Serum thyroglobulin level in newly detected thyrotoxicosis and its role in differential diagnosis of thyrotoxicosis

Mohammad Omar Faruque, A. B. M. Kamrul-Hasan, M. Ahamedul Kabir, Rehnuma Nasim, Mohammad Jahangir Alam, Shahjada Selim, Muhammad Abul Hasanat, M. Farid Uddin


Background: Elevated serum thyroglobulin (Tg) level is commonly observed in various forms of thyrotoxicosis; the levels vary according to different etiologies. This study aimed at identifying the value of serum Tg level in the differential diagnosis of common etiologies of thyrotoxicosis.  

Methods: This cross-sectional study was conducted at the endocrine outpatient department of a tertiary hospital in Bangladesh from March 2015 to May 2017. In this study, 200 subjects with newly detected untreated thyrotoxicosis were evaluated. Serum Tg was assayed by chemiluminescent immunometric assay.  

Results: Serum Tg level was raised in 48% of subjects. Subjects aged ≥40 years, and those having a family history of thyroid disorders had relatively higher thyroglobulin levels. The frequency of subjects with an elevated Tg was highest in subacute thyroiditis (89.5%) followed by toxic nodular goiter (77.3%) and Graves’ disease (32.9%); the difference in the frequencies was statistically significant (p<0.001). Median Tg was highest in the subjects with subacute thyroiditis (132.6 ng/ml) followed by toxic nodular goiter (99.55 ng/ml); those with Graves’ disease had the lowest Tg level (12.5 ng/ml); the differences in median Tg levels across the three groups were also statistically significant (p<0.001).  

Conclusions: Serum thyroglobulin level may be useful for the etiological diagnosis of thyrotoxicosis.


Thyroglobulin; Thyrotoxicosis; Graves’ disease; Subacute thyroiditis; Toxic nodular goiter

Full Text:



Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26:1343-421.

Taylor P, Albrecht D, Scholz A. Gutierrez-Buey G, Lazarus JH, Dayanet CM, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018;14:301-16.

Grebe SKG. Diagnosis and management of thyroid carcinoma: focus on serum thyroglobulin. Expert Rev Endocrinol Metabol. 2009;4:25-43.

Giovanella L. Highly sensitive thyroglobulin measurements in differentiated thyroid carcinoma management. Clinic Chem Laborat Med. 2008;46:1067-73.

Refetoff S, Lever EG. The Value of Serum Thyroglobulin Measurement in Clinical Practice. J Am Med Assoc. 1983;250:2352-7.

Mariotti S, Martino E, Cupini C, Lari R, Giani C, Baschieri L, et al. Low serum thyroglobulin as a clue to the diagnosis of thyrotoxicosis factitia. N Engl J Med. 1982;307:410-2.

Madeddu G, Casu AR, Costanza C, Marras G, Arras ML, Marrosu A, et al. Serum Thyroglobulin Levels in the Diagnosis and Follow-up of Subacute 'Painful' Thyroiditis: A Sequential Study. Arch Intern Med. 1985;145:243-7.

Van Herle AJ, Vassart G, Dumont JE. Control of thyroglobulin synthesis and secretion (second of two parts). N Engl J Med. 1979;301:307-14.

Chapter 2: Selecting target groups and Chapter 5: Selecting appropriate indicators: Biochemical indicators. In: Indicators for Assessing Iodine Deficiency Disorder and their Control Through Salt Iodination. Geneva: World Health Organization; 1994. WHO/UNICEF/ICCIDD. WHO/NUT/94.6.

Rasmussen LB, Ovesen L, Bülow I, Jørgensen T, Knudsen N, Laurberg P, et al. Relations between various measures of iodine intake and thyroid volume, thyroid nodularity, and serum thyroglobulin. Am J Clin Nutr. 2002;76:1069-76.

Spencer CA, Lopresti JS. Measuring thyroglobulin and thyroglobulin autoantibody in patients with differentiated thyroid cancer. Nat Clin Pract Endocrinol Metab. 2008;4:223-33.

Melmed S, Polonsky K, Larsen PR. Williams Textbook of Endocrinology. 12th. Philadelphia: Saunders; 2012.

Pacini F, Pinchera A, Giani C, Grasso L, Doveri F, Baschieri L. Serum thyroglobulin in thyroid carcinoma and other thyroid disorders. J Endocrinol Invest. 1980;3:283-92.

Shlossberg AH, Jacobson JC, Ibbertson HK. Serum thyroglobulin in the diagnosis and management of thyroid carcinoma. Clin Endocrinol. 1979;10:17-27.

Pezzino V, Vigneri R, Squatrito S, Filetti S, Camus M, Polosa P. Increased serum thyroglobulin levels in patients with nontoxic goiter. J Clin Endocrinol Metab. 1978;46:653-7.

Van Herle AJ, Hershman JM, Hornabrook RW, Chopra IJ. Serum thyroglobulin in inhabitants of an endemic goiter region of New Guinea. J Clin Endocrinol Metab. 1976;43:512-6.

Amino N, Hagen SR, Yamada N, Refetoff S. Measurement of circulating thyroid microsomal antibodies by the tanned red cell haemagglutination technique: its usefulness in the diagnosis of autoimmune thyroid diseases. Clin Endocrinol (Oxf). 1976;5:115–25.

Van Voorthuizen WF, Dinsart C, Flavell RA, DeVijlder JJ, Vassart G. Abnormal cellular localization of thyroglobulin mRNA associated with hereditary congenital goiter and thyroglobulin deficiency. Proc Natl Acad Sci USA. 1978;75:74-8.

Hidaka Y, Nishi I, Tamaki H, Takeoka K, Tada H, Mitsuda N, Amino N. Differentiation of postpartum thyrotoxicosis by serum thyroglobulin: usefulness of a new multisite immunoradiometric assay. Thyroid. 1994;4:275-8.

Torrigiani G, Doniach D, Roitt IM. Serum thyroglobulin levels in healthy subjects and in patients with thyroid disease. J Clin Endocrinol Metab. 1969;29:305-14.

Rink T, Dembowski W, Schroth HJ, Klinger K. Impact of serum thyroglobulin concentration in the diagnosis of benign and malignant thyroid diseases. Nuklearmedizin. 2000;39:133-8.

Feldt-Rasmussen U. Serum thyroglobulin and thyroglobulin autoantibodies in thyroid diseases. Allergy. 1983;38:369-87.

Feldt-Rasmussen U, Bech K, Date J. Serum thyroglobulin in patients with toxic and nontoxic goitres compared to sex- and age-matched control subjects. Acta Endocrinol (Copenh). 1979;91:264-70.