Published: 2020-01-27

Preoperative serum thyroglobulin levels as a predictor of thyroid carcinoma

Mir Mohammed Noorul Hassan, Prakash S. Kattimani, Aeiman Saniya


Background: Incidence of thyroid nodules varies according to the methods of diagnosis, 4-7% by palpation and 17-67% by high resolution ultrasound. The gold standard of diagnosis for thyroid nodules is fine needle aspiration (FNA); however, fine needle aspiration cytology (FNAC) alone is insufficient to detect cancer because of inadequate cytology (5-15%) and in cases of follicular neoplasm (15-25%) where only surgery is diagnostically conclusive. Therefore, other factors in addition to FNA should be considered to predict malignancy. This study was done to evaluate the association between elevated pre-operative thyroglobulin levels and histopathologically proven thyroid carcinoma.

Methods: This retrospective study was conducted in Bowring and Lady Curzon Hospital, from December 2017 to November 2018. All patients above 18 years, undergoing total thyroidectomy, with normal antithyroglobulin levels and with indeterminate thyroid nodules or disease on FNAC were included. Patients proven to have malignancy by FNAC, who underwent hemithyroidectomy and patients with thyroglossal cyst or ectopic thyroid swellings were excluded.

Results: A total of 50 patients were included. The Fischer’s exact test shows significant value of 0.037 and also the two-tailed test showed a p value <0.05, hence it is significant to conclude that the mean value of thyroglobulin levels among histopathologically proven malignant thyroid cancers is significantly higher compared to the benign thyroid disease.

Conclusions: In addition to thyroid-stimulating hormone, thyroid nodules with elevated thyroglobulin levels were independently associated with the presence of thyroid cancer; therefore, the evaluation of pre-operative thyroglobulin level in patients with indeterminate FNAC might give additional information to predict malignancy.


Thyroid carcinoma, Elevated thyroglobulin levels, Histopathological analysis

Full Text:



Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol. 1977;7:481-93.

Vander JB, Gatson EA, Dawber TR. The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann Intern Med. 1968;69:537-40.

Hegedus L. Thyroid ultrasound. Endocrinol Metab Clin North Am. 2001;30:339-60.

Knudsen N, Laurberg P, Perrild H, Bulow I, Ovesen L, Jorgensen T. Risk factors for goitre and thyroid nodules. Thyroid. 2002;12:879-88.

Belfoire A, La Rosa GL, La Porta GA, Giuffrida D, Milazzo G, Lupo L. Cancer risk in patients with cold thyroid nodules: revelance of iodine intake, sex, age, and multinodularity. Am J Med. 1992;93:363-9.

Wang C, Crapo LM. The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin North Am. 1997;26:189-218.

Davies L, Welch HG. Increasing incidence of the thyroid cancer in the United States, 1973-2002. JAMA. 2006;295:2164-7.

Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet Pm, Gawande A, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111:508-16.

Alexander EK. Approach to the patient with a cytologically indeterminate thyroid nodule. J Clin Endocrinol Metab. 2008;93:4175-82.

Sinclair D. Clinical and laboratory aspects of thyroid autoantibodies. Ann Clin Biochem. 2006;43:173-83.

Latrofa F, Ricci D, Grasso L, Vitti P, Masserini L, Basolo F, et al. Characterization of thyroglobulin epitopes in patients with autoimmune and non-autoimmune thyroid diseases using recombinant human monoclonal thyroglobulin autoantibodies. J Clin Endocrinol Metab. 2008;93:591-6.

Carayon P, Thomas -Morvan C, Castanas E, Tubiana M. Human thyroid cancer: membrane thyrotropin binding and adenylate cyclase activity. J Clin Endocrinol Metab. 1980;51:915-20.

Ichikawa Y, Saito E, Abe Y, Homma M, Muraki T. Presence of TSH receptor in thyroid neoplasms. J Clin Endocrinol Metab. 1976;42:395-8.

Petric R, Perhavec A, Gazic B, Besic N. Preoperative serum thyroglobulin concentration is an independent predictive factor of malignancy in follicular neoplasms of the thyroid gland. J Surg Oncol. 2012;105:351-6.

Petric R, Besic H, Besic N. Preoperative serum thyroglobulin concentration as a predictive factor of malignancy in small follicular and Hurthle cell neoplasms of the thyroid gland. World J Surg Oncol. 2014;12:282.

Oltmann SC, Leverson G, Lin SH, Schneider DF, Chen H, Sippel RS. Markedly elevated thyroglobulin levels in the preoperative thyroidectomy patient correlates with metastatic burden. J Surg Res. 2014;187:1-5.

Herle AJ, Uller RP. Elevated serum thyroglobulin. A marker of metastases in differentiated thyroid carcinomas. J Clin Invest. 1975;56:272–7.

Guarino E, Tarantini B, Pilli T, Checchi S, Brilli L, Ciuoli C, et al. Presurgical serum thyroglobulin has no prognostic value in papillary thyroid cancer. Thyroid. 2005;15:1041-5.

Suh I, Vriens MR, Guerrero MA, Griffin A, Shen WT, Duh QY, et al. Serum thyroglobulin is a poor diagnostic biomarker of malignancy in follicular and Hurthle-cell neoplasms of the thyroid. Am J Surg. 2010;200:41-46.

Latrofa F, Ricci D, Montanelli L, Rocchi R, Piaggi P, Sisti E. Lymphocytic thyroiditis on histology correlates with serum thyroglobulin autoantibodies in patients with papillary thyroid carcinoma: impact on detection of serum thyroglobulin. J Clin Endocrinol Metab. 2012;97:2380-7.

Kim ES, Lim DJ, Baek KH, Lee JM, Kim MK, Kwon HS, et al. Thyroglobulin antibody is associated with increased cancer risk in thyroid nodules. Thyroid. 2010;20(8):885-91.