Non-suppressed thyrotropin and elevated thyroglobulin are independent predictors of recurrence in differentiated thyroid carcinoma

Objective: Although in most cases differentiated thyroid carcinoma (DTC) responds to surgery and radioiodine (RaI) therapy, some patients will have recurrence and eventually cancer-related death. However although various prognostic factors of DTC have been identified (e.g, staging, suppressed thyrotropin), none of the previous studies have assessed simultaneously their role in multivariate analysis. Design and Methods: In this retrospective population-based study, we reviewed the clinicopathological data of 254 DTC patients treated in eastern Finland during the pears 1976-1995, for clinical characteristics, primary treatment, follow-up and cancer recurrence. Tumor stage was based on pathological tumor-node-metastasis (pTNM) classification, and histopathological specimens were reevaluated. Results: DTC recurrence occurred in 33 patients (13%). In univariate analyses, the predictors of recurrence were older age (>60 years, P < 0.05), follicular tumor type (P < 0.01), pTNM classification system (P< 0.05) and post-ablative radioiodine uptake outside the neck (P < 0.05). Non-suppressed serum thyrotropin (TSH) and elevated serum thyroglobulin (>31 mu g/l) measured one year after operation were both related to tumor recurrence (P < 0.05 and P < 0.001 respectively). In multivariate analysis the independent predictors for recurrence were both elevated thyroglobulin (P < 0.001) and non-suppressed TSH (P < 0.05) independent of histology, pTNM stage and RaI uptake. Adjusted risk ratio for recurrence of DTC for unsuppressed thyrotropin was 2.3, for elevated thyroglobulin 14.0 and, if both conditions were present, the risk ratio increased to 45.1. Conclusion: Our results suggest that both non-suppressed serum TSH and elevated serum thyroglobulin are related to an increased risk of DTC recurrence independent of tumor type and pTNM stage.