Ladenson P W
Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287-4904, USA.
Clin Chem. 1996 Jan;42(1):183-7.
Optimal use of laboratory tests to diagnose and monitor patients with goiter, thyroid nodules, or thyroid cancer requires an appreciation of the pathophysiologic factors implicated in thyroid hyperplasia and neoplasia: growth factors (especially thyrotropin, TSH), growth-stimulating immunoglobulins, activating mutations of the TSH receptor, and other oncogenic transformations. In patients with diffuse goiter and thyroid nodules, serum TSH measurement in a highly sensitive assay excludes both primary hypothyroidism and common causes of thyrotoxicosis. In selected patients, screening for anti-thyroid peroxidase with or without anti-thyroglobulin antibodies can confirm the diagnosis of autoimmune thyroiditis. Serum calcitonin measurement is appropriate only when medullary thyroid carcinoma (MTC) is clinically suspected. Laboratory testing is essential in management of thyroid carcinoma patients after primary surgical therapy. Serum TSH measurement is vital to ensure that thyroxine replacement and TSH suppression are adequate in treatment of epithelial cancers. Serial monitoring of serum thyroglobulin (Tg) can detect tumor recurrence and quantify tumor burden. Interpretation of serum Tg results requires an appreciation of certain technical considerations (e.g., anti-Tg antibody interference) and the patient's concurrent TSH status. Periodic serum Tg measurements and 131I scans are complementary monitoring techniques. Serum calcitonin measurement and screening for ret protooncogene mutations are both valuable for identifying individuals with MTC.
最佳利用实验室检查来诊断和监测患有甲状腺肿、甲状腺结节或甲状腺癌的患者，需要了解与甲状腺增生和肿瘤形成相关的病理生理因素：生长因子（尤其是促甲状腺激素，TSH）、生长刺激免疫球蛋白、TSH受体的激活突变以及其他致癌转化。对于患有弥漫性甲状腺肿和甲状腺结节的患者，采用高灵敏度检测法测定血清TSH可排除原发性甲状腺功能减退症和甲状腺毒症的常见病因。在特定患者中，筛查抗甲状腺过氧化物酶抗体（无论是否伴有抗甲状腺球蛋白抗体）可确诊自身免疫性甲状腺炎。仅在临床怀疑有甲状腺髓样癌（MTC）时，测定血清降钙素才合适。实验室检查对于甲状腺癌患者接受初次手术治疗后的管理至关重要。测定血清TSH对于确保上皮癌治疗中甲状腺素替代和TSH抑制充分至关重要。连续监测血清甲状腺球蛋白（Tg）可检测肿瘤复发并量化肿瘤负荷。解读血清Tg结果需要了解某些技术因素（例如，抗Tg抗体干扰）以及患者同时存在的TSH状态。定期测定血清Tg和进行131I扫描是互补的监测技术。测定血清降钙素和筛查原癌基因ret突变对于识别患有MTC的个体均有价值。
