Schilddrüsenspezifische Tumormarker

Zusammenfassung

Thyreoglobulin (hTg) bzw. Kalzitonin (hCt) sind etablierte humorale Tumormarker für die Therapieüberwachung und Nachsorge der behandelten thyreoidalen Follikelzell- bzw. C-Zell-Karzinome. Hierfür besitzen diese Analyten eine im Vergleich zu vielen anderen Tumormarkern hohe diagnostische Spezifität, die mit dem Ausmaß der Radikalität der Schilddrüsenablation zunimmt. In den letzten Jahren werden Assays mit zunehmender funktioneller Sensitivität angeboten, die allerdings mit neuen Herausforderungen an die labortechnische Durchführung, die Qualitätssicherung sowie die Interpretation der im „ultrasensitiven” Bereich messbaren Werte einhergehen. Ohnehin sind hTg und hCt als relativ anspruchsvolle Laborparameter anzusehen. Die Messergebnisse sind zum Teil deutlich abhängig von diversen In-vivo- und In-vitro-Einflussfaktoren, aber auch bei konstanten Rahmenbedingungen ist die Vergleichbarkeit der gemessenen Werte zwischen verschiedenen Assays nicht ohne weiteres garantiert. Hinsichtlich der hCt-Bestimmung bieten Assays mit weitgehend selektiver Erfassung der monomeren (reifen) Kalzitoninform den Vorteil einer weiteren Steigerung der diagnostischen Spezifität. Abgesehen von der Überwachung der wegen eines Schilddrüsenkarzinom behandelten Patienten wird die hCt-Bestimmung von zahlreichen Fachgesellschaften auch bei der Dignitätsabklärung thyreoidaler Raumforderungen als gerechtfertigt angesehen, wohingegen die hTg-Bestimmung nicht als Routinemaßnahme zur Schilddrüsenknotenabklärung in die Leitlinien aufgenommen wurde. Die hTg-Bestimmung kann aber bei der Evaluierung bestimmter benigner Schilddrüsenprozesse indiziert sein wie der Differenzialdiagnose der konnatalen Hypothyreose, der Abklärung einer vermuteten faktitiellen Hyperthyreose oder als Aktivitätsmarker für destruierende Schilddrüsenprozesse wie der subakuten oder Amiodaron-induzierten Thyreoiditis.

Abstract

Thyroglobulin and calcitonin are established humoral tumor markers for therapy monitoring and follow up of thyroid cancer of follicular origin or medullary thyroid cancer, respectively. In comparison to many other tumor markers these analytes offer a high diagnostic specificity, which increases with the radicalness of thyroid ablation. Over the last years, assays with rising functional sensitivity became commercially available, being however a challenge in respect to laboratory performance, quality assurance and medical judgement in the „ultrasensitive” range of detectable concentrations. Anyway, hTg and hCT must be considered to be ambitious laboratory parameters. The results considerably depend on various in vivo and in vitro influences, and even under constant conditions, different assays may not necessarily produce identical results. hCt assays that measure the monomer (mature) calcitonin form have the advantage of an enhancement of the diagnostic specificity. Apart from follow up investigations in treated MTC patients, a couple of medical societies assume hCt measurement to be justified in the presence of a thyroid nodule. In contrast, guidelines do not recommend hTg measurement as a routine procedure for the assessment of the malignancy of thyroid nodules. However, hTg measurement may have an indication in differential diagnosis of connatal hypothyroidism, in assumed thyrotoxicosis factitia and as a marker of destructive thyroidal disease like subacute or amiodarone-induced thyroiditis.

Schlüsselwörter

Thyreoglobulin (hTg) - Kalzitonin (hCt) - differenziertes Schilddrüsenkarzinom - medulläres Schilddrüsenkarzinom - Nachsorge - Schilddrüsenknoten

Key words

thyroglobulin (hTg) - calcitonin (hCt) - differentiated thyroid cancer - medullary thyroid cancer - restaging - thyroid nodule

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