Published: 2019-11-26

Preoperative significance of thyroglobulin, thyroid stimulating hormone and thyroglobulin antibody in differentiated papillary thyroid carcinoma

Tarek M. Rageh, Asmaa G. Abdou, Enas A. Elkhouly, Dalia H. Abou El- Ela, Mohamed A. Zidan


Background: The objective of the study was to compare the levels of preoperative thyroglobulin (TG), thyroid stimulating hormone level (TSH), FT3, FT4 and TG Ab among 50 malignant and 50 benign thyroid swellings. Papillary thyroid cancer (PTC) is the most common malignancy in thyroid gland. TG antibodies (Ab) occur in around 20% of patients with papillary thyroid cancer (PTC), and the presence of TG Ab complicates the follow-up of these patients because TG-Ab interferes with the assay of serum TG7.

Methods: A prospective and retrospective study conducted on 100 patients with thyroid nodule diagnosed by neck ultrasound and confirmed by histopathological evaluation in Faculty of Medicine, Menoufia University Hospital, Egypt, during January 2017 to July 2019. History taking, levels of TG, TSH free T3, free T4 and TG Ab, neck ultrasound or CT and pathological evaluation were done.

Results: There were statistically significant differences between malignant and benign thyroid swellings regarding, TG level, TSH and T4 level. Also, there was statistically significant difference between the level of TG and tumor recurrence (p=0.01). While, there was no statistical significance between focality, staging, lymph node status, capsular invasion, lymphovascular embolization, and evidence of hashimoto thyroiditis and the level of TG.

Conclusions: Preoperative serum TG concentration is a useful marker for predicting the presence of initial distant metastasis of PTC and tumor recurrence. TSH level considered an important prognostic factor for papillary thyroid cancer patients.


Papillary thyroid carcinoma, Recurrence, Thyroglobulin, TSH

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Baker Jr JR. The immune response to papillary thyroid cancer. J Clin Endocrinol Metabol. 1995;80(12):3419-20.

Haymart MR, Glinberg SL, Liu J, Sippel RS, Jaume JC, Chen H. Higher serum TSH in thyroid cancer patients occurs independent of age and correlates with extrathyroidal extension. Clin Endocrinol. 2009;71(3):434-9.

Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006;295(18):2164-7.

Boelaert K. The association between serum TSH concentration and thyroid cancer. Endocrine-related Cancer. 2009;16(4):1065-72.

Polyzos SA, Κita M, Efstathiadou Z, Poulakos P, Slavakis A, Sofianou D, et al. Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules. J Cancer Res Clin Oncol. 2008;134(9):953-60.

Haugedes BR, Alexander EK, Bible KC. 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. 2016;26(1):1-133.

Leung AM, Pearce EN, Braverman LE. Environmental perchlorate exposure: potential adverse thyroid effects. Current opinion in endocrinology, diabetes, and obesity. 2014;21(5):372.

Sipos JA, Mazzaferri EL. The therapeutic management of differentiated thyroid cancer. Expert opinion on pharmacotherapy. 2014;9(15):2627-37.

Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard BAG, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol. 2014;81:1-22.

Fiore E, Rago T, Provenzale MA, Scutari M, Ugolini C, Basolo F, et al. Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role. Endocrine-Related Cancer. 2009;16(4):1251-60.

El gammal SA, El.Balshy AM, Zahran MK. Relation between thyroid nodule size and incidence of thyroid cancer. MMJ, 2019;32:1142-8.

Zafon C, Obiols G, Baena JA, Castellví J, Dalama B, Mesa J. Preoperative thyrotropin serum concentrations gradually increase from benign thyroid nodules to papillary thyroid microcarcinomas then to papillary thyroid cancers of larger size. J Thyroid Res. 2012;2012.

Kim HK, Yoon JH, Kim SJ, Cho JS, Kweon SS, Kang HC. Higher TSH level is a risk factor for differentiated thyroid cancer. Clin Endocrinol. 2013;78(3):472-7.

Rageh MT, Samaka MR, Hagag GM, Motawa AE. Relation between focality and cervical lymph nodes metastasis in papillary thyroid cancer. Int Surg J. 2019;6(2):453-8.

Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 1988;104:947-953.

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. Journal of surgical oncology. 2012;105(4):351-6.

Haymart MR, Glinberg SL, Liu J, Sippel RS, Jaume JC, Chen H. Higher serum TSH in thyroid cancer patients occurs independent of age and correlates with extrathyroidal extension. Clin Endocrinol. 2009;71(3):434-9.

Zheng J, Li C, Lu W, Wang C, Ai Z. Quantitative assessment of preoperative serum thyrotropin level and thyroid cancer. Oncotarget. 2016;7(23):34918.

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 Ḧurthle-cell neoplasms of the thyroid. The Am J Surg. 2010;200(1):41-6.

Latrofa F, Ricci D, Montanelli L, Rocchi R, Piaggi P, Sisti E, et al. Lymphocytic thyroiditis on histology papillary thyroid carcinoma: impact on detection of serum thyroglobulin. J Clin Endocrinol Metabol. 2012;97(7):2380-7.

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):1-5.

Choi YM, Kim TY, Jang EK, Kwon H, Jeon MJ, Kim WG, et al. Standardized thyroid cancer mortality in Korea between 1985 and 2010. Endocrinol Metabol. 2014;29(4):530-5.

Jonklaas J, Nsouli-Maktabi H, Soldin SJ. Endogenous thyrotropin and triiodothyronine concentrations in individuals with thyroid cancer. Thyroid. 2008;18(9):943-52.

Rinaldi S, Plummer M, Biessy C, Tsilidis KK, Østergaard JN, Overvad K, et al. Thyroid-stimulating hormone, thyroglobulin, and thyroid hormones and risk of differentiated thyroid carcinoma: the EPIC study. J National Cancer Institute. 2014;106(6):97.