Klopstra, J.M. (2014) The clinical value of thyroglobulin antibodies and Hashimoto’s thyroiditis in the follow-up of patients with differentiated thyroid carcinoma. thesis, Medicine.
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Abstract
Introduction: Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy. Thyroglobulin (Tg) is the tumor marker of DTC, however, thyroglobulin antibodies (TgAbs) decrease the reliability of Tg measurements. For TgAb measurements, a luminescence immunoassay (TgAb-ILMA) and a radioimmunoassay (TgAb-RIA) are used in our institute. In literature, Hashimoto’s thyroiditis (HT) is associated with both DTC and TgAbs. HT is often associated with a more favorable disease outcome, although the exact causality and clinical association between these associations is unknown. We aim to find out which TgAb assay is clinically the most reliable. Furthermore, we aim to create more insight in the clinical outcome of TgAb positive and negative DTC patients, either with or without HT. Methods: All DTC patients still in follow-up in our institute between March 21st, 2006 and September 2nd, 2013 were included. Their medical files were consulted for patient-related data, laboratory values of Tg and TgAbs, cumulative radioiodine doses, pathological data and final disease state. Research questions involving TgAbs only used a subgroup of patients who were diagnosed with DTC after March 21st, 2006, the date of introduction of the TgAb assays in our institute. Patients without available data were excluded from analysis. Results: 621 DTC patients were included in this study, 236 of them were included in the subgroup for TgAb analysis. 54 of these 236 (22.9%) patients were TgAb-ILMA positive, 43 (18.2%) were TgAb-RIA positive and 37 (15.7%) were positive in both assays. Only 6 patients (2.5%) were TgAb-RIA positive and TgAb-ILMA negative. They had small tumors, were all in remission and did not show any recurrence. 578/621 DTC patients had available pathological data of the thyroidectomy. HT was found in 87/578 patients (15.1%). The presence of HT was associated with female gender (89.7% vs. 70.1%; p <0.001), younger age (42.3 vs. 46.8 years; p = 0.023), less distant metastases (1.1% vs. 9.4%; p = 0.009), lower cumulative radioiodine doses (p = 0.015) and a more favorable disease outcome (p = 0.001), compared to the absence of HT. From the subgroup for TgAb analysis, 225/236 patients had both available pathological data and reliable TgAb values. Comparison between TgAb positive patients with HT (23/225; 10.2%) and TgAb positive patients without HT (13/225; 5.8%) revealed a younger age (47.9 years vs. 61.1 years; p = 0.011) and no T4-tumors (extensive local tumor growth) (0.0% vs. 26.7%; p = 0.007) in the first group. Besides, the number of patients in remission was higher (65.2% vs. 53.3%) and persistent disease was lower (4.3% vs. 26.7%) (p = 0.049). Conclusions: TgAb-ILMA is more suitable for detecting TgAbs in DTC patients than TgAb-RIA; abolishing the latter would not lead to missing patients with extensive disease. HT-patients have a more favorable disease state and outcome, compared to non-HT patients. TgAb positivity with HT is associated with a more favorable disease state and outcome than without HT.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Links, Prof. dr. T.P. and Klein Hesselink, Drs. M.S. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2458 |
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