Thyroid carcinoma is diagnosed in about 22,000 people each year in the United States
[
[1]
]. More than 90% of thyroid carcinomas, including papillary and follicular cancers,
are well-differentiated. Although thyroid carcinomas are among the most curable cancers,
some patients are at high risk of recurrent disease or even death; life-long follow-up
is required. Thyroid tissue is the only source of circulating thyroglobulin and serial
monitoring of serum thyroglobulin is a vital tool to detect residual or recurrent
cancer. Use of serum thyroglobulin as a highly specific tumor marker for the management
of differentiated thyroid carcinoma requires an appreciation of the assay's biologic
and analytical limitations. This article focuses on the pathophysiology of thyroglobulin
and on the methodology and clinical usefulness of thyroglobulin measurements.To read this article in full you will need to make a payment
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References
- Cancer statistics, 2003.CA Cancer J Clin. 2003; 53: 5-26
- Control of thyroglobulin synthesis and secretion. Part II.N Engl J Med. 1979; 301: 307-314
- Control of thyroglobulin synthesis and secretion. Part I.N Engl J Med. 1979; 301: 239-249
- Thyroglobulin, the prothyroid hormone: chemistry, synthesis and degradation.Biochim Biophys Acta. 1999; 1430: 157-178
- The importance of thyroglobulin structure for thyroid hormone biosynthesis.Biochimie. 1999; 81: 505-509
- Modulation of the carbohydrate moiety of thyroglobulin by thyrotropin and calcium in Fisher rat thyroid line-5 cells.J Biol Chem. 1992; 267: 1938-1944
- Iodine content of serum thyroglobulin in normal individuals and patients with thyroid tumors.J Clin Endocrinol Metab. 1983; 57: 1251-1256
- Biochemical characterization of serum thyroglobulin from patients with bone metastases from follicular carcinoma of the thyroid.Indian J Biochem Biophys. 1991; 28: 198-202
- Monoclonal antibodies to thyroglobulin elucidate differences in protein structure of thyroglobulin in healthy individuals and those with papillary adenocarcinoma.J Clin Endocrinol Metab. 1985; 61: 343-350
- The dynamics of serum thyroglobulin elimination from the body after thyroid surgery.Eur J Surg Oncol. 1997; 23: 208-210
- Hepatic membrane receptors for glycoproteins.Prog Liver Dis. 1986; 8: 99-123
- Intracellular routing of GLcNAc-bearing molecules in thyrocytes: selective recycling through the Golgi apparatus.J Cell Biol. 1993; 123: 1695-1706
- Binding and internalization of thyroglobulin: selectivity, pH dependence, and lack of tissue specificity.Endocrinology. 1997; 138: 2325-2332
- Thyroglobulin molecules internalized by thyrocytes are sorted in early endosomes and partially recycled back to the follicular lumen.Endocrinology. 1993; 132: 2645-2653
- Role of megalin (gp330) in transcytosis of thyroglobulin by thyroid cells. A novel function in the control of thyroid hormone release.J Biol Chem. 2000; 275: 7125-7137
- Thyroglobulin autoregulation of thyroid-specific gene expression and follicular function.Rev Endocr Metab Disord. 2000; 1: 217-224
- Effects of thyroglobulin and pendrin on iodide flux through the thyrocyte.Trends Endocrinol Metab. 2001; 12: 10-16
- Thyroglobulin regulates follicular function and heterogeneity by suppressing thyroid-specific gene expression.Biochimie. 1999; 81: 329-340
- Localization of the thyroglobulin gene by in situ hybridization to human chromosomes.Hum Genet. 1985; 69: 28-31
- Genomic organization of the human thyroglobulin gene: the complete intron-exon structure.Eur J Endocrinol. 2001; 145: 485-496
- The thyroglobulin gene: evolutionary and regulatory issues.Trends Endocrinol Metab. 1990; 1: 351-356
