Clinical significance of thyroglobulin autoantibodies enhancement in patients with differentiated thyroid cancer after thyroidectomy and radioiodine therapy

Cover Page

Abstract


Purpose: to evaluate the clinical utility of antithyroglobulin antibodies (TgAb) as a tumor marker in patients with differentiated thyroid cancer (DTC) after thyroidectomy and radioiodine ablation. Patients and methods. From 345 consecutive DTC patients after thyroidectomy and radioiodine ablation we select ed 148 patients with elevated TgAb level (with distant metastasis n = 93, without distant metastasis n = 55). Serum TgAb concentration was measured before radioiodine ablation and then every time before 131I treatment (RIT) or diagnostic 131I whole body scanning (WBS). Results were compared with serum thyroglobulin (Tg) concentration, neck echography, lung and bone roentgenography and 131I WBS findings. Results. TgAb level was elevated in 21% DTC patients before 131I ablation. The other 22% with initially normal TgAb displayed their rising during followup. In absence of distant metastasis TgAb declined after 1 st–2 nd cycle of RIT (an average 8.9 months after 131I ablation). Persistance or rising of TgAb in the longer term was associated with detectable thyroid remnant, residual tumor or metastatic lymph nodes. In case of negative TgAb status after sugery an increase of TgAb during first 3–6 months after ablation indicated mostly a response to the rise of Tg antigen secondary to 131I ablation. A rise TgAb in the longer term (after 3rd–5th cycles of RIT) indicated to residual or recurrent disease in 86% cases. In patients with distant metastasis there were no correlation between change in TgAb concentration and clinical sta tus, including the rate of regression of metastatic disease. But in case of low or undetectable Tg and permanent high TgAb level only TgAb indicated the presence of disease. Conclusion: persistence or rising TgAb in longer term after 131I ablation can serve as surrogate tumor marker of per sistent or recurrent disease. It is critical to measure TgAb concentration, especially in patients with low or unde tectable Tg, because in these cases TgAb appears to be the only serum DTC tumor marker.

About the authors

Email: severskn@mrrc.obninsk.ru
kandidat med. nauk, vrachendokrinolog, starshiy nauchnyy sotrudnik otdeleniya “InVitro” radionuklidnoy diagnostiki FGBU MRNTs

vrach klinicheskoy laboratornoy diagnosti ki otdeleniya “InVitro” radionuklidnoy diagnostiki FGBU MRNTs

doktor med. nauk, zam. direktora FGBU ENTs

kandidat med. nauk, vedushchiy nauchnyy sotrudnik otdeleniya radiokhirurgicheskogo lecheniya otkrytymi radionuklidami FGBU MRNTs

nauchnyy sotrud nik otdeleniya radiokhirurgicheskogo lecheniya otkrytymi radionuklidami FGBU MRNTs

References

  1. Spencer CA. Clinical utility of thyroglobulin antibody (TgAb) mea surements for patients with differentiated thyroid cancers (DTC). J Clin Endocrinol Metab. 2011;96(12):3615-3627.
  2. Kumar A, Shah DH, Shrihari U et al. Significance of antithyroglob ulin autoantibodies in differentiated thyroid carcinoma. Thyroid. 1994;4:199-202.
  3. Pacini F, Mariotti S, Formica N et al. Thyroid autoantibodies in thyroid cancer: incidence and relationship with tumor outcome. Acta Endocrinol. 1988;119:373-380.
  4. Spencer CA, Takeuchi M, Kazarosyan M et al. Serum thyroglobulin autoantibodies: prevalence, influence on serum thyroglobulin measurement and prognostic significance in patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab. 1998;83:1121-1127.
  5. Chung JK, Park YJ, Kim TY et al. Clinical significance of elevated level of serum antithyroglobulin antibody in patients with differentiated thyroid cancer after thyroid ablation. Clin Endocrinol (Oxf). 2002;57:215-221.
  6. Pacini F, Schlumberger M, Dralle H et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154:787-803.
  7. Baloch Z, Carayon P, Conte Devolx B et al. Laboratory medicine practice guidelines: laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid. 2003;13:57–67.
  8. Cooper DS, Doherty GM, Haugen BR et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19:1167-1214.
  9. Spencer CA, Takeuchi M, Kazarosyan M. Current status and performance goals for serum thyroglobulin assays. Clin Chem. 1996; 42:164-173.
  10. Rosario PW, Maia FF, Fagundes TA et al. Anti-thyroglobulin anti bodies in patients with differentiated thyroid carcinoma: methods of detection, interference with serum thyroglobulin measurement and clinical significance. Arq Bras Endocrinol Metab. 2004;48:487-492.
  11. Mariotti S, Barbesino G, Caturegli P et al. Assay of thyroglobulin in serum with thyroglobulin autoantibodies: an unobtainable goal? J Clin Endocrinol Metab. 1995;80:468-472.
  12. Gao Y, Yuan Z, Yu Y, Lu H. Mutual interference between serum thyroglobulin and antithyroglobulin antibody in an automated chemiluminescent immunoassay. Clin Biochem. 2007;40:735-738.
  13. Spencer CA, Bergoglio LM, Kazarosyan M et al. Clinical impact of thyroglobulin (Tg) and Tg autoantibody method differences on the management of patients with differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2005;90:5566-5575.
  14. Haapala AM, Soppi E, Morsky P et al. Thyroid antibodies in association with thyroid malignancy II: qualitative properties of thyroglobulin antibodies. Scand J Clin Lab Invest. 1995;55:317-322.
  15. Spencer C, Petrovic I, Fatemi S. Current thyroglobulin autoanti body (TgAb) assays often fail to detect interfering TgAb that can result in the reporting of falsely low/undetectable serum Tg IMA values for patients with differentiated thyroid cancer. J Clin Endocrinol Metab. 2011;96:1283-1291.
  16. Okosieme OE, Evans C, Moss L et al. Thyroglobulin antibodies in serum of patients with differentiated thyroid cancer: relationship between epitope specificities and thyroglobulin recovery. Clin Chem. 2005;51:729-734.
  17. Cubero JM, RodriguezEspinosa J, Gelpi C et al. Thyroglobulin autoantibody levels below the cutoff for positivity can interfere with thyroglobulin measurement. Thyroid. 2003;13:659-661.
  18. Weightman DR, Mallick UK, Fenwick JD, Perros P. Discordant serum thyroglobulin results generated by two classes of assay in patients with thyroid carcinoma: correlation with clinical outcome after 3 years of follow-up. Cancer. 2003;98:41-47.
  19. Chiovato L, Latrofa F, Braverman LE et al. Disappearance of humoral thyroid autoimmunity after complete removal of thyroid antigens. Ann Intern Med. 2003;139:346-351.
  20. Kucuk ON, Aras G, Kulak HA, Ibis E. Clinical importance of anti thyroglobulin autoantibodies in patients with differentiated thy roid carcinoma: comparison with 99mTcMIBI scans. Nucl Med Commun. 2006;27:873-876.
  21. Thomas D, Liakos V, Vassiliou E et al. Possible reasons for different pattern disappearance of thyroglobulin and thyroid peroxidase autoantibodies in patients with differentiated thyroid carcinoma following total thyroidectomy and iodine131 ablation. J Endocrinol Invest. 2007;30:173-180.
  22. Kim WG, Yoon JH, Kim WB et al. Change of serum antithyroglobulin antibody levels is useful for prediction of clinical recurrence in thyroglobulin-negative patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2008;93:4683-4689.

Statistics

Views

Abstract - 1173

PDF (Russian) - 799

Cited-By


PlumX

Dimensions


Copyright (c) 2013 ., ., ., ., .

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies