The role of thyroglobulin in thyroid cancer.
Nijher GMK, Bhalla S, Walker E, Meeran K
Endocrinology Unit and Department of Metabolic Medicine,
Imperial College NHS Trust.
Introduction: Serum thyroglobulin (Tg) is used as a marker to detect residual/metastatic disease after treatment for differentiated thyroid cancer (DTC). This clinical audit was designed to investigate whether Imperial College Hospital National Trust (ICHNT) is adhering to the British Thyroid Association Guidelines on the management of DTC, particularly focusing on the clinical appropriateness of measurement of serum Tg.
Methods: A retrospective clinical audit was performed on patients who had requests for serum Tg made between November 2013 and February 2014. The audit criteria were the timing and appropriateness of thyroglobulin requests as recommended by the 2014 guidelines.148 patients were audited using clinical letters and patient notes to obtain clinical data for each patient.
Results: 8.3% of patients with DTC had serum Tg measured before thyroidectomy. 26.5% of patients had serum Tg measured more often than every 3 months. 5.7% of patients had serum Tg measured after stimulation with recombinant human TSH. Of those with detectable thyroglobulin antibodies (TgAb), 88.9% of these patients had TgAb measured more often than every 6 months.
Discussion: There were a number of criteria failures identified by this audit. Increased awareness of the guidelines as to how often serum Tg should be measured should be promoted. This would reduce inappropriate testing, with both cost and time saving to the NHS, and patient benefit in the form of reduced number of blood tests.