title: Effectiveness of peripheral thyrotropin receptor mRNA in follow-up of differentiated thyroid cancer.
abstract: Thyroid cells in peripheral circulation have been linked to thyroid cancer (TC). These cells express thyrotropin receptor (TSHR) messenger RNA (mRNA), which has been studied as a marker of initial TC diagnosis. We examined the utility of TSHR mRNA in long-term follow-up of TC patients. From 2002 to 2007, TSHR mRNA was prospectively measured by quantitative reverse-transcription polymerase chain reaction (RT-PCR) from peripheral blood samples in 259 patients, and those followed > or =3 months since initial thyroidectomy were studied. TSHR mRNA levels were correlated to thyroglobulin (Tg), imaging studies, and disease status during follow-up. Thirty-four patients underwent 20 +/- 14 months median follow-up for papillary (n = 31, 91%), follicular (n = 2) or Hurthle cell (n = 1) TC. Advanced-stage disease occurred in 24% at presentation, and 11 (32%) developed cervical node metastases or recurrence requiring reoperation during follow-up. Of 52 simultaneous TSHR mRNA and serum Tg measurements, 52% were concordant. TSHR mRNA missed disease in 21% patients, but was better than Tg in 27%, including all those with Tg antibodies. TSHR mRNA concurred with whole-body scan detectable disease for 11/14 patients (79%) and accurately predicted overall TC disease status in 77% patients. In discordant cases, TC recurrence was apparent from other imaging modalities [positron emission tomography (PET) scan or ultrasound]. TSHR mRNA in conjunction with Tg diagnosed TC recurrence with 90% sensitivity and 94% specificity. We conclude that TSHR mRNA demonstrates high concordance rates with present methods of detecting TC recurrence, and appears to be more accurate in patients with Tg antibodies. As a novel adjunct, TSHR mRNA may enhance long-term management of TC patients.
authors.affiliation: Department of General Surgery, Cleveland Clinic, OH 44195, USA. milasm@ccf.org
authors.forename: Mira
authors.initials: M
authors.lastname: Milas
authors.forename: German F
authors.initials: GF
authors.lastname: Barbosa
authors.forename: Jamie
authors.initials: J
authors.lastname: Mitchell
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
authors.forename: Manjula
authors.initials: M
authors.lastname: Gupta
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000097:blood / Q000556:secondary / Q000601:surgery; D018249:Adenoma, Oxyphilic / Q000097:blood / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D002291:Carcinoma, Papillary / Q000097:blood / Q000556:secondary / Q000601:surgery; D002454:Cell Differentiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis / Q000601:surgery; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012333:RNA, Messenger / Q000097:blood*; D011989:Receptors, Thyrotropin / Q000235:genetics*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013954:Thyroglobulin / Q000097:blood / Q000235:genetics / Q000276:immunology; D013964:Thyroid Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D013972:Thyrotropin / Q000494:pharmacology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D014408:Biomarkers, Tumor; D012333:RNA, Messenger; D011989:Receptors, Thyrotropin; D013972:Thyrotropin; D013954:Thyroglobulin