Thyroglobulin surveillance after thyroid cancer surgery
THE CONTEXT
Thyroglobulin is produced by normal thyroid cells and most differentiated thyroid cancers, making its postoperative interpretation dependent on the extent of surgery.
Interpretation after surgery
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After lobectomy, thyroglobulin will not be undetectable, but changes over time can help monitor for recurrence.
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After total thyroidectomy, the goal is an undetectable thyroglobulin level.
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Patients who achieve undetectable thyroglobulin have an extremely low risk of recurrence.
Follow-up and suspected recurrence
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Follow-up combines thyroglobulin measurement every 6–12 months with ultrasonographic assessment of the neck.
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If thyroglobulin remains detectable, it can be followed serially; an increase should prompt imaging for gross recurrent disease.
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Resectable recurrence should be treated surgically, and further radioactive iodine would normally be indicated.
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The role of radioactive iodine for rising thyroglobulin without structural disease is controversial.