Serum thyrotropin level of 30 mu IU/mL is inadequate for preablative thyroglobulin to serve as a prognostic marker for differentiated thyroid cancer

Preablative-stimulated thyroglobulin (ps-Tg) has manifested its potential for predicting prognosis in patients with differentiated thyroid carcinoma (DTC), but its level can be affected by thyrotropin (TSH). The objective of this study was to evaluate the utility of ps-Tg in predicting individual response after radioactive iodine (RAI) therapy, and further explore the appropriate TSH level for ps-Tg to serve as a prognostic marker in DTC without initial distant metastasis (DM). A total of 208 consecutive non-DM DTC patients with serial ps-Tg, TSH, and anti-Tg antibody (TgAb) measured simultaneously were enrolled. The initial and last measurements of ps-Tg were marked as Tg1 and Tg2, respectively, with a median interval of 8 days, so does TSH. Clinical response was retrospectively evaluated as excellent, indeterminate, biochemical incomplete, or structural incomplete response (ER, IDR, BIR, or SIR) after a mean follow-up of 21.5 months. Tg1 and Tg2 were tested and compared for their performances in predicting ER and incomplete response (IR, including BIR and SIR) by receiver operating characteristic (ROC) curve analysis. The 416 ps-Tg levels (Tg1 and Tg2) were then categorized by their corresponding TSH grouping of 30-< 60 (n = 100), 60-< 90 (n = 131), 90-< 120 (n = 99), and a parts per thousand yen120 mu IU/mL (n = 86), and the predictive performances were further compared among TSH groups. Tg2, with a higher corresponding TSH level than Tg1 (median: 104.763 vs. 65.046 mu IU/mL), presented higher area under the ROC curve (AUC) in predicting both ER and IR (ER: 0.889 vs. 0.836, P = 0.003; IR: 0.925 vs. 0.869, P = 0.046). The performances of ps-Tg in predicting ER and IR were both improved significantly as TSH rose from 30-< 60 to 60-< 90 mu IU/mL, with an increase in AUC from 0.810 to 0.888 in predicting ER (P = 0.006) and from 0811 to 0.937 in predicting IR (P = 0.014), respectively. However, this kind of benefit was not further enlarged as TSH rose from 60-< 90 to 90-< 120 mu IU/mL (both P > 0.05). In comparison with the TSH context of 30 mu IU/mL, a higher preablative TSH level of 60-< 90 mu IU/mL might be more appropriate for ps-Tg to serve as a prognostic marker for DTC.Ministry of Health Industry Special Scientific Research Projects of China [201202012]; National Natural Science Foundation of China [81571714]SCI(E)PubMedARTICLElinys@pumch.cn1166-1735