Could Serum TSH Levels Predict Malignancy in Euthyroid Patients Affected by Thyroid Nodules with Indeterminate Cytology?

Abstract

Background. Serum TSH levels in the upper-normal range were reported to be associated with increased risk of thyroid malignancy. However, measurement of TSH levels is currently not recommended for assessing the risk of malignancy in patients with newly diagnosed thyroid nodules. Objective. To evaluate a possible relationship between the serum levels of TSH and the histological outcome of patients undergoing thyroidectomy for thyroid nodules with indeterminate cytology. Materials and Methods. We collected the clinical data of all patients who had performed ultrasound-guided FNA of thyroid nodules with cytological diagnosis of indeterminate lesions (TIR3A and TIR3B) and serum TSH levels within the normal range. All patients had been submitted to thyroid surgery (hemi or thyroidectomy, as appropriate), and histological diagnosis had been performed. Results. A histological diagnosis of thyroid malignancy was rendered in 74/378 (19.6%) nodules. Patients with histologically proven thyroid malignancy were characterized by higher serum levels of TSH as compared to patients with histologically proven benign nodules (3.03 ± 1.16 vs. 2.37 ± 1.19 mIU/L, p<0.001). To further analyze the role of serum TSH in predicting thyroid cancer, patients were stratified in 4 groups according to quartiles of TSH concentrations. The prevalence of malignancy was 12.2% for the first quartile and 50.0% for the last quartile. ROC curve analysis identified that a serum TSH level of ≥2.7 mIU/L predicted thyroid malignancy with a sensitivity of 61% and a specificity of 65%. Conclusions. TSH levels in the upper-normal range are associated with an increased risk of thyroid malignancy in patients affected by thyroid nodules with indeterminate cytology at FNA. The measurement of serum TSH levels represents an easily performed additional tool for decision-making in patients with indeterminate cytological findings.

Utility of Fine-Needle Aspirations to Diagnose Pediatric Thyroid Nodules

“…However, patients with malignancy exhibited lower mean serum TSH levels than patients with benign pathology (3.2 ± 5.7 µIU/L vs. 3.7 ± 12.9 µIU/L; shown in Table 5). Previous studies have also demonstrated correlations between serum TSH concentrations and thyroid nodule malignancy, reporting the risk of malignancy to increase with preoperative TSH levels >2.7 µIU/L [44], above the population mean [45], in the upper quartile [46], and within the normal range [47]. However, despite the median association between serum TSH concentration and nodules harboring malignancy in this study being statistically significant ( p = 1.58e−3), the application of mild elevation in TSH as an independent, clinically relevant risk factor of malignancy is low.…”

Radiomics analysis improves 18FDG PET/CT-based risk stratification of cytologically indeterminate thyroid nodules

“…Serum TSH levels in the upper-normal range were recently associated with an increased risk of thyroid malignancy in patients affected by thyroid nodules with indeterminate cytology and proposed as an easily performed additional tool for decision-making in patients with indeterminate cytological findings [ 11 ]. Accordingly we added TSH levels, together TLG to RFs (first-order and shape PyRadiomics parameters comprised SUVmax, SUVmean and MTV) in our analysis.…”

Usefulness of accessible imaging methods in thyroid nodules with indeterminate cytology

“…The relationship between RoM and serum TSH in euthyroid individuals with cytologically indeterminate nodules corroborates this observation. A recent study showed that among 378 euthyroid patients the RoM was 9.8% for TIR3A nodules and 27.3% for TIR3B nodules (Cappelli et al 2020). However, in the subgroup with TSH in the lower quartile (0.4-1.42 mIU/L), the RoM was significantly lower, 5.9% for TIR3A and 12% for TIR3B (Cappelli et al 2020), possibly reflecting a higher probability of the nodules being autonomous in this TSH quartile.…”