Research Article
No access
Published Online: 1 August 2018

Changes in Serum Thyroglobulin Levels After Lobectomy in Patients with Low-Risk Papillary Thyroid Cancer

Publication: Thyroid
Volume 28, Issue Number 8

Abstract

Background: Low-risk patients with differentiated thyroid cancer can be treated with thyroid lobectomy. Serial measurements of serum thyroglobulin (Tg) are recommended for surveillance, but the cutoff values indicating recurrence are not known. This study documented the natural course of serum Tg levels during follow-up after lobectomy for low-risk papillary thyroid carcinoma (PTC) and evaluated whether changes in serum Tg levels predict disease recurrence.
Methods: This historical cohort study included 208 patients with low-risk PTC who underwent lobectomy but did not require hormone replacement. Postoperative serum Tg levels and Tg/thyrotropin (TSH) ratios and neck ultrasound were evaluated during a follow-up period with a median of 6.9 years.
Results: The serum Tg levels increased gradually, and the proportion of patients with levels >10 ng/dL increased annually by 13.9%, 18.8%, 22.1%, 21.9%, 28.4%, and 28.9% during the six-year follow-up period (β = 0.574, p = 0.027). The relative serum Tg levels increased by 10% annually (β = 0.105, p < 0.001), and the levels of Tg and Tg/TSH ratios in 19 patients with recurrent disease did not differ significantly (β = 0.150, p = 0.090). Patients without recurrent disease were more likely to have serum Tg levels increased by >20% (p = 0.022). There were no significant differences in the proportions of patients with serum Tg levels increased by ≥50% or ≥100% in terms of the disease recurrence.
Conclusions: Serum Tg levels and the Tg/TSH ratio increased gradually after lobectomy in patients with and without recurrences, without any significant differences. Periodic measurements of serum Tg levels seem to have limited value in predicting recurrent PTCs after lobectomy.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M 2009 Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214.
2.
Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R 2013 Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol 2013:965212.
3.
Durante C, Attard M, Torlontano M, Ronga G, Monzani F, Costante G, Ferdeghini M, Tumino S, Meringolo D, Bruno R, De Toma G, Crocetti U, Montesano T, Dardano A, Lamartina L, Maniglia A, Giacomelli L, Filetti S 2010 Identification and optimal postsurgical follow-up of patients with very low-risk papillary thyroid microcarcinomas. J Clin Endocrinol Metab 95:4882–4888.
4.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M 2016 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133.
5.
Yi D, Song P, Huang T, Tang X, Sang J 2017 A meta-analysis on the effect of operation modes on the recurrence of papillary thyroid microcarcinoma. Oncotarget 8:7148–7156.
6.
Kwon H, Jeon MJ, Kim WG, Park S, Kim M, Song DE, Sung T-Y, Yoon JH, Hong SJ, Kim TY 2017 A comparison of lobectomy and total thyroidectomy in patients with papillary thyroid microcarcinoma: a retrospective individual risk factor-matched cohort study. Eur J Endocrinol 176:371–378.
7.
Shaha AR, Shah JP, Loree TR 1996 Risk group stratification and prognostic factors in papillary carcinoma of thyroid. Ann Surg Oncol 3:534–538.
8.
Yi KH 2016 The Revised 2016 Korean Thyroid Association guidelines for thyroid nodules and cancers: differences from the 2015 American Thyroid Association guidelines. Endocrinol Metab 31:373–378.
9.
Tan GH, Gharib H 1997 Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 126:226–231.
10.
Park S, Kim WG, Song E, Oh H-S, Kim M, Kwon H, Jeon MJ, Kim TY, Shong YK, Kim WB 2017 Dynamic risk stratification for predicting recurrence in patients with differentiated thyroid cancer treated without radioactive iodine remnant ablation therapy. Thyroid 27:524–530.
11.
Choi YM, Kim WG, Kim TY, Bae SJ, Kim HK, Jang EK, Jeon MJ, Han JM, Lee SH, Baek JH, Shong YK, Kim WB 2014 Low levels of serum vitamin D3 are associated with autoimmune thyroid disease in pre-menopausal women. Thyroid 24:655–661.
12.
Durante C, Filetti S 2011 Management of papillary thyroid cancer patients in absence of postoperative radioiodine remnant ablation: tailoring follow-up by neck sonography. J Clin Endocrinol Metab 96:3059–3061.
13.
Jeon MJ, Kim WG, Jang EK, Choi YM, Lee YM, Sung TY, Yoon JH, Chung KW, Hong SJ, Baek JH, Lee JH, Kim TY, Shong YK, Kim WB 2015 Thyroglobulin level in fine-needle aspirates for preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: two different cutoff values according to serum thyroglobulin level. Thyroid 25:410–416.
14.
Vaisman F, Momesso D, Bulzico DA, Pessoa CH, da Cruz MD, Dias F, Corbo R, Vaisman M, Tuttle RM 2013 Thyroid lobectomy is associated with excellent clinical outcomes in properly selected differentiated thyroid cancer patients with primary tumors greater than 1 cm. J Thyroid Res 2013:398194.
15.
Momesso DP, Vaisman F, Yang SP, Bulzico DA, Corbo R, Vaisman M, Tuttle RM 2016 Dynamic risk stratification in patients with differentiated thyroid cancer treated without radioactive iodine. J Clin Endocrinol Metab 101:2692–2700.
