4/3/2019 DynaMed Plus: Thyroglobulin antibody measurement

Thyroglobulin antibody measurement

Synonyms
Anti-thyroglobulin antibody measurement

Reference Range
Adults:
Enzyme-linked immunosorbent assay: <5 International Units/mL (<0.3 kiloInternational Units/L)
(1)

Radioimmunoassay: <20 International Units/mL (<20 kiloInternational Units/L) (1)

Tanned RBC agglutination: ≤ 1:10 (1, 2)
Indirect immunofluorescence microscopy: Negative (3)

Please refer to your institution's reference ranges as lab normals may vary.

Indications
Suspected autoimmune thyroiditis (4, 5, 6, 7)

Strength of Recommendation: Class IIb

Strength of Evidence: Category C

Results Interpretation

Autoantibody titer positive

Thyroglobulin antibodies are present in approximately 60% of patients with autoimmune thyroid disease (5) ;
however, 11% of the normal population will also have measurable levels of the antibody (4, 7) .

An elevated TSH is more strongly associated with antithyroid peroxidase antibodies than with thyroglobulin
antibodies (5) .

The presence of antithyroid antibodies (thyroglobulin and thyroid peroxidase [TPO]) has been associated with a
significantly increased risk of spontaneous abortions; thus women with recurrent spontaneous abortions should
be checked for these antibodies prior to becoming pregnant again (4, 7) .

Efficacy

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Thyroglobulin antibodies are common in autoimmune thyroid disease, but have limited use as a screening tool
because of their lack of specificity. Thyroglobulin antibody is often positive in Graves disease, thyroid
carcinoma, idiopathic myxedema, and during treatment with certain drugs. Sixty percent of patients with diffuse
goiter or hypothyroidism have positive thyroglobulin antibody titers (4, 7) . In one prospective study of patients
with subclinical hypothyroidism of various etiologies, thyroglobulin antibody levels were not useful in
predicting the development of thyroid failure (6) .

Related Tests/Procedures

Measurement of thyroperoxidase antibody

Suspected Graves' disease (8)

Strength of Recommendation: Class IIa

Strength of Evidence: Category B

Results Interpretation

Antibody studies abnormal

High levels of thyroglobulin antibody (TgAb) are consistent with autoimmune thyroid disease, which includes
Graves' disease, as well as Hashimoto's (7) . Graves' disease patients with positive titers of TgAb prior to drug
treatment may have decreased rates of hyperthyroidism relapse after treatment (8) .

Efficacy

In a cohort study of 117 subjects with Graves' disease treated for 2 years with methimazole, the relapse rate rate
due to hyperthyroidism after more than one year after treatment was evaluated. Patients with positive
thyroglobulin antibody (TgAb) titers were compared to those with negative titers. Relapse rate was significantly
lower for those with a positive titer compared to the negative titer group (39% versus 11%), suggesting a
positive titer is associated with a better prognosis for long term remission (8) .

Related Tests/Procedures

Microsomal thyroid antibody measurement

Measurement of thyroperoxidase antibody
Thyroid stimulating immunoglobulins measurement
Thyroid stimulating hormone measurement
Serum total T4 measurement
Serum total T3 level

Suspected thyroid cancer (9)

Strength of Recommendation: Class I

Strength of Evidence: Category B

Results Interpretation

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Postoperative state

The prevalence of thyroglobulin antibody (TgAb) in the general population is 10.1%. Of patients with
differentiated thyroid carcinoma (DTC), 25% have detectable levels of thyroglobulin antibody (TgAb) with rates
higher for women. Continued positive results for TgAb postoperatively may indicate persistent tumor tissue;
negative results may reflect disease-free status. Testing for TgAb should be done with the more sensitive
immunoassay technique (9) . TgAb monitoring alone (without thyroglobulin testing) may be sufficient for
tracking thyroid tumor activity (10) .

Frequency of Monitoring

Thyroglobulin antibody (TgAb) testing should be ordered each time a thyroglobulin level is checked in TgAb-
positive patients (9) .

Timing of Monitoring

Thyroglobulin antibody testing is performed after thyroid tumor removal surgery as an adjunctive check for the
persistence of tumor (9) .

Efficacy

The measurement of thyroglobulin, an established tumor marker for differentiated thyroid carcinoma (DTC), in
patients who are positive for thyroglobulin antibody (TgAb), is a challenging clinical issue. In a case-control
study of 213 subjects with DTC, TgAb interference was present in 69% of TgAb-positive specimens. It appeared
that TgAb may be an adjunctive tumor marker in TgAb-positive patients, and the test method with the highest
concordance to tumor status was radioimmunoassay (9) .

Related Tests/Procedures

Thyroglobulin measurement

Clinical Notes
Serial testing (done for monitoring purposes) should be performed by the same laboratory, using the same test
method to insure uniformity of results (11) .

