甲状腺結節患者における血中サイログロブリン値

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Since human serum thyroglobulin (HSTG) could be measured by radioimmunoassay (RIA), it has been found to increase in various thyroid disorders providing a new aspect on thyroid pathophysiology. It is not easy to make a diagnosis of thyroid carcinoma, follicular adenoma, nontoxic multiple nodular goiter and cyst among thyroid diseases presenting thyroid nodules, prior to obtaining histological findings. The purpose of this study is to evaluate the diagnostic significance of HSTG in patients with these four diseases. HSTG levels were measured by RIA in 27 patients with thyroid carcinoma, 12 with follicular adenoma, 8 with nontoxic multiple nodular goiter and 16 with cyst. The HSTG of patients with thyroid carcinoma was 223±632 ng/ml (mean±SD), that in follicular adenoma 148±72 ng/ml, that in nontoxic multiple nodular goiter 103.8±127 ng/ml and that in cyst 114.3±201.9 ng/ml. The HSTG of all patients with follicular adenoma elevated above normal, and that in the other three diseases ranged from normal to very high levels. The HSTG level of six patients with non-metastatic, well-differentiated thyroid carcinoma was within the normal range, (32.4±15.4 ng/ml, mean±SD, n=7). On the other hand, the HSTG level of all patients with metastatic, well-differentiated thyroid carcinoma elevated above normal (312.2±758.8 ng/ml, mean±SD, n=18). The size of the thyroid nodules in patients with non-metastatic, well-differentiated thyroid carcinoma was 5.0±5.0 cm2 (mean±SD, n=7, maximum diameter X minimum diameter in cm) and that in metastatic carcinoma was 34.8±33.7 cm2 (mean±SD, n=18). There was a significant relationship between HSTG and the size of the nodules in well-differentiated thyroid carcinoma (p<0.005). Performing 99mTc and 201Tl scintigraphies for patients with these thyroid nodules, which discriminate nontoxic multiple nodular goiter and cyst from thyroid carcinoma and follicular adenoma, the above results may lead us to the following diagnostic evaluations of patients with thyroid nodules. The patients with a cold nodule in these scintigraphies are considered to have nontoxic multiple nodular goiter or cyst regardless of HSTG levels. On the other hand, the patients with a hot nodule in 201Tl scintigraphies are considered to have non-metastatic well-differentiated carcinoma in cases of normal HSTG levels and to have metastatic well-differentiated carcinoma or follicular adenoma in cases of elevated HSTG levels. A well-differentiated thyroid carcinoma was found to change to an anaplastic one in one patient, whose elevated HSTG level returned to normal concomitantly. Five patients with follicular adenoma were put on triiodothyronine therapy. In one of them, the size of the thyroid nodule decreased remarkably and the elevated HSTG level was restored to normal at the same time. These results suggest that HSTG, as well as thyroid scintigraphies, is useful for the differential diagnosis of these thyroid nodules and helpful for understanding their pathophysiology.
日本内分泌学会の論文

甲状腺結節患者における血中サイログロブリン値

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