Báo cáo đồng thuận về vai trò của thyroglobulin huyết thanh như một phương pháp giám sát cho bệnh nhân nguy cơ thấp mắc carcinoma tuyến giáp nhú

Journal of Clinical Endocrinology and Metabolism - Tập 88 Số 4 - Trang 1433-1441 - 2003
Ernest L. Mazzaferri1, Richard J. Robbins2, Carole A. Spencer3, Lewis E. Braverman4, Furio Pacini5, Leonard Wartofsky6, Bryan R. Haugen7, Steven I. Sherman8, David S. Cooper9, Glenn D. Braunstein10, S. Lee11, Terry F. Davies12, Baha'uddin M. Arafah13, Paul W. Ladenson14, Aldo Pinchera15
1Division of Endocrinology (E.L.M.), Shands Hospital, Gainesville, Florida 32610
2Endocrine Service, Department of Medicine (R.J.R.), Memorial Sloan-Kettering Cancer Center, New York, New York 10021
3Department of Medicine (C.A.S.), University of Southern California, Los Angeles, California 90033
4Section of Endocrinology, Diabetes, and Nutrition (L.E.B.), Boston Medical Center, Boston, Massachusetts 02118
5Division of Endocrinology (F.P.), University of Siena, 53100 Siena, Italy
6Department of Medicine (L.W.), Washington Hospital Center, Washington, D.C. 20010
7Division of Endocrinology (B.R.H.), University of Colorado Health Sciences Center, Denver, Colorado 80262
8Department of Endocrine Neoplasia and Hormonal Disorders (S.I.S.), University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
9Division of Endocrinology (D.S.C.), Sinai Hospital, Baltimore, Maryland 21215
10Department of Medicine (G.D.B.), Cedars Sinai Medical Center, Los Angeles, California 90048
11Section of Endocrinology, Diabetes, and Nutrition (S.L.), Boston Medical Center, Boston, Massachusetts 02118
12Division of Endocrinology and Metabolism (T.F.D.), Mount Sinai Medical Center, New York, New York 10029-6574
13Division of Clinical and Molecular Endocrinology (B.M.A.), University Hospitals of Cleveland, Cleveland, Ohio 44106
14Division of Endocrinology (P.W.L.), Johns Hopkins Hospital, Baltimore, Maryland 21278
15Division of Endocrinology (A.P.), University of Pisa, 56124 Pisa, Italy

Tóm tắt

Các nghiên cứu gần đây đã cung cấp thông tin mới về các phác đồ giám sát tối ưu cho những bệnh nhân có nguy cơ thấp mắc ung thư tuyến giáp biệt hóa (DTC). Bài viết này tóm tắt những vấn đề chính được nêu ra trong một hội nghị đồng thuận của các chuyên gia ung thư tuyến giáp, những người đã phân tích và thảo luận về dữ liệu mới này.

Ngày càng có sự công nhận giá trị của thyroglobulin huyết thanh (Tg) như một phần của giám sát định kỳ. Một chỉ số Tg huyết thanh không thể phát hiện được trong quá trình ức chế hormone tuyến giáp của TSH (THST) thường dễ gây hiểu lầm. Tám nghiên cứu cho thấy 21% trong số 784 bệnh nhân không có bằng chứng lâm sàng về khối u với mức Tg huyết thanh ban đầu thường dưới 1 μg/lít trong thời gian THST đã có sự gia tăng Tg huyết thanh lên trên 2 μg/lít khi phản ứng với TSH tái tổ hợp người (rhTSH). Khi điều này xảy ra, 36% bệnh nhân được phát hiện có di căn (36% ở các vị trí xa) được xác định ở 91% trong số họ bằng Tg kích thích bởi rhTSH nằm trên 2 μg/lít. Quét toàn thân chẩn đoán, sau khi ngừng sử dụng rhTSH hoặc hormone tuyến giáp, chỉ nhận diện được 19% các trường hợp di căn. Mười nghiên cứu với 1599 bệnh nhân cho thấy một thử nghiệm Tg kích thích TSH sử dụng ngưỡng Tg 2 μg/lít (sau khi dừng hormone tuyến giáp hoặc 72 giờ sau khi sử dụng rhTSH) có độ nhạy đủ để sử dụng như một bài kiểm tra chính trong quản lý theo dõi các bệnh nhân có nguy cơ thấp mắc DTC và việc sử dụng thường xuyên quét toàn thân chẩn đoán trong theo dõi nên bị khuyến cáo không nên thực hiện. Dựa trên những điều đã nêu, chúng tôi đề xuất một hướng dẫn giám sát sử dụng mức Tg kích thích TSH cho các bệnh nhân đã trải qua cắt bỏ tuyến giáp toàn bộ hoặc cắt gần toàn bộ và điều trị bằng 131I cho DTC và không có bằng chứng lâm sàng về khối u còn lại với mức Tg huyết thanh dưới 1 μg/lít trong thời gian THST.

Từ khóa


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Thông tin xuất bản

Journal of Clinical Endocrinology and Metabolism

Tập 88 Số 4

1433-1441

Thông tin tác giả