16.
Edge SB, Byrd DR, Comptom CC, Fritz AG, Green FL, Trotti A; American Joint Committee on Cancer 2010 AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual. Seventh edition. Springer-Verlag, New York, NY.
17.
Schvartz C, Bonnetain F, Dabakuyo S, Gauthier M, Cueff A, Fieffé S, Pochart J-M, Cochet I, Crevisy E, Dalac A 2012 Impact on overall survival of radioactive iodine in low-risk differentiated thyroid cancer patients. J Clin Endocrinol 97:1526–1535.
18.
Vaisman F, Shaha A, Fish S, Michael Tuttle R 2011 Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer. Clin Endocrinol (Oxf) 75:112–119.
19.
Jeon MJ, Kim WG, Kim TH, Kim HK, Kim BH, Yi H-S, Kim ES, Kim H, Kim YN, Kim EH, Kim TY, Kim SW, Kang H-C, Chung JH, Shong YK, Kim WB 2017 Disease-specific mortality of differentiated thyroid cancer patients in Korea: a multicenter cohort study. Endocrinol Metab 32:434–441.
20.
Durante C, Montesano T, Attard M, Torlontano M, Monzani F, Costante G, Meringolo D, Ferdeghini M, Tumino S, Lamartina L, Paciaroni A, Massa M, Giacomelli L, Ronga G, Filetti S 2012 Long-term surveillance of papillary thyroid cancer patients who do not undergo postoperative radioiodine remnant ablation: is there a role for serum thyroglobulin measurement? J Clin Endocrinol Metab 97:2748–2753.
21.
Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS 1993 Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 114:1050–1058.
22.
Shaha AR, Loree TR, Shah JP 1994 Intermediate-risk group for differentiated carcinoma of thyroid. Surgery 116:1036–1041.
23.
Ross DS, Litofsky D, Ain KB, Bigos T, Brierley JD, Cooper DS, Haugen BR, Jonklaas J, Ladenson PW, Magner J 2009 Recurrence after treatment of micropapillary thyroid cancer. Thyroid 19:1043–1048.
24.
BASKIN HJ 1994 Effect of postoperative 131I treatment on thyroglobulin measurements in the follow-up of patients with thyroid cancer. Thyroid 4:239–242.
25.
Schlumberger M, Baudin E 1998 Serum thyroglobulin determination in the follow-up of patients with differentiated thyroid carcinoma. Eur J Endocrinol 138:249–252.
26.
Park S, Kim WG, Han M, Jeon MJ, Kwon H, Kim M, Sung T-Y, Kim TY, Kim WB, Hong SJ 2017 Thyrotropin suppressive therapy for low-risk small thyroid cancer: a propensity score–matched cohort study. Thyroid 27:1164–1170.
27.
Bachelot A, Cailleux AF, Klain M, Baudin E, Ricard M, Bellon N, Caillou B, Travagli JP, Schlumberger M 2002 Relationship between tumor burden and serum thyroglobulin level in patients with papillary and follicular thyroid carcinoma. Thyroid 12:707–711.
28.
Torlontano M, Attard M, Crocetti U, Tumino S, Bruno R, Costante G, D'Azzò G, Meringolo D, Ferretti E, Sacco R 2004 Follow-up of low risk patients with papillary thyroid cancer: role of neck ultrasonography in detecting lymph node metastases. J Clin Endocrinol Metab 89:3402–3407.
29.
Torlontano M, Crocetti U, D'Aloiso L, Bonfitto N, Di Giorgio A, Modoni S, Valle G, Frusciante V, Bisceglia M, Filetti S 2003 Serum thyroglobulin and 131I whole body scan after recombinant human TSH stimulation in the follow-up of low-risk patients with differentiated thyroid cancer. Eur J Endocrinol 148:19–24.

Information & Authors

Information

Published In

cover image Thyroid®
Thyroid
Volume 28Issue Number 8August 2018
Pages: 997 - 1003
PubMed: 29845894

History

Published in print: August 2018
Published online: 1 August 2018
Published ahead of print: 24 July 2018
Published ahead of production: 30 May 2018

Permissions

Request permissions for this article.

Topics

Authors

Affiliations

Suyeon Park
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
Min Ji Jeon
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Hye-Seon Oh
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Yu-Mi Lee
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Tae-Yon Sung
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Minkyu Han
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ji Min Han
Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Tae Yong Kim
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ki-Wook Chung
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Won Bae Kim
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Young Kee Shong
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Notes

Address correspondence to:Won Gu Kim, MD, PhDDepartment of Internal MedicineAsan Medical CenterUniversity of Ulsan College of Medicine88, Olympic-ro 43-gilSongpa-guSeoul, 05505Korea [email protected]

Author Disclosure Statement

No authors have any conflicts of interest in relation to this manuscript.

Metrics & Citations

Metrics

Citations

Export citation

Select the format you want to export the citations of this publication.

View Options

Get Access

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.

Society Access

If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF/EPUB

View PDF/ePub

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media

Back to Top