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L’Endocrinologo

, Volume 11, Issue 6, pp 248–253 | Cite as

Innovazioni nel dosaggio della tireoglobulina circolante nei pazienti con carcinoma differenziato della tiroide

  • Furio Pacini
  • Maria Grazia Castagna
  • Valentina Belardini
Article
  • 26 Downloads

Riassunto

Nei pazienti affetti da carcinoma differenziato della tiroide (CDT), la rilevanza clinica ed economica di un follow-up ottimale, attraverso test diagnostici accurati, è una questione fondamentale, considerando il grande numero di pazienti nel mondo che vi si sottopongono per tutta la vita. I criteri di remissione a oggi utilizzati per i pazienti definiti a basso rischio di recidiva sono rappresentati da valori indosabili di tireoglobulina (Tg) stimolata associati a negatività dell’ecografia del collo. Al momento del primo controllo dopo il trattamento iniziale (tiroidectomia totale e terapia ablativa con 131I) circa l’80% dei pazienti con CDT presenta valori indosabili di Tg stimolata ed ecografia del collo negativa e pertanto vengono considerati in remissione di malattia. Una piccola percentuale di pazienti può invece presentare valori indosabili di Tg in terapia ormonale che diventano dosabili dopo stimolo con TSH, quando si utilizzano metodiche di dosaggio con sensibilità funzionale (SF) di 1,0 ng/ml. Ciò significa che, in questi pazienti, la Tg in terapia ormonale è falsamente negativa. Recentemente sono state introdotte nella pratica clinica nuove metodiche di dosaggio della Tg con SF molto bassa e, utilizzando tali metodiche, è possibile teoricamente migliorare la sensibilità diagnostica della Tg, soprattutto durante la terapia ormonale. I risultati riportati sull’impiego delle metodiche ultrasensibili appaiono incoraggianti, almeno per quanto riguarda la possibilità di individuare correttamente i pazienti in remissione di malattia (elevato valore predittivo negativo, VPN) soprattutto se combinate con l’uso routinario dell’ecografia del collo. Tuttavia, la bassa specificità del metodo e quindi l’elevato numero di falsi positivi le rendono, al momento, poco applicabili nella pratica clinica. Saranno pertanto necessari ulteriori studi prima che il dosaggio della Tg con metodiche ultrasensibili possa sostituire definitivamente le metodiche di indagini a oggi in uso (dosaggio della Tg stimolata con TSH esogeno o endogeno) per la definizione dello stato di malattia del paziente con CDT.

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Copyright information

© Springer International Publishing AG 2010

Authors and Affiliations

  • Furio Pacini
    • 1
  • Maria Grazia Castagna
    • 1
  • Valentina Belardini
    • 1
  1. 1.Dipartimento di Medicina Interna, Scienze Endocrino-Metaboliche e Biochimica, Sezione di Endocrinologia e Malattie MetabolicheUniversità di SienaSienaItalia

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