Using stimulated Tg testing alone on low risk WDTC Patients

A recently published consensus report addresses the use of TSH-stimulated Tg testing alone to monitor certain low-risk, well-differentiated thyroid cancer patients (WDTC) for recurrences^[1]. The report reviews recent data from 8 published studies demonstrating that TSH-stimulated Tg testing is sufficiently sensitive to monitor most low-risk, WDTC patients. The report includes an algorithm with guidelines for monitoring low-risk WDTC patients with TSH stimulated Tg testing. Some highlights of the report include:

Presents surveillance guidelines for low-risk WDTC patients who appear clinically free of disease (after near total/total thyroidectomy and 131 I ablation)

Outlines minimal acceptable performance standards for Tg assays

Concludes that an undetectable Tg on thyroid hormone suppression therapy is misleading and may miss residual or metastatic disease in some patients

Concludes that TSH-stimulated Tg testing is sufficiently sensitive to be used as the principal test in the follow-up of most low-risk, WDTC patients.

Reviews data demonstrating that both methods of TSH-stimulated Tg testing (withdrawal of thyroid hormone suppression therapy or rhTSH administration) are equally effective in detecting metastatic disease.

Download Algorithm (PDF)

Download Tg Consensus paper (PDF)

Download the Tg Lab Tracking Form (PDF)

References

1. Mazzaferri EL, Robbins RJ, et al. A consensus report of the role of serum thyroglobulin as a monitoring mehtod for low-risk patients with papillary thyroid carcinoma. J. Clin Endocrinol Metab. 2003; 88: 1433-1441.