Higher Serum Thyroid Stimulating Hormone Level in Thyroid Nodule Patients Is Associated with Greater Risks of Differentiated Thyroid Cancer and Advanced Tumor Stage

Haymart, Megan R.; Repplinger, Daniel; Leverson, Glen; Elson, Diane F.; Sippel, Rebecca S.; Jaume, Juan Carlos; Chen, Herbert

doi:10.1210/jc.2007-2215

Cited by 438 publications

(432 citation statements)

References 28 publications

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“…The hypothesis that TSH is involved in the progression of PTC is further supported by the observation that higher TSH levels are associated with a more advanced cancer stage, as reported by Haymart et al (2008b). In our series, in agreement with the results reported by Haymart et al when patients with PTC were grouped according to TNM, significantly higher TSH values were observed in patients in T3-T4 with respect to those in T1-T2.…”

Section: E Fiore Et Al: Tsh and Risk Of Ptcsupporting

confidence: 93%

“…An increased risk of differentiated thyroid cancer in patients with higher TSH has been reported also by Haymart et al (2008b). In this work, only a histological series has been evaluated and the possibility of bias cannot be ruled out, as the prevalence of thyroid cancer in this series (241/843Z28.1%) quite high compared with the frequency of differentiated thyroid cancer in patients with nodular thyroid disease.…”

Section: E Fiore Et Al: Tsh and Risk Of Ptcmentioning

confidence: 87%

“…Higher TSH levels have also been associated with advanced stage thyroid cancer and it has been suggested that TSH may play a central role in its development and progression (Haymart et al 2008b). However, in some of these studies (Boelaert et al 2006, Polyzos et al 2008) different thyroid malignancies were grouped, including medullary or anaplastic cancers or thyroid lymphomas, that have never been reported to be TSH dependent.…”

Section: Introductionmentioning

confidence: 99%

“…However, in some of these studies (Boelaert et al 2006, Polyzos et al 2008) different thyroid malignancies were grouped, including medullary or anaplastic cancers or thyroid lymphomas, that have never been reported to be TSH dependent. Besides, in other studies (Haymart et al 2008b, Jonklaas et al 2008 only patients submitted to thyroid surgery were included, and it is not possible to rule out a potential selection bias because histological series usually do not include patients with small benign nodular goiter.…”

Section: Introductionmentioning

confidence: 99%

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Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role

Fiore¹,

Rago²,

Provenzale³

et al. 2009

Endocrine-Related Cancer

217

172

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Higher TSH values, even within normal ranges, have been associated with a greater risk of thyroid malignancy. The relationship between TSH and papillary thyroid cancer (PTC) has been analyzed in 10 178 patients submitted to fine needle aspiration of thyroid nodules with a cytology of PTC (nZ497) or benign thyroid nodular disease (BTND, nZ9681). In 942 patients, submitted to surgery (521 from BTND and 421 from PTC), the histological diagnosis confirmed an elevated specificity (99.6%) and sensitivity (98.1%) of cytology. TSH levels were significantly higher in PTC than in BTND both in the cytological and histological series and also in patients with a clinical diagnosis of multinodular goiter (MNG) and single/isolate nodule (S/I). A significant agedependent development of thyroid autonomy (TSH !0.4 mU/ml) was observed in patients with benign thyroid disease, but not in those with PTC, diagnosed both on cytology and histology. In patients with MNG, the frequency of thyroid autonomy was higher and the risk of PTC was lower compared to those with S/I. In all patients, the presence of thyroid auto-antibodies (TAb) was associated with a significant increase of TSH. However, both in TAb positive and TAb negative patients TSH levels were significantly higher in PTC than in BTND. Our data confirm a direct relationship between TSH levels and risk of PTC in patients with nodular thyroid diseases. Thyroid autonomy conceivably protects against the risk of PTC, while thyroid autoimmunity does not play a significant role.

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Section: E Fiore Et Al: Tsh and Risk Of Ptcsupporting

confidence: 93%

Section: E Fiore Et Al: Tsh and Risk Of Ptcmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role

Fiore¹,

Rago²,

Provenzale³

et al. 2009

Endocrine-Related Cancer

217

172

View full text Add to dashboard Cite

show abstract

“…This finding is important as autonomous nodules are almost never malignant and FNAB is generally not required. On the other hand, a higher serum TSH is associated with an increased risk of cancer in a thyroid nodule 5 , 6 . While the cost‐effectiveness of routine serum calcitonin measurement is debatable given the low incidence of medullary thyroid cancer, serum calcitonin level should be measured if there is a family history of medullary cancer or MEN2 2 , 3 .…”

Section: Clinical Risk Factors and Thyroid Functionmentioning

confidence: 99%

Thyroid nodules and evaluation of thyroid cancer risk

Hoang

2010

Australas J Ultrason Med

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Accuracy of Fine-Needle Aspiration Biopsy for Predicting Neoplasm or Carcinoma in Thyroid Nodules 4 cm or Larger

Pinchot

Al-Wagih²,

Schaefer³

et al. 2009

Arch Surg

156

130

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Hypothesis All thyroid nodules ≥4 cm should be surgically removed regardless of fine-needle aspiration biopsy (FNAB) results due to an unacceptably high rate of false-negative pre-operative biopsies in these large nodules. Design Retrospective cohort study. Setting Single institution, tertiary academic referral center. Patients and Methods A retrospective analysis was done on all patients who underwent surgery for a thyroid nodule ≥4 cm from 5/94 through 1/07. Preoperative FNAB results were correlated with final surgical pathologic results. FNAB results were reported as non-diagnostic, benign, inconclusive (follicular neoplasm), or malignant while final surgical pathologic data was reported as benign or malignant. Results Of 155 patients who had a thyroidectomy for a ≥4cm nodule, 21 patients (14%) had clinically significant thyroid carcinoma within the ≥4cm nodule on final pathology. Preoperative cytology of the ≥4cm mass was obtained and read as benign in 52/97 patients, inconclusive in 23/97 patients, non-diagnostic in 11/97 patients, and malignant in 11/97 patients. In lesions ≥4cm, 26/52 (50%) FNAB results reported as benign turned out to be either neoplastic (22/52) or malignant (4/52) on final pathology. Among patients with non-diagnostic FNAB, the risk of malignancy was 27%. Conclusions In patients with thyroid nodules ≥4cm, FNAB results are highly inaccurate, misclassifying half of all patients with reportedly benign lesions on FNAB. Furthermore, those patients with a non-diagnostic FNAB display a very high risk of differentiated thyroid carcinoma. Therefore, we recommend that diagnostic lobectomy, at a minimum, be performed in patients with thyroid nodules ≥4 cm regardless of FNA cytology.

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Higher Serum Thyroid Stimulating Hormone Level in Thyroid Nodule Patients Is Associated with Greater Risks of Differentiated Thyroid Cancer and Advanced Tumor Stage

Cited by 438 publications

References 28 publications

Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role

Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role

Thyroid nodules and evaluation of thyroid cancer risk

Accuracy of Fine-Needle Aspiration Biopsy for Predicting Neoplasm or Carcinoma in Thyroid Nodules 4 cm or Larger

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