4
|
D'Aurizio F, Metus P, Ferrari A, Caruso B, Castello R, Villalta D, Steffan A, Gaspardo K, Pesente F, Bizzaro N, Tonutti E, Valverde S, Cosma C, Plebani M, Tozzoli R. Definition of the upper reference limit for thyroglobulin antibodies according to the National Academy of Clinical Biochemistry guidelines: comparison of eleven different automated methods. AUTOIMMUNITY HIGHLIGHTS 2017. [PMID: 28631225 PMCID: PMC5476530 DOI: 10.1007/s13317-017-0096-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose In the last two decades, thyroglobulin autoantibodies (TgAb) measurement has progressively switched from marker of thyroid autoimmunity to test associated with thyroglobulin (Tg) to verify the presence or absence of TgAb interference in the follow-up of patients with differentiated thyroid cancer. Of note, TgAb measurement is cumbersome: despite standardization against the International Reference Preparation MRC 65/93, several studies demonstrated high inter-method variability and wide variation in limits of detection and in reference intervals. Taking into account the above considerations, the main aim of the present study was the determination of TgAb upper reference limit (URL), according to the National Academy of Clinical Biochemistry guidelines, through the comparison of eleven commercial automated immunoassay platforms. Methods The sera of 120 healthy males, selected from a population survey in the province of Verona, Italy, were tested for TgAb concentration using eleven IMA applied on as many automated analyzers: AIA-2000 (AIA) and AIA-CL2400 (CL2), Tosoh Bioscience; Architect (ARC), Abbott Diagnostics; Advia Centaur XP (CEN) and Immulite 2000 XPi (IMM), Siemens Healthineers; Cobas 6000 (COB), Roche Diagnostics; Kryptor (KRY), Thermo Fisher Scientific BRAHMS, Liaison XL (LIA), Diasorin; Lumipulse G (LUM), Fujirebio; Maglumi 2000 Plus (MAG), Snibe and Phadia 250 (PHA), Phadia AB, Thermo Fisher Scientific. All assays were performed according to manufacturers’ instructions in six different laboratories in Friuli-Venezia Giulia and Veneto regions of Italy [Lab 1 (AIA), Lab 2 (CL2), Lab 3 (ARC, COB and LUM), Lab 4 (CEN, IMM, KRY and MAG), Lab 5 (LIA) and Lab 6 (PHA)]. Since TgAb values were not normally distributed, the experimental URL (e-URL) was established at 97.5 percentile according to the non-parametric method. Results TgAb e-URLs showed a significant inter-method variability. Considering the same method, e-URL was much lower than that suggested by manufacturers (m-URL), except for ARC and MAG. Correlation and linear regression were unsatisfactory. Consequently, the agreement between methods was poor, with significant bias in Bland–Altman plot. Conclusions Despite the efforts for harmonization, TgAb methods cannot be used interchangeably. Therefore, additional effort is required to improve analytical performance taking into consideration approved protocols and guidelines. Moreover, TgAb URL should be used with caution in the management of differentiated thyroid carcinoma patients since the presence and/or the degree of TgAb interference in Tg measurement has not yet been well defined.
Collapse
Affiliation(s)
- F D'Aurizio
- Clinical Pathology Institute, University Hospital, P.le S. Maria della Misericordia, 33100, Udine, Italy.