Collection/Storage Information
Specimen Collection and Handling:
Collect venous blood specimen in a marbled serum separator tube (SST) (2)
Store specimen at -20°C (1)

Test Definition
Measurement of thyroglobulin autoimmune antibody (TgAb) in serum for evaluation of suspected or known
thyroid disorders (1)

Test Methodology
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General Technique

Techniques include:
Enzyme-linked immunosorbent assay (ELISA) (1)
Radioimmunoassay (RIA) (9)
Radiobinding assay (RBA) (1)
Tanned RBC agglutination (1)
Indirect immunofluorescence microscopy (IIFM) (12)

LOINC Codes
Code: 8098-6( Short Name - Thyroglob Ab Ser-aCnc)
Code: 5381-9( Short Name - Thyroglob Ab Titr Ser LA)
Code: 15210-8( Short Name - Thyroglob Ab Ser Ql)
Code: 17705-5( Short Name - Thyroglob IgM Ser-aCnc)
Code: 5380-1( Short Name - Thyroglob Ab Ser RIA-aCnc)

Related Information
Tests & Procedures

Microsomal thyroid antibody measurement

Serum total T4 measurement
Thyroid stimulating hormone measurement

References
General references used

1. Tietz NW (Ed): Clinical Guide to Laboratory Tests, 3rd ed. W. B. Saunders, Philadelphia, PA, 1995.
2. Nicoll D, McPhee SJ, Pignone M, et al: Pocket Guide to Diagnostic Tests, 4th. McGraw-Hill, New
York, NY, US, 2004.
3. Kratz A, Ferraro M, Sluss PM, et al: Case records of the Massachusetts General Hospital: laboratory
values. N Engl J Med 2004; 351(15):1549-1563.
4. Sinclair D: Clinical and laboratory aspects of thyroid autoantibodies. Ann Clin Biochem 2006; 43(Pt
3):173-183.
5. Roberts CG, Ladenson PW: Hypothyroidism. Lancet 2004; 363(9411):793-803.
6. Huber G, Staub JJ, Meier C, et al: Prospective study of the spontaneous course of subclinical
hypothyroidism: prognostic value of thyrotropin, thyroid reserve, and thyroid antibodies. J Clin
Endocrinol Metab 2002; 87(7):3221-3226.
7. Dayan CM, Daniels GH: Chronic autoimmune thyroiditis.. N Engl J Med. 1996 Jul 11; 335(2):99-107.
8. Takaichi Y, Tamai H, Honda K, et al: The significance of antithyroglobulin and antithyroidal
microsomal antibodies in patients with hyperthyroidism due to Graves' Disease treated with antithyroidal
drugs. J Clin Endocrinol Metab 1989; 68 (6):1097-1100.
9. Spencer CA, Takeuchi M, Kazarosyan M, et al: Serum thyroglobulin autoantibodies: prevalence,
influence on serum thyroglobulin measurement, and prognostic significance in patients with differentiated
thyroid carcinoma. J Clin Endocrinol Metab 1998; 83(4):1121-1127.
10. McLachlan SM, Rapoport B: Why measure thyroglobulin autoantibodies rather than thyroid
peroxidase autoantibodies. Thyroid 2004; 14(7):510-520.

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11. Thyroid Antibodies. American Association for Clinical Chemistry. Washington DC, US. 2001.
Available from URL: http://labtestsonline.org/understanding/analytes/thyroid‗antibodies/multiprint.html.
As accessed 6/23/05.
12. Henry JB: Clinical Diagnosis and Management by Laboratory Methods, 20th ed. Saunders, 2001.

Attributions
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Last Modified

February 24, 2011

Definitions
Strength of Recommendation
Class I - Recommended
The given test or treatment has been proven to be useful, and should be performed or
administered.
Class IIa - Recommended, In Most Cases
The given test, or treatment is generally considered to be useful, and is indicated in most
cases.
Class IIb - Recommended, In Some Cases
The given test, or treatment may be useful, and is indicated in some, but not most, cases.
Class III - Not Recommended
The given test, or treatment is not useful, and should be avoided.
Class Indeterminate - Evidence Inconclusive
Strength of Evidence
Category A

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Category A evidence is based on data derived from: Meta-analyses of randomized controlled

trials with homogeneity with regard to the directions and degrees of results between
individual studies. Multiple, well-done randomized clinical trials involving large numbers of
patients.
Category B
Category B evidence is based on data derived from: Meta-analyses of randomized controlled
trials with conflicting conclusions with regard to the directions and degrees of results between
individual studies. Randomized controlled trials that involved small numbers of patients or
had significant methodological flaws (e.g., bias, drop-out rate, flawed analysis, etc.).
Nonrandomized studies (e.g., cohort studies, case-control studies, observational studies).
Category C
Category C evidence is based on data derived from: Expert opinion or consensus, case reports
or case series.
No Evidence

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