- Thyroid transcription factor 1 and Pax8 synergistically activate the promoter of the human thyroglobulin gene.J Mol Endocrinol. 2001; 27: 59-67
- Transcriptional activation of the thyroglobulin promoter directing suicide gene expression by thyroid transcription factor-1 in thyroid cancer cells.Cancer Res. 2001; 61: 3640-3646
- Isolation of a normal human thyroid cell line: hormonal requirement for thyroglobulin regulation.Thyroid. 2002; 12: 539-546
- Atrial natriuretic peptide inhibits iodide uptake and thyroglobulin messenger ribonucleic acid expression in cultured bovine thyroid follicles.Regul Pept. 2002; 106: 19-26
- 15-Deoxy-delta(12, 14)-prostaglandin J(2) facilitates thyroglobulin production by cultured human thyrocytes.Am J Physiol Cell Physiol. 2000; 279: C1859-C1869
- Thyroid transcription factor 1 phosphorylation is not required for protein kinase A-dependent transcription of the thyroglobulin promoter.Cell Growth Differ. 2000; 11: 649-654
- Expression of the sodium iodide symporter and thyroglobulin genes are reduced in papillary thyroid cancer.Mod Pathol. 2001; 14: 289-296
- Restoration of iodide uptake in dedifferentiated thyroid carcinoma: relationship to human Na+/I− symporter gene methylation status.J Clin Endocrinol Metab. 1999; 84: 2449-2457
- Low concentrations of the histone deacetylase inhibitor, depsipeptide (FR901228), increase expression of the Na(+)/I(−) symporter and iodine accumulation in poorly differentiated thyroid carcinoma cells.J Clin Endocrinol Metab. 2001; 86: 3430-3435
- Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan.J Clin Endocrinol Metab. 1995; 80: 1488-1492
- The predictive value of serum thyroglobulin in the follow-up of differentiated thyroid cancer.Eur J Nucl Med. 1997; 24: 722-727
- Clinical evaluation of tumor characteristics predisposing serum thyroglobulin to be undetectable in patients with differentiated thyroid cancer.Cancer. 1988; 61: 976-981
- Undetectable serum thyroglobulin in a patient with metastatic follicular thyroid cancer.Clin Nucl Med. 1999; 24: 346-349
- Comparison of histology and immunohistochemistry with thyroglobulin serum levels and radioiodine uptake in recurrences and metastases of differentiated thyroid carcinomas.Acta Endocrinol (Copenh). 1985; 108: 504-510
- Relationship between tumor burden and serum thyroglobulin level in patients with papillary and follicular thyroid carcinoma.Thyroid. 2002; 12: 707-711
- Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum Tg levels after initial treatment.J Clin Endocrinol Metab. 2002; 87: 1499-1501
- Value of immunoperoxidase staining of thyroglobulin in fine needle aspiration cytology of thyroid diseases.Acta Cytol. 1995; 39: 396-401
- Immunohistochemical study of thyroglobulin in thyroid carcinomas with monoclonal antibodies.Cancer. 1987; 59: 471-476
- Thyroid transcription factor-1, thyroglobulin, cytokeratin 7, and cytokeratin 20 in thyroid neoplasms.Appl Immunohistochem Mol Morphol. 2000; 8: 189-194
- Application of an immunodiagnostic method for improving preoperative diagnosis of nodular thyroid lesions.Lancet. 2001; 357: 1644-1650
- Serum and tissue thyroglobulin measurement: clinical applications in thyroid disease.Biochimie. 1999; 81: 463-467
- Thyroid-associated antigens in routinely embedded carcinomas. Possibilities and limitations studied in 116 cases.Cancer. 1984; 54: 274-279
- Radioimmunoassay for measurement of thyroglobulin in human serum.J Clin Invest. 1973; 52: 1320-1327
- Can we measure serum thyroglobulin?.Ann Clin Biochem. 2002; 39: 196-202
- Thyroglobulin measurement: techniques, clinical benefits, and pitfalls.Endocrinol Metab Clin N Amer. 1995; 24: 841-863
- Serum thyroglobulin measurement. Utility in clinical practice.Endocrinol Metab Clin North Am. 2001; 30: 429-467
- Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease.Thyroid. 2003; 13: 3-126
- High-sensitivity human thyroglobulin (hTG) immunoradiometric assay in the follow-up of patients with differentiated thyroid cancer.Clin Chem Lab Med. 2002; 40: 480-484
- Technical evaluation of a new immunoradiometric and a new immunoluminometric assay for thyroglobulin.Clin Chem. 2002; 48: 1077-1083
- Comparison of two thyroglobulin immunoradiometric assays on the basis of comprehensive imaging in differentiated thyroid carcinoma.Thyroid. 1999; 9: 933-941
- Prediction of disease status by recombinant human TSH-stimulated serum Tg in the postsurgical follow-up of differentiated thyroid carcinoma.J Clin Endocrinol Metab. 2001; 86: 5686-5690
- A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer.J Clin Endocrinol Metab. 1999; 84: 3877-3885
- Detection of residual and recurrent differentiated thyroid carcinoma by serum thyroglobulin measurement.Thyroid. 1999; 9: 435-441
- Papillary and follicular thyroid carcinoma.N Engl J Med. 1998; 338: 297-306
- Current status and performance goals for serum thyroglobulin assays.Clin Chem. 1996; 42: 164-173
- Phantoms in the assay tube: heterophile antibody interferences in serum thyroglobulin assays.J Clin Endocrinol Metab. 2003; 88: 3069-3074
- European interlaboratory comparison of serum thyroglobulin measurement.J Endocrinol Invest. 1988; 11: 175-181
- Human thyroglobulin reference material (CRM 457).Ann Biol Clin (Paris). 1996; 54: 337-342
- Human thyroglobulin reference material (CRM 457).Ann Biol Clin (Paris). 1996; 54: 343-348
- Tumour markers: same marker, different assay, different result.Clin Oncol (R Coll Radiol). 1999; 11: 221-222
- Serum thyroglobulin autoantibodies: prevalence, influence on serum thyroglobulin measurement, and prognostic significance in patients with differentiated thyroid carcinoma.J Clin Endocrinol Metab. 1998; 83: 1121-1127
- Thyroglobulin antibodies in differentiated thyroid cancer.Clin Oncol (R Coll Radiol). 1999; 11: 240-244
- Clinical meaning of circulating antithyroglobulin antibodies in differentiated thyroid cancer: a prospective study.J Nucl Med. 1992; 33: 1478-1480
- Serum thyroglobulin determination in the follow-up of patients with differentiated thyroid carcinoma.Eur J Endocrinol. 1998; 138: 249-252
- Importance of the detection method for thyroglobulin antibodies for the validity of thyroglobulin measurements in sera from patients with Graves disease.Clin Chem. 2002; 48: 102-107
- Recoveries cannot be used to authenticate thyroglobulin (Tg) measurements when sera contain Tg autoantibodies.Clin Chem. 1996; 42: 661-663
- Highly sensitive immunoradiometric assay for serum thyroglobulin with minimal interference from autoantibodies.Clin Chem. 1996; 42: 258-262
- Assay of thyroglobulin in serum with thyroglobulin autoantibodies: an unobtainable goal?.J Clin Endocrinol Metab. 1995; 80: 468-472
- Should one measure serum thyroglobulin in the presence of anti-thyroglobulin antibodies?.Clin Endocrinol (Oxf). 1983; 19: 597-601
- Early diagnosis by genetic analysis of differentiated thyroid cancer metastases in small lymph nodes.J Clin Endocrinol Metab. 1997; 82: 1638-1641
- Quantitative reverse transcription-polymerase chain reaction of circulating thyroglobulin messenger ribonucleic acid for monitoring patients with thyroid carcinoma.J Clin Endocrinol Metab. 1999; 84: 4037-4042
- Detection of recurrent thyroid cancer by sensitive nested reverse transcription-polymerase chain reaction of thyroglobulin and sodium/iodide symporter messenger ribonucleic acid transcripts in peripheral blood.J Clin Endocrinol Metab. 2000; 85: 3623-3627
