SERIAL SERUM THYROGLOBULIN MEASUREMENTS IN THE MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMA
SERIAL SERUM THYROGLOBULIN MEASUREMENTS IN THE MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMA
复制标题
分化型甲状腺癌治疗中的连续血清甲状腺球蛋白测量
作者：
E. Black;M. Sheppard;R. Hoffenberg
在416例分化型甲状腺癌患者接受初始治疗后长达7年的时间里，反复检测血清甲状腺球蛋白（Tg）。所有患者都进行了甲状腺切除术和/或消融治疗，所有测量都是在患者接受T4替代治疗时进行的。Tg采用双抗体放射免疫分析法测定。血清Tg浓度与是否存在癌症之间的总体相关性为95‐9%。在首次测量时，295名患者血清Tg <5 μg/1，而在最新的分析中，这些患者中只有1‐7%显示出疾病的证据。121例患者中有19例血清Tg≤5 μg/l，未见明显肿瘤。在这19名受试者中，有8人在首次检测后3 - 5年内被诊断为复发或转移性疾病，这表明在这些病例中血清Tg值具有“预测性”。血清Tg似乎是检测残余、复发或转移甲状腺癌的一种敏感和特异性手段，在大多数情况下可以取代常规、昂贵和不方便的放射性甲状腺扫描；当血清Tg值升高或有临床证据表明复发时，应进行这些检查。
Serum thyreoglobulin (Tg) was measured on repeated occasions in 416 patients with differentiated thyroid cancer for up to 7 years after initial therapy. All patients had thyroidectomy and/or ablative 131I therapy and all measurements were done while patients were receiving T4 replacement. Tg was measured using a double‐antibody radioimmunoassay. Overall correlation between serum Tg concentration and presence or absence of cancer was 95‐9%. At the time of initial measurement 295 patients had serum Tg <5 μg/1, and in the latest analysis only 1‐7% of these patients showed evidence of disease. Initially there were 19 patients of a total of 121 with serum Tg > 5 μg/l in whom no cancer was apparent. In eight of these 19 subjects recurrent or metastatic disease has been diagnosed up to 3‐5 years after the first measurement indicating that in these cases serum Tg values were ‘predictive’. Serum Tg appears to be a sensitive and specific means of detecting residual, recurrent or metastatic thyroid cancer and in most situations can replace routine, expensive and inconvenient radioactive thyroid scans; these should be performed when serum Tg values are elevated or when there is clinical evidence suggesting recurrence.