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Thyroglobulin and Tg Antibodies

  • Ulla Feldt-RasmussenEmail author
  • Luca Giovanella
Chapter

Abstract

Differentiated thyroid cancer is a rare malignancy but leaves numerous survivors for lifelong follow-up. The initial treatment consists of total thyroidectomy followed by ablation of thyroid remnants by radioiodine in most cases. Because thyroid cells are the only source of thyroglobulin (Tg), it serves as a biochemical marker of persistent or recurrent disease in the follow-up of DTC. Due to the suboptimal clinical detection rate of older Tg assays, endogenous or exogenous thyrotropin (TSH) stimulations are recommended for unmasking occult disease. However, the development of new Tg assays with improved analytical sensitivity and precision at low concentrations now allows detection of very low Tg concentrations, reflecting minimal amounts of thyroid tissue, even without the need for TSH stimulation. Thus, the cornerstone in current guidelines for long-term follow-up is by measuring the thyroid-specific tumour marker Tg in serum, and most patients can be followed up by this method. However, some thyroid cancer patients have antithyroglobulin antibodies (TgAb) in serum, both at diagnosis and after treatment, where follow-up is commenced. These antibodies interfere technically in the immunological methods for measuring Tg, and the TgAb-positive patients are thus eliminated from following current guidelines. In recent years complementary laboratory methods, such as Tg mini-recovery test and Tg measurement by tandem mass liquid spectrometry, were proposed, and studies have indicated that following the concentration of TgAb in serum may be a particularly important surrogate marker for recurrence of thyroid carcinoma in cases with TgAb where Tg measurement cannot be used. Adding the quantitative changes in TgAb to the follow-up strategy of these patients will improve the general management of differentiated thyroid carcinoma patients and open the road for individualized tailored follow-up.

Keywords

Anti-thyroglobulin autoantibodies Thyroglobulin Antibody interference Differentiated thyroid cancer Follow-up 

Notes

Acknowledgement

UFR’s research salary was sponsored by Novo Nordic Research Foundation.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medical Endocrinology and MetabolismRigshospitalet, University of CopenhagenCopenhagenDenmark
  2. 2.Department of Nuclear Medicine and Thyroid CentreOncology Institute of Southern SwitzerlandBellinzonaSwitzerland
  3. 3.Department of Laboratory Medicine EOLABEnte Ospedaliero CantonaleBellinzonaSwitzerland

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