- Quantitative reverse transcription-PCR measurement of thyroglobulin mRNA in peripheral blood of healthy subjects.Clin Chem. 1999; 45: 785-789
- Detection of thyroglobulin mRNA transcripts in peripheral blood of individuals with and without thyroid glands: evidence for thyroglobulin expression by blood cells.Eur J Endocrinol. 2001; 145: 409-413
- Quantitative detection of peripheral thyroglobulin mRNA has limited clinical value in the follow-up of thyroid cancer patients.Ann Clin Biochem. 2003; 40: 94-99
- Thyroglobulin mRNA quantification in the peripheral blood is not a reliable marker for the follow-up of patients with differentiated thyroid cancer.Eur J Endocrinol. 2002; 147: 575-582
- Quantitative measurement of thyroglobulin mRNA in peripheral blood of patients after total thyroidectomy.Br J Cancer. 2001; 85: 102-106
- Validity of thyroglobulin mRNA assay in peripheral blood of postoperative thyroid carcinoma patients in predicting tumor recurrences varies according to the histologic type: results of a prospective study.Cancer. 2001; 92: 2273-2279
- Molecular detection of thyroglobulin mRNA transcripts in peripheral blood of patients with thyroid disease by RT-PCR.Br J Cancer. 2000; 82: 1650-1655
- Analysis of Tg transcripts by real-time RT-PCR in the blood of thyroid cancer patients.J Clin Endocrinol Metab. 2002; 87: 635-639
- Relation between effective radiation dose and outcome of radioiodine therapy for thyroid cancer.N Engl J Med. 1983; 309: 937-941
- The value of serum thyroglobulin measurement in clinical practice.JAMA. 1983; 250: 2352-2357
- Circulating thyroglobulin and thyroid hormones in patients with metastases of differentiated thyroid carcinoma: relationship to serum thyrotropin levels.J Clin Endocrinol Metab. 1980; 51: 513-519
- Sequential serum thyroglobulin determinations, 131I scans, and 131I uptakes after triiodothyronine withdrawal in patients with thyroid cancer.J Clin Endocrinol Metab. 1981; 53: 1199-1206
- A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma.J Clin Endocrinol Metab. 2003; 88: 1433-1441
- Value of stimulated serum thyroglobulin levels for detecting persistent or recurrent differentiated thyroid cancer in high- and low-risk patients.Surgery. 1999; 126: 13-19
- Efficacy of high therapeutic doses of iodine-131 in patients with differentiated thyroid cancer and detectable serum thyroglobulin.Eur J Nucl Med. 2001; 28: 198-202
- Sensitivity of 123I whole-body scan and thyroglobulin in the detection of metastases or recurrent differentiated thyroid cancer.Eur J Nucl Med Mol Imaging. 2002; 29: 768-774
- Lack of impact of radioiodine therapy in tg-positive, diagnostic whole-body scan-negative patients with follicular cell-derived thyroid cancer.J Clin Endocrinol Metab. 2002; 87: 1521-1526
- Clinical impact of (18)F-FDG PET in thyroid carcinoma patients with elevated thyroglobulin levels and negative (131)I scanning results after therapy.J Nucl Med. 2001; 42: 1464-1469
- Management of undifferentiated thyroid cancer.Baillieres Best Pract Res Clin Endocrinol Metab. 2000; 14: 615-629
- Recurrent differentiated thyroid cancer without elevation of serum thyroglobulin.Thyroid. 2000; 10: 171-176
- N-ras mutation in poorly differentiated thyroid carcinomas: correlation with bone metastases and inverse correlation to thyroglobulin expression.Thyroid. 2000; 10: 19-23
- Clinical significance of elevated level of serum antithyroglobulin antibody in patients with differentiated thyroid cancer after thyroid ablation.Clin Endocrinol (Oxf). 2002; 57: 215-221
Article info
Footnotes
☆Funding support by VA Merit Review 596-0007 and NCI Grant #K24CA82116 (to KBA).
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© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.