title: Risk-adapted management of differentiated thyroid cancer assessed by a sensitive measurement of basal serum thyroglobulin.
abstract: BACKGROUND
  Treatment and follow-up of patients thyroidectomized for differentiated thyroid carcinoma (DTC) mainly depends on the identification of the patient's risk of recurrence. Thyroglobulin (Tg) is the most important marker of persistent/recurrent disease. The recent introduction of a new, more sensitive Tg measurement allows for the early detection of the disease by measuring the basal (under L-T(4) therapy) serum Tg level without TSH stimulation.
  
  
  OBJECTIVE
  The goal of this study is to identify the basal serum Tg threshold value that indicates recurrent disease by using a second-generation Tg assay.
  
  
  METHODS
  A continuous series of 425 DTC patients, all thyroidectomized and treated with (131)I after surgery and having basal Tg of no more than 1.0 ng/ml, negative anti-Tg antibodies, and a recombinant human TSH-stimulated Tg measurement was retrospectively analyzed.
  
  
  METHODS
  The study took place at an academic hospital.
  
  
  RESULTS
  The most accurate basal Tg value for predicting the presence of recurrent/residual disease was more than 0.15 ng/ml (sensitivity 87%, specificity 91%, negative predictive value 98.6%, and positive predictive value 47.8%). When the basal Tg level was no more than 0.15 ng/ml, the risk of disease presence was very low, even in patients classified at an intermediate or high risk. In contrast, when the basal Tg level was more than 0.15 ng/ml, the percentage of recurrent disease was relatively high (12.5% or one in eight cases) in low-risk patients.
  
  
  CONCLUSIONS
  Basal Tg, measured using a second-generation Tg assay allows for the identification of DTC patients who are likely to remain disease free with great accuracy. This simple measurement, therefore, may be sufficient to assess the risk-adapted management of DTC patients.
authors: Endocrinology, Department of Clinical and Molecular Medicine, University of Catania, Garibaldi-Nesima Hospital, via Palermo n.636, 95122 Catania, Italy. linomalandrino@gmail.com
authors: Pasqualino
authors: P
authors: Malandrino
authors: Adele
authors: A
authors: Latina
authors: Salvatore
authors: S
authors: Marescalco
authors: Angela
authors: A
authors: Spadaro
authors: Concetto
authors: C
authors: Regalbuto
authors: Rosa Anna
authors: RA
authors: Fulco
authors: Claudia
authors: C
authors: Scollo
authors: Riccardo
authors: R
authors: Vigneri
authors: Gabriella
authors: G
authors: Pellegriti
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000097:blood* / Q000175:diagnosis; D000231:Adenocarcinoma, Papillary / Q000097:blood* / Q000175:diagnosis; D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000175:diagnosis; D012372:ROC Curve; D013954:Thyroglobulin / Q000097:blood*; D013960:Thyroid Function Tests; D013964:Thyroid Neoplasms / Q000097:blood* / Q000175:diagnosis; D013972:Thyrotropin / Q000097:blood
chemical_list: D014408:Biomarkers, Tumor; D013972:Thyrotropin; D013954:Thyroglobulin