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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.
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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
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