| | - P Metus
- Clinical Pathology Laboratory, 'S. Maria degli Angeli' Hospital, Pordenone, Italy
| | - A Ferrari
- Clinical Pathology Laboratory, University Hospital, Verona, Italy
| | - B Caruso
- Clinical Pathology Laboratory, University Hospital, Verona, Italy
| | - R Castello
- General Medicine and Endocrinology, University Hospital, Verona, Italy
| | - D Villalta
- Allergology and Immunology, 'S. Maria degli Angeli' Hospital, Pordenone, Italy
| | - A Steffan
- Oncological Clinical Pathology Laboratory, CRO, IRCCS, Aviano, Italy
| | - K Gaspardo
- Oncological Clinical Pathology Laboratory, CRO, IRCCS, Aviano, Italy
| | - F Pesente
- Clinical Pathology Laboratory, 'S. Antonio Hospital', Tolmezzo, Italy
| | - N Bizzaro
- Clinical Pathology Laboratory, 'S. Antonio Hospital', Tolmezzo, Italy
| | - E Tonutti
- Laboratory of Immunopathology and Allergology, University Hospital, Udine, Italy
| | - S Valverde
- Laboratory Medicine, 'Madonna della Navicella' Hospital, Chioggia (Ve), Italy
| | - C Cosma
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - M Plebani
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - R Tozzoli
- Clinical Pathology Laboratory, 'S. Maria degli Angeli' Hospital, Pordenone, Italy
| |
Collapse
|
12
|
Giovanella L, Clark PM, Chiovato L, Duntas L, Elisei R, Feldt-Rasmussen U, Leenhardt L, Luster M, Schalin-Jäntti C, Schott M, Seregni E, Rimmele H, Smit J, Verburg FA. Thyroglobulin measurement using highly sensitive assays in patients with differentiated thyroid cancer: a clinical position paper. Eur J Endocrinol 2014; 171:R33-46. [PMID: 24743400 PMCID: PMC4076114 DOI: 10.1530/eje-14-0148] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Differentiated thyroid cancer (DTC) is the most common endocrine cancer and its incidence has increased in recent decades. Initial treatment usually consists of total thyroidectomy followed by ablation of thyroid remnants by iodine-131. As thyroid cells are assumed to be the only source of thyroglobulin (Tg) in the human body, circulating Tg serves as a biochemical marker of persistent or recurrent disease in DTC follow-up. Currently, standard follow-up for DTC comprises Tg measurement and neck ultrasound combined, when indicated, with an additional radioiodine scan. Measurement of Tg after stimulation by endogenous or exogenous TSH is recommended by current clinical guidelines to detect occult disease with a maximum sensitivity due to the suboptimal sensitivity of older Tg assays. However, the development of new highly sensitive 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 without the need for TSH stimulation. Use of these highly sensitive Tg assays has not yet been incorporated into clinical guidelines but they will, we believe, be used by physicians caring for patients with DTC. The aim of this clinical position paper is, therefore, to offer advice on the various aspects and implications of using these highly sensitive Tg assays in the clinical care of patients with DTC.
Collapse
Affiliation(s)
- Luca Giovanella
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Penelope M Clark
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Luca Chiovato
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Leonidas Duntas
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Rossella Elisei
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Ulla Feldt-Rasmussen
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Laurence Leenhardt
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Markus Luster
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Camilla Schalin-Jäntti
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Matthias Schott
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Ettore Seregni
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Herald Rimmele
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Jan Smit
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| | - Frederik A Verburg
- Department of Nuclear MedicinePET Centre and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, SwitzerlandClinical Laboratory ServicesQueen Elizabeth Hospital Birmingham, Birmingham, UKDepartment of Internal Medicine and EndocrinologyFondazione Salvatore Maugeri IRCCS, University of Pavia Hospital, 27100 Pavia, ItalyEndocrine UnitEvgenidion Hospital, University of Athens Medical School, Athens, GreeceDepartment of EndocrinologyUniversity Hospital Pisa, Pisa, ItalyDepartment of EndocrinologyRigshospitalet, Copenhagen University, Copenhagen, DenmarkDepartment of Nuclear MedicinePitié Salpêtrière Hospital, Paris, FranceDepartment of Nuclear MedicineUniversity Hospital Marburg, Marburg, GermanyDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of Specific EndocrinologyUniversity Hospital Dusseldorf, Dusseldorf, GermanyDepartment of Nuclear Medicine - Radioisotopic Therapy and Endocrinology UnitInstituto Nazionale Tumori, Milan, ItalySelf-Help Organization of Thyroid Cancer Patients 'Ohne Schilddrüse leben e.V.'Berlin, GermanyDepartment of EndocrinologyUniversity Medical Center St Radboud, Nijmegen, The NetherlandsDepartment of Nuclear MedicineRWTH University Hospital Aachen, Aachen, Germany
| |
Collapse
|