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Nuklearmedizin 1986; 25(05): 194-200
DOI: 10.1055/s-0038-1624341
Originalarbeiten - Original Articles
Schattauer GmbH

Serum-Thyreoglobulin in der Metastasendiagnostik des differenzierten Schilddrüsenkarzinoms

DerEinfluß der suppressiven Schilddrüsenhormonsubstitution auf die diagnostische Zuverlässigkeit des ThyreoglobulinwertesSerum Thyroglobulin in the Diagnosis of Metastases in Differentiated Thyroid CancerThe Influence of Suppressive Thyroid Hormone Therapy on the Diagnostic Accuracy of Serum Thyroglobulin Determination
H.-W. Müller-Gärtner
1   Aus der Abteilung für Nuklearmedizin, Radiologische Klinik, Universitätskrankenhaus Eppendorf, Hamburg, Bundesrepublik Deutschland
,
C. Schneider
1   Aus der Abteilung für Nuklearmedizin, Radiologische Klinik, Universitätskrankenhaus Eppendorf, Hamburg, Bundesrepublik Deutschland
,
M.-Th. Tempel
1   Aus der Abteilung für Nuklearmedizin, Radiologische Klinik, Universitätskrankenhaus Eppendorf, Hamburg, Bundesrepublik Deutschland
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Publication History

Eingegangen: 02 July 1986

Publication Date:
12 January 2018 (online)

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The diagnostic accuracy of serum thyroglobulin (S-TG) determination as measured under endogenous thyrotropin(TSH)stimulation (ETS) has been investigated in 372 patients with completed therapy for differentiated thyroid cancer. In 51 of these (13.7%) S-TG could be detected by means of the IRMA-technique. In 34 S-TG determination was additionally performed during suppressive thyroxine therapy (SSH): S-TG in SSH was significantly lower as compared with S-TG in ETS (p <0.001). In seven cases with proven metastases S-TG values were pushed below the minimal detection level by SSH. Tumor manifestations with suppressive S-TG were significantly smaller (x͂ = 5 ccm, range 1-25 ccm) than those with non-suppressible S-TG (x͂ = 90 ccm, range 11-125 ccm, p <0.005) and displayed a papillary histology. There was a moderate correlation between S-TG concentration and tumor volume (r = 0.71 ; p <0.001). 21 % (n = 66) of patients with undetectable S-TG in ETS showed 131l-uptake in the thyroid region; 2% (n = 7) had proven metastases. Sensitivity of S-TG determination for the detection of metastases amounted to 82.5% in ETS and 53.3% in SST, specificity was 94.6% in ETS and 99.7% in SST. It is concluded that small metastases of papillary thyroid carcinomas may escape S-TG screening more readily than follicular carcinoma metastases when S-TG concentrations are measured during thyroxine treatment.

Zusammenfassung

Bei 372 Patienten mit differenziertem Schilddrüsenkarzinom wurde anläßlich der Nachsorgeuntersuchung die Aussagekraft der Serum-Thyreoglobulinbestimmung (S-TG) unter endogener TSH-Stimulation (ETS) untersucht. 51 Patienten (13,7%) hatten im S-TG-IRMA nachweisbare Serumkonzentrationen. Bei 34 von ihnen wurde S-TG unter suppressiver Schilddrüsenhormonsubstitution (SSH) erneut gemessen. Bei ihnen war das S-TG unter SSH signifikant niedriger als unter ETS (p <0,001). In sieben Fällen mit gesicherter Metastasierung fiel der Wert unter die Nachweisgrenze. Tumormanifestationen mit suppressiblem S-TG waren signifikant kleiner (x͂ = 5 ccm, Spannweite 1-25 ccm) als Tumormanifestationen mit nicht suppressiblem S-TG (x[0342 = 90 ccm, Spannweite 11-125 ccm, p <0,005) und gehörten zur Gruppe der papillären Tumoren. Die S-TG-Konzentration unter ETS korrelierte mäßig mit dem Tumorvolumen (r = 0,71; p <0,001). Von den Patienten mit negativem S-TG hatten unter endogener TSH-Stimulation 21% (n = 66) im Bereich der Schilddrüsenlogen jodavides Gewebe und 2% (n = 7) nachweisbare Metastasen. Die Sensitivität des Metastasennachweises betrug für die S-TG-Bestimmung unter ETS 82,5% und unter SST 53,3%. Die Spezifität des Nachweises war unter ETS 94,6% und unter SST 99,7%. Es ergibt sich, daß papilläre Schilddrüsenkarzinommetastasen mit geringem Volumen unter Schilddrüsenhormonsubstitution dem Tumorscreening mit S-TG eher entgehen als Metastasen follikulärer Karzinome.

 

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