Approach to Follow-up of the Patient with Differentiated Thyroid Cancer and Positive Anti-Thyroglobulin Antibodies

Anti-thyroglobulin antibodies are commonly identified in patients with differentiated follicular cell-derived thyroid cancer. When present, they interfere with the measurement of thyroglobulin (Tg), which is the primary biochemical marker used for disease surveillance, creating challenges in monitoring patients for residual or recurrent disease. Moreover, there is variability in measuring anti-Tg antibodies according to the different assays, such that not all patients with anti-Tg antibodies are identifiable on a single assay system. The persistence of anti-Tg antibodies, especially if levels are rising, may indicate persistent, recurrent, or progressive thyroid cancer. In contrast, declining anti-Tg antibody levels may indicate reduced tumor burden or the absence of disease. In this review, we will explore in a case-based manner the data supporting monitoring and treatment paradigms for patients with anti-Tg antibodies and will stress areas where more evidence is needed to better inform clinicians regarding the management of patients with this challenging situation.

Learning Objectives

Upon completion of this educational activity, participants shouldbe able to:

  • Compare the effectiveness of assays in measuring anti-Tg antibodies, including the use of single and multiple assays in detecting all interfering antibodies.
  • Appropriately monitor anti-Tg antibodies as a surrogate marker of disease course in patients with thyroid cancer.
  • Recommend radiographic imaging in thyroid cancer patients with positive anti-Tg antibodies.

Additional Information

Target Audience: 
Physician-in-practice
Fellow
Resident
Clinical researcher
Scientific researcher
Educator/Teacher
Pharmacist
Nurse/Nurse practitioner
Physician assistant
Allied health professional
Other
Competency Area: 
Professionalism
Patient Care and Procedural Skills
Medical Knowledge
Topic Area: 
General Endocrinology
Hormones and Cancer
Thyroid/HPT Axis
Level of Outcomes: 
Level 1 (Participation)
Level 2 (Satisfaction)
Level 3A (Learning: Declarative Knowledge (Knows))
Level 3B (Learning: Procedural Knowledge (Knows How))
Level 4 (Learning: Competence (Shows How))
Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credits
  • 1.00 CME Certificate of Participation
Course opens: 
08/01/2013
Course expires: 
08/31/2015
Rating: 
0

Disclosure Policy

Authors, editors, and Endocrine Society staff involved in planning this JCEM Journal-based CME activity are required to disclose to The Endocrine Society and to learners any relevantfinancial relationship(s) of the individual or spouse/partner that have occurred within the last12 months with any commercial interest(s) whose products orservices are discussed in the CME content. The Endocrine Societyhas reviewed all disclosures and resolved all identifiedconflicts of interest.

The following author reported no relevant financial relationships:

Fadi Nabhan, M.D., has no relevant financial relationships.

The following author reported relevant financial relationships:

Matthew D. Ringel, M.D., has previously served on a medical advisory board for Veracyte and has been a member of the Board of the International Thyroid Oncology Group.

The following JCEM Editors reported relevant financial relationships:

The Editor-in-Chief, Leonard Wartofsky, M.D., is a Consultant for Asurogen, Genzyme, and IBSA, and is on the Speaker's Bureau for Genzyme. Kenneth Burman, M.D., is a Consultant for Medscape and UpToDate; a Reviewer for the Endocrine Fellows Foundation; and has received Institutional Grants for Research from Amgen, Eisei, and Pfizer. Samuel Dagogo-Jack, M.D., is a Consultant for Merck and Novo Nordisk; a Grantee for the American Diabetes Association, AstraZeneca, Boehringer Ingelheim, National Institutes of Health, and Novo Nordisk; and a Grant Reviewer for the American Diabetes Association and National Institutes of Health. Silvio Inzucchi, M.D., is a Consultant/Advisor for Boehringer Ingelheim, Genentech, Janssen, Merck, and Takeda; has DSMB Activity with Amgen, Esai, and Gilead; and receives CME support from Abbott, Amylin, Boeringher-Ingelheim, Merck, and Takeda. Kieren Mather, M.D., received an Investigator-initiated Grant from Novo Nordisk. Lynnette Nieman, M.D., is an Author/Editor for UpToDate, and receives Research Support from HRA-Pharmaceutical.

The following JCEM Editors reported no relevant financial relationships: Paolo Beck-Peccoz, M.D.; David Ehrmann, M.D.; David Handelsman, Ph.D.; Michael Kleerekoper, M.D.; Merrily Poth, M.D.; Constantine Stratakis, M.D.

Endocrine Society staff associated with the development of contentfor this activity reported no relevant financial relationships.

Acknowledgement of Commercial Support

JCEM Journal-based CME activities are not supported by grants, other funds, or in-kindcontributions from commercial supporters.

Available Credit

  • 1.00 AMA PRA Category 1 Credits
  • 1.00 CME Certificate of Participation

Accreditation Period

Course opens: 
08/01/2013
Course expires: 
08/31/2015