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Lucia Conte  (Conte L) 1 Article
Clinical Study
Detection of Polyethylene Glycol Thyrotropin (TSH) Precipitable Percentage (Macro-TSH) in Patients with a History of Thyroid Cancer
Massimo Giusti, Lucia Conte, Anna Maria Repetto, Stefano Gay, Paola Marroni, Miranda Mittica, Michele Mussap
Endocrinol Metab. 2017;32(4):460-465.   Published online December 14, 2017
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AbstractAbstract PDFPubReader   

Owing to its large molecular size, polyethylene glycol (PEG)-precipitable thyrotropin (TSH) can accumulate in the circulation, elevating TSH levels. PEG-precipitable TSH can be used to detect macro-TSH (mTSH) in serum. Our aim was to evaluate the prevalence of mTSH in patients who had undergone thyroidectomy for thyroid cancer.


Seventy-three thyroid cancer patients and 24 control subjects on levothyroxine (LT4) TSH-suppressive or replacement therapy were evaluated. Screening for mTSH was performed by adding PEG to serum in order to precipitate γ-globulin. A percentage of PEG-precipitable TSH ≥80% was considered suggestive of mTSH.


No correlation between free-T4 (fT4) and TSH levels was found. PEG-precipitable TSH was 39.3%±1.9% in thyroid cancer patients and 44.1%±3.9% in controls. Macro-TSH was deemed to be present in one thyroid cancer patient and in two control subjects. Only in the thyroid cancer group was PEG-precipitable TSH found to be negatively correlated with fT4 concentration. No correlation was found between PEG-precipitable TSH and other clinical conditions in any patients.


The presence of mTSH seems to be a rare phenomenon in thyroid cancer. In some patients with low PEG-precipitable TSH, a reduction in LT4 dosage could be suggested. LT4 dosage adjusted to body weight is the main factor in maintaining TSH in a semi-suppressed or normal range. Evaluation of mTSH could be necessary in patients in whom a balance is required between adequate TSH suppression and the avoidance of unnecessary exogenous hyperthyroxinemia.


Citations to this article as recorded by  
  • Prevalence and Pathogenesis of Macro-Thyrotropin in Neonates: Analysis of Umbilical Cord Blood from 939 Neonates and Their Mothers
    Naoki Hattori, Kohzo Aisaka, Ayato Yamada, Takeshi Matsuda, Akira Shimatsu
    Thyroid.2023; 33(1): 45.     CrossRef
  • Pars Distalis and Pars Tuberalis Thyroid-Stimulating Hormones and Their Roles in Macro-Thyroid-Stimulating Hormone Formation
    Eleonore Fröhlich, Richard Wahl
    International Journal of Molecular Sciences.2023; 24(14): 11699.     CrossRef
  • A comparative cross-sectional study on sleep quality in patients with a history of differentiated thyroid carcinoma and its correlation with quality of life
    Marsida Teliti, Eleonora Monti, Martina Comina, Lucia Conte, Lara Vera, Stefano Gay, Giorgia Saccomani, Diego Ferone, Massimo Giusti
    Endocrine.2021; 73(2): 347.     CrossRef
  • A rare cause of subclinical hypothyroidism: macro-thyroid-stimulating hormone
    Cem Onur Kirac, Sedat Abusoglu, Esra Paydas Hataysal, Aysegul Kebapcilar, Suleyman Hilmi Ipekci, Ali Ünlü, Levent Kebapcilar
    Diagnosis.2020; 7(1): 75.     CrossRef
  • Neuroendocrine neoplasms – think about it and choose the most appropriate diagnostic and therapeutic steps
    Christian A. Koch, S. Petersenn
    Reviews in Endocrine and Metabolic Disorders.2018; 19(2): 107.     CrossRef
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