title: The utility of peripheral thyrotropin receptor mRNA in the management of differentiated thyroid cancer.
abstract: BACKGROUND
  Our aim was to analyze the utility of peripheral thyrotropin receptor (TSHR) messenger RNA (mRNA) in predicting and detecting the recurrence of differentiated thyroid cancer.
  
  
  METHODS
  Peripheral blood TSHR-mRNA was obtained in 103 patients before and after total thyroidectomy. An analysis was performed to correlate peripheral blood TSHR-mRNA concentration with oncologic outcomes.
  
  
  RESULTS
  Tumor types were papillary (n = 92), follicular (n = 9) and Hürthle cell (n = 2) cancer. Preoperative TSHR-mRNA was ≥1.02 ng/μg in 85% (88/103). On follow-up (median 48 months), 10 patients (10 %) developed recurrence. Recurrence rate in patients with a preoperative TSHR-mRNA ≥ 1.02 ng/μg was 11% versus 0% in those with a lesser concentration. TSHR-mRNA correctly diagnosed 7 (70%) of 10 recurrences. Of 19 patients with positive thyroglobulin (Tg) antibodies, TSHR-mRNA confirmed disease-free status in 12 (63%) and recurrence in 1 (5%). For Tg, TSHR-mRNA and whole-body radioactive iodine scan, sensitivity was 70%, 70%, and 75%; specificity 94%, 76%, 97%; PPV 54%, 24%, and 67%; and NPV 97%, 96%, and 98%, respectively, in detecting recurrent disease.
  
  
  CONCLUSIONS
  This study shows that patients with preoperative TSHR-mRNA ≥1.02 ng/μg may be at a greater risk for recurrence compared with those with a lesser concentration. In the presence of Tg antibodies, TSHR-mRNA accurately predicted disease status in 68% of patients. Its overall performance in detecting recurrence was similar to Tg and whole-body radioactive iodine scan, albeit with lower specificity and PPV.
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Altay
authors.initials: A
authors.lastname: Aliyev
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Saranya
authors.initials: S
authors.lastname: Soundararajan
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Emre
authors.initials: E
authors.lastname: Bucak
authors.affiliation: Department of Pathology, Cleveland Clinic, Cleveland, OH.
authors.forename: Manjula
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Betul
authors.initials: B
authors.lastname: Hatipoglu
authors.affiliation: Department of Endocrinology, Cleveland Clinic, Cleveland, OH.
authors.forename: Christian
authors.initials: C
authors.lastname: Nasr
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH. Electronic address: berbere@ccf.org.
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood* / Q000235:genetics; D002277:Carcinoma / Q000097:blood / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis* / Q000235:genetics; D011184:Postoperative Period; D057234:Preoperative Period; D011379:Prognosis; D012333:RNA, Messenger / Q000097:blood*; D011989:Receptors, Thyrotropin / Q000235:genetics*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D012333:RNA, Messenger; D011989:Receptors, Thyrotropin