Associations of Serum Thyrotropin Concentrations with Recurrence and Death in Differentiated Thyroid Cancer

Hovens, Guido C.; Stokkel, Marcel P. M.; Kievit, J.; Corssmit, Eleonora P M; Pereira, Alberto M.; Romijn, Johannes A.; Smit, Johannes

doi:10.1210/jc.2006-2566

Cited by 140 publications

(96 citation statements)

References 21 publications

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“…Moreover, more aggressive TSH suppression to yield an undetectable TSH did not further improve survival in these lower risk patients (13). Similarly, in another European cohort of patients with thyroid cancer, higher serum TSH levels were found to be associated with increased rates of thyroid carcinoma-related death and relapse (15).…”

Section: Introductionmentioning

confidence: 90%

Endogenous Thyrotropin and Triiodothyronine Concentrations in Individuals with Thyroid Cancer

Jonklaas

Nsouli-Maktabi

Soldin

2008

Thyroid

113

102

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Background: Thyroid hormone suppression therapy is associated with decreased recurrence rates and improved survival in patients with differentiated thyroid cancer. Recently higher baseline thyrotropin (TSH) levels have been found to be associated with a postoperative diagnosis of differentiated thyroid cancer. Our objective was to confirm whether preoperative TSH levels were higher in patients who were diagnosed with differentiated thyroid cancer after undergoing thyroidectomy, compared with patients who were found to have benign disease. We also sought to determine whether thyroid hormone levels were lower in the patients with malignancy. Methods: The study was a retrospective analysis of a prospective study. The study setting was the General Clinical Research Center of an Academic Medical Center. Participants were 50 euthyroid patients undergoing thyroidectomy. Thyroxine, triiodothyronine (T 3 ), and TSH levels were documented in patients prior to their scheduled thyroidectomy. Following thyroidectomy, patients were divided into those with a histologic diagnosis of either differentiated thyroid cancer or benign disease. Preoperative thyroid profiles were correlated with patients' postoperative diagnoses. Results: All patients had a normal serum TSH concentration preoperatively. One-third of the group was diagnosed with thyroid cancer as a result of their thyroidectomy. These patients had a higher serum TSH level (mean ¼ 1.50 mIU=L, CI 1.22-1.78 mIU=L) than patients with benign disease (mean ¼ 1.01 mIU=mL, CI 0.84-1.18 mIU=L). There was a greater risk of having thyroid cancer in patients with TSH levels in the upper three quartiles of TSH values, compared with patients with TSH concentrations in the lowest quartile of TSH values (odd ratio ¼ 8.7, CI 2.2-33.7). Patients with a thyroid cancer diagnosis also had lower T 3 concentrations measured by liquid chromatography tandem mass spectrometry (mean ¼ 112.6 ng=dL, CI 103.8-121.4 ng=dL) than did patients with a benign diagnosis (mean 129.9 ng=dL, CI 121.4-138.4 ng=dL). Conclusion: These data confirm that higher TSH concentrations, even within the normal range, are associated with a subsequent diagnosis of thyroid cancer in individuals with thyroid abnormalities. This further supports the hypothesis that TSH stimulates the growth or development of thyroid malignancy during its early or preclinical phase. We also show for the first time that patients with thyroid cancer also have lower T 3 levels than patients with benign disease.

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Section: Introductionmentioning

confidence: 90%

Endogenous Thyrotropin and Triiodothyronine Concentrations in Individuals with Thyroid Cancer

Jonklaas

Nsouli-Maktabi

Soldin

2008

Thyroid

113

102

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“…Moreover, therapy with suppressive doses of thyroxine (T 4 ) has long been known to positively affect outcomes in differentiated thyroid cancer (Mazzaferri & Jhiang 1994), and retrospective studies have shown that TSH suppression is an independent predictor of recurrence of differentiated thyroid cancer (Pujol et al 1996). More recently, prospective studies have indicated reductions in thyroid carcinoma-related death and relapse with aggressive TSH suppression, especially in high-risk patients (Jonklaas et al 2006, Hovens et al 2007). Based on these findings, it is plausible that the higher rates of malignancy with increasing serum TSH concentrations reflect a tropic effect of TSH on thyroid tissue promoting neoplasia and carcinogenesis.…”

