Should all thyroid cancer patients have thyroglobulin levels measured pre-operatively?

Should all patients be tested? No

A] Situations where TG might play a supportive role:

1. In a rare patient with pathological bone fracture due to bone metastasis as a presenting manifestation of thyroid cancer. This is an uncommon presentation, where in TG estimation may assist in the diagnosis.
2. Similarly, when an unexpected lung nodule biopsy yields findings suspicious for thyroid cancer metastasis.

B] Reasons when not to estimate TG:

1. Immediately after the biopsy of any thyroid nodule. Because TG elevates in the serum after biopsy of even benign nodules (due to the trauma of biopsy causing TG release).
2. In patients with imaging features of Hashimoto's thyroiditis (HT). Also applies to all patients with a history of HT.

I don't believe that thyroglobulin should be measured before surgery in any situation.