high thyroid-stimulating hormone (TSH) concentrations in clinically euthyroid children with congenital (CH) undergoing appropriate treatment. Whether this TSH is biologically active or not is still unclear. It has been shown that ectopic thyroid tissue does not involute during thyroxine (T₄) therapy and thus can continue to secrete thyroglobulin (Tg). This study was undertaken to determine whether the Tg levels in ectopic CH infants represent residual thyroid tissue stimulated by biologically active TSH and whether this Tg can be used to help monitor CH treatment. Among the 51 primary CH children (age 2-14 years) diagnosed and followed up by us, 28 had measurable Tg values ( > 2 pmol/l) several years after the T₄ treatment had been started. In 8 of the children, Tg was measured as early as the time of diagnosis and followed up for at least 3 years. The Tg levels decreased much more slowly than the TSH levels did, and secondary Tg rises were observed. By 5 months of age, all children had Tg levels less than 25 pmol/l. Although in some infants the Tg levels paralleled TSH behavior, in others the TSH-Tg correlation was not so obvious. In another group of 8 children who had high TSH values despite normal T₄, the LT₄ replacement dosage was increased by 60% for 1 week (from 3.5 ± 0.2 to 5.5 ± 0.5 μg/kg/day) in order to examine the TSH-Tg dependence. As a result, the serum levels of T₄ increased from 143 ± 10 to 176 ± 12 nmol/l, while the levels of TSH and Tg decreased from 8.1 ± 2.1 mU/l and 4.5 ± 0.5 ρmol/l to 1.7 ± 0.5 mU/l and 2.9 ± 0.6 pmol/l, respectively (p < 0.05). The data suggest that in primary CH children with ectopic thyroid tissue the residual gland is active and secretes Tg in response to endogenous TSH, years after the T₄ replacement treatment has been started. Therefore the high TSH found in some CH children despite adequate LT₄ replacement treatment is biologically active and easily suppressible with the increase in LT₄ dosage. Since Tg is TSH dependent and since Tg clearance is much slower compared to TSH clearance, Tg might be useful in monitoring more accurately the long-term compliance to the therapeutic protocol. Tg monitoring is especially valuable in those infants with fluctuating high TSH levels despite normal T₄ values.

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Serum thyroglobulin determinations in the differential diagnosis of congenital hypothyroidism

Cited by 15 publications

References 18 publications

Thyroglobulin Reference Values in a Pediatric Infant Population

Thyroglobulin Reference Values in a Pediatric Infant Population

The Value of Neonatal Serum Thyroglobulin Determinations in the Follow‐up of Patients with Congenital Hypothyroidism

The Importance of Thyroglobulin Levels in Monitoring the Treatment of Congenital Hypothyroidism

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