Postoperative Unstimulated Thyroglobulin Accurately Predicts Outcomes in High‐Risk Differentiated Thyroid Cancer: A Retrospective Cohort Study
Authors' conclusion
Postoperative UTg is a strong prognostic marker in high-risk DTC patients, providing a non-inferior alternative to STg with greater accessibility and fewer side effects. We propose a clinical algorithm to optimize the management of these cases. When UTg levels exceed 2.1 ng/mL, particularly higher than 3.8 ng/mL, investigation of potentially resectable metastatic foci should be considered before radioiodine therapy. Prospective studies are needed to validate this algorithm.
Study context
- Population
- High-risk differentiated thyroid cancer (DTC) patients at two Brazilian tertiary hospitals (144 high-risk of 1000 DTC patients identified)met inclusion criteria
- Participants
- 57 patients
- Exposure
- Postoperative unstimulated thyroglobulin (UTg) vs stimulated thyroglobulin (STg) for predicting outcomes and metastases
- Outcome
- Prognostic value of postoperative UTg for outcomes:
- Favorable: excellent/indeterminate responses
- Unfavorable: biochemical/structural incomplete responses
- Follow-up
- 1 year
Methodological detailstwo Brazilian tertiary hospitals, 2015-2024
- Two Brazilian tertiary hospitals
- 2015-2024
Main finding
As reported in the abstract
Prediction of outcomes by UTg · 1-year
| Group | Value | Sensitivity | Specificity | Accuracy |
|---|---|---|---|---|
| UTg | cutoff 2.1 ng/mL | 83.3% | 96.0% | 90.7% |
UTg
Valuecutoff 2.1 ng/mL
Sensitivity83.3%
Specificity96.0%
Accuracy90.7%
- UTg vs STg: P = 0.964 — non-inferiority of UTg to STg in predicting outcomes
- UTg independent risk factor for 1-year outcomes (OR)
- 0.008; 95% CI: 0.001-0.088; p < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Non-inferiority of UTg to STg in predicting outcomes and metastasisUTg vs STg · predicting outcomes; non-inferiority | P = 0.964 |
| Non-inferiority of UTg to STg in predicting outcomes and metastasisUTg vs STg · predicting metastasis; non-inferiority | P = 0.980 |
Metastases: UTg cutoff of 3.8 ng/mL
- UTg cutoff identifying metastases
- 3.8 ng/mL
- Sensitivity
- 86.4%
- Specificity
- 90.5%
Predictors of unfavorable outcomes
- Advanced age
- P = 0.048
- Larger tumor size
- P = 0.002
- Higher UTg
- P < 0.001
- Higher STg
- P < 0.001
Original publication
Postoperative Unstimulated Thyroglobulin Accurately Predicts Outcomes in High‐Risk Differentiated Thyroid Cancer: A Retrospective Cohort Study. Clin Endocrinol (Oxf). Published 4 May 2025. doi:10.
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