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KMID : 0876319990010010021
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Cachon Medical Journal
1999 Volume.1 No. 1 p.21 ~ p.27
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The Value of Serum Thyroglobulin in the Follow-up of Patients with Treated Differentiated Thyroid Cancer
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Park Heung-Kyu
Lee Yeong-Don
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Abstract
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Purpose: Serum thyroglobulin(Tg) level is a sensitive method for the detection of recurrence or metastases in the follow up of patients with treated differentiated thyroid cancer. However there are some discrepancies between the serum Tg level and disease activity. So we evaluated available serum Tg level on and off T4 therapy in the patients with treated thyroid cancer.
Materials and Methods: 141 patients with differentiated thyroid cancer who had no evidence of active disease after treatment were grouped according to operatives and 131I ablative therapy. Tg was measured by RIA by interaction between 125I-Tg and anti-Tg-antibody.
Results: In patients with a partial thyroidectomy with or without 131I ablation, the presence of Tg did not indicate the presence of cancer since levels were often above either a 5ng/㎖ or a 10ng/㎖ cut off. In patients who underwent near total(NNT) or total thyroidectomy(TT) and 131I ablation, 16 of 34(47%) patients had Tg greater than 5ng/㎖ and 9 of 34(26.5%) patients had Tg greater than 10ng/㎖ during T4 therapy, whereas in off therapy 18 of 27(66.7%) patients had Tg greater than 5ng/㎖ and 16 of 27(59.3%) patients had Tg levels greater than 10ng/㎖. Therefore we had no valuable cut-off level in serum Tg determining recurrence or metastases of thyroid cancer. TSH levels were not associated with Tg levels in the patients treated with NTT or TT with 131I ablation. In the Tg with or without 131I ablation therapy Tg levels decreased gradually over time and in 90.0% of the patients underwent TT, Tg levels was below 1ng/㎖ after 5 years. These data suggest that even in patients who underwent 131I ablation and TT and were thought to be cured, small foci of thyroid tissue may exist and produce some Tg. However, these residual cells do not appear to cause an adverse prognosis in most patients because after 131I therapy and during T4 treatment there may be gradual atrophy or death of residual Tg producing cells.
Conclusions: We concluded that only serum Tg assay can not be used to rule out the presence of cancer in most patients regardless of T4 treatment or off therapy and that Tg and 131I scans are complementary in the follow up of patients with differentiated thyroid cancer.
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KEYWORD
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131I ablation, Thyroglobulin, Thyroid cancer
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