Section: Introductionmentioning

confidence: 99%

The association between serum TSH concentration and thyroid cancer

Boelaert

2009

Endocrine-Related Cancer

126

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There is mounting evidence that the serum concentration of TSH is an independent predictor for the diagnosis of thyroid malignancy in patients with nodular thyroid disease. Furthermore, preoperative serum TSH concentrations are higher in patients with more aggressive tumours, suggesting a potential role for TSH in the progression of differentiated thyroid cancer. Based on these observations, patients with higher serum TSH concentrations and borderline cytological results may require more aggressive investigation and treatment when compared with those with lower baseline TSH levels. The mechanisms underlying the finding of higher serum TSH in patients with thyroid cancer remain unexplained. In this issue of Endocrine-Related Cancer, Fiore et al. have analysed the relationship between serum TSH and diagnosis of papillary thyroid cancer in 10 178 patients with nodular thyroid disease who were investigated by fine-needle aspiration biopsy. They found significantly higher TSH concentrations in patients who were subsequently diagnosed with thyroid cancer compared with those with benign disease. In addition, they found that the development of autonomous thyroid function (TSH!0.4 mU/ml) was associated with a reduction in the risk of papillary thyroid carcinoma. In this commentary, the evidence regarding the association between serum TSH and thyroid cancer is discussed placing these new findings into context.

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“…Similarly, the prognostic value of Tg measurements was demonstrated in numerous studies [18,23,[27][28][29][30][31][32][33][34][35]. In 2012 Webb et al published the results of meta-analysis involving nearly 4000 DTC patients and evaluating the utility of serum Tg measurement performed at the time of RAI remnant ablation [36].…”

Section: Prace Oryginalnementioning

confidence: 94%

Ciągła stratyfikacja ryzyka w zróżnicowanym raku tarczycy (DTC) — stymulowane stężenie tyreoglobuliny (Tg) w surowicy, przed leczeniem uzupełniającym radiojodem (RAI), najważniejszym czynnikiem ryzyka nawrotu raka u pacjentów M0

Krajewska

Jarząb

Czarniecka

et al. 2016

Endokrynologia Polska

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Ongoing risk stratification for differentiated thyroid cancer (DTC) -stimulated serum thyroglobulin (Tg) before radioiodine (RAI) ablation, the most potent risk factor of cancer recurrence in M0 patients Ciągła stratyfikacja ryzyka w zróżnicowanym raku tarczycy (DTC) -stymulowane stężenie tyreoglobuliny (Tg) w surowicy, przed leczeniem uzupełniającym radiojodem (RAI), najważniejszym czynnikiem ryzyka nawrotu raka u pacjentów M0 AbstractIntroduction: Adequate postoperative risk assessment currently constitutes the principle of DTC treatment and further management. The aim of the study -a retrospective assessment of risk factors influencing DTC relapse. Material and methods:The study group consisted of 510 DTC staged pT1b-T4N0-N1M0, in whom total thyroidectomy and complementary radioiodine (RAI) treatment were carried out. In 71% papillary thyroid cancer was diagnosed, whereas in the remaining 29% -follicular thyroid carcinoma. Based on TNM classification from 1997, T1 feature was diagnosed in 11.6%, T2 in 35.1%, T3 in 8.4%, T4 in 9,4%, while in 35.5% -Tx. Lymph node metastases were present in 24.7% of cases. Median follow-up was 12.1 years (1.5-15.2). Results: Age at DTC diagnosis, tumour diameter (T), lymph node metastases (N1), stimulated thyroglobulin, and RAI uptake in thyroid bed at qualification for RAI ablation significantly influenced freedom from progression time (FFP) in a multivariate analysis. When postoperative stimulated Tg was > 30 ng/mL the risk of relapse increased nearly six-fold, whereas the presence of N1 feature -four-fold. The total risk of relapse in the whole group was 12.55% while median FFP was 154.8 months. Five-year and 10-year FFP was 90.1% and 87.5%, respectively. Conclusions: Postoperative stimulated thyroglobulin level was the most potent, independent risk factor influencing FFP in DTC patients. Age above 60 years, an initial DTC stage (T and N features), and low RAI uptake in thyroid bed ( < 1%) were related to a higher risk of DTC relapse, whereas the investigated histopathological features were insignificant. (Endokrynol Pol 2016; 67 (1): 2-11)

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Associations of Serum Thyrotropin Concentrations with Recurrence and Death in Differentiated Thyroid Cancer

Abstract: Our study supports current guidelines, which advise to aim at TSH levels in the low normal range in cured low-risk patients, whereas TSH levels should be suppressed in noncured or high-risk patients.

Cited by 140 publications

References 21 publications

Endogenous Thyrotropin and Triiodothyronine Concentrations in Individuals with Thyroid Cancer

Endogenous Thyrotropin and Triiodothyronine Concentrations in Individuals with Thyroid Cancer

The association between serum TSH concentration and thyroid cancer

Ciągła stratyfikacja ryzyka w zróżnicowanym raku tarczycy (DTC) — stymulowane stężenie tyreoglobuliny (Tg) w surowicy, przed leczeniem uzupełniającym radiojodem (RAI), najważniejszym czynnikiem ryzyka nawrotu raka u pacjentów M0

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