Optimal laboratory testing for diagnosis and monitoring of thyroid nodules, goiter, and thyroid cancer

Research output: Contribution to journalArticle

Abstract

Optimal use of laboratory tests to diagnose and monitor patients with goiter, thyroid nodules, or thyroid cancer requires an appreciation of the pathophysiologic factors implicated in thyroid hyperplasia and neoplasia: growth factors (especially thyrotropin, TSH), growth-stimulating immunoglobulins, activating mutations of the TSH receptor, and other tricogenic transformations. In patients with diffuse goiter and thyroid nodules, serum TSH measurement in a highly sensitive assay excludes both primary hypothyroidism and common causes of thyrotoxicosis. In selected patients, screening for anti-thyroid peroxidase with or without anti- thyroglobulin antibodies can confirm the diagnosis of autoimmune thyroiditis. Serum calcitonin measurement is appropriate only when medullary thyroid carcinoma (MTC) is clinically suspected. Laboratory testing is essential in management of thyroid carcinoma patients after primary surgical therapy. Serum TSH measurement is vital to ensure that thyroxine replacement and TSH suppression are adequate in treatment of epithelial cancers. Serial monitoring of serum thyroglobulin (Tg) can detect tumor recurrence and quantify tumor burden. Interpretation of serum Tg results requires an appreciation of certain technical considerations (e.g., anti-Tg antibody interference) and the patient's concurrent TSH status. Periodic serum Tg measurements and 131I scans are complementary monitoring techniques. Serum calcitonin measurement and screening for ret protooncogene mutations are both valuable for identifying individuals with MTC.

Original languageEnglish (US)
Pages (from-to)183-187
Number of pages5
JournalClinical Chemistry
Volume42
Issue number1
StatePublished - 1996

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Thyroid Nodule
Clinical Laboratory Techniques
Goiter
Thyroid Neoplasms
Thyroglobulin
Monitoring
Testing
Serum
Calcitonin
Tumors
Screening
Thyrotropin Receptors
Iodide Peroxidase
Thyrotropin
Thyroxine
Autoimmune Thyroiditis
Neoplasms
Mutation
Immunoglobulins
Thyrotoxicosis

Keywords

  • calcitonin
  • oncogenes
  • thyroglobulin
  • thyroid status
  • thyrotropin

ASJC Scopus subject areas

  • Clinical Biochemistry

Cite this

Optimal laboratory testing for diagnosis and monitoring of thyroid nodules, goiter, and thyroid cancer. / Ladenson, Paul W.

In: Clinical Chemistry, Vol. 42, No. 1, 1996, p. 183-187.

Research output: Contribution to journalArticle

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