Kirk J M, Mort C, Grant D B, Touzel R J, Plowman N
Department of Radiotherapy, St. Bartholomew's Hospital, West Smithfield, London, England.
Med Pediatr Oncol. 1992;20(3):201-8. doi: 10.1002/mpo.2950200304.
Serum thyroglobulin has been measured serially in ten children aged 5-17 years presenting with differentiated thyroid carcinoma. At presentation 4 had intra-thyroidal disease, 3 had lymph node metastases, and 3 had lung metastases. During follow-up for a median of 37.0 months (range 21-108) 3 patients have been disease-free, 4 have had a local relapse, and 3 have had persistent disease. Seventy-seven separate serum thyroglobulin measurements have been performed; 36 on and 41 off thyroid replacement therapy. A level of thyroglobulin of less than 5 ng/ml was taken as indicative of absence of disease, and compared against combined clinical examination and 131I scanning. Overall sensitivity of thyroglobulin measurement was 36/37 (97%), and although specificity was 30/40 (75%), this rose to 30/32 (94%) if raised thyroglobulin levels noted within 3 months of 131I therapy in otherwise asymptomatic patients (n = 4) or in subjects with intact thyroid tissue (n = 4) were excluded. Concordance with clinical status was 30/31 (97%) in measurements taken on, and 31/32 (94%) in those taken off, thyroid replacement. These data indicate that thyroglobulin measurement is a sensitive and specific means of detecting residual, recurrent, and metastatic thyroid carcinoma in children.
对10名年龄在5至17岁、患有分化型甲状腺癌的儿童进行了血清甲状腺球蛋白的连续检测。初诊时，4例为甲状腺内疾病，3例有淋巴结转移，3例有肺转移。在中位时间为37.0个月（范围21 - 108个月）的随访期间，3例患者无疾病，4例出现局部复发，3例疾病持续存在。共进行了77次血清甲状腺球蛋白检测；其中36次在甲状腺替代治疗期间进行，41次在治疗中断期间进行。甲状腺球蛋白水平低于5 ng/ml被视为无疾病迹象，并与临床综合检查和131I扫描结果进行比较。甲状腺球蛋白检测的总体敏感性为36/37（97%），尽管特异性为30/40（75%），但如果排除在131I治疗后3个月内（在无症状患者中n = 4例，或甲状腺组织完整的受试者中n = 4例）甲状腺球蛋白水平升高的情况，则特异性升至30/32（94%）。在进行甲状腺替代治疗时的检测与临床状况的一致性为30/31（97%），在治疗中断时的检测中为31/32（94%）。这些数据表明，甲状腺球蛋白检测是检测儿童残留、复发和转移性甲状腺癌的一种敏感且特异的方法。
