Patients with III and IV category of the Bethesda System under levothyroxine non-suppressive therapy have a lower rate of thyroid malignancy

Abstract

Thyroid nodules (TNs) assigned to the Bethesda System categories III and IV include numerous clinical characteristics, which increase or decrease the risk of malignancy. However, there are very few data regarding the influence of TSH non-suppressive thyroid hormone therapy (NSTHT) on the risk of malignancy in patients in the aforementioned categories. We assessed the number of patients with thyroid nodules assigned to categories III and IV who take TSH NSTHT and if thyroid hormone therapy is associated with a rate of malignancy. We retrospectively analyzed the medical records of 4,716 individuals and selected 532 (11.28%) patients with Bethesda System category III and IV thyroid nodules. All participants underwent surgery, and histopathological verification was obtained in all cases. In all, 33.1% of individuals with category III and IV thyroid nodules took TSH NSTHT. In patients with category III nodules, application of NSTHT was associated with a lower rate of thyroid cancer (TC), though this observation was not significant (OR = 0.55, p = 0.381). In patients with category IV nodules, we demonstrated a significantly lower rate of TC when NSTHT was applied (OR = 0.44, p = 0.005). In conclusion, the prevalence of patients with Bethesda System category III and IV thyroid nodules who take NSTHT is high. TSH NSTHT significantly decreases a rate of malignancy in category IV, but not category III patients.

Thyroid Cancer Risk Factors in Children with Thyroid Nodules: A One-Center Study

“…Since the introduction of the TBSRTC in 2009, it has undergone some modifications to improve the system, e.g., reclassification of the noninvasive encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) in noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), which was aimed at reducing ROM and surgical overtreatment of benign lesions [ 49 , 50 , 51 ].…”

“…In the case of lesions highly suspected of being malignant or confirmed malignant (classes V and VI), surgery is the treatment of choice [ 5 , 33 , 36 , 52 ]. Problems with treatment choice for the intermediate classes of TBSRTC (classes III and IV) has already been addressed in several studies [ 49 , 52 , 53 ].…”

Assessment of Preoperative TSH Serum Level and Thyroid Cancer Occurrence in Patients with AUS/FLUS Thyroid Nodule Diagnosis

“…A higher concentration of TSH may predict thyroid malignancy, even if it is within the normal range [ 17 ]. In one of our previous studies, we estimated a significantly lower rate of TC in patients with category IV TBSRTC, in whom nonsuppressive thyroid hormone therapy was applied [ 18 ]. Category IV is also treated as the uncertain category, and many authors treat cases in this category individually [ 19 ].…”

“…Category IV is also treated as the uncertain category, and many authors treat cases in this category individually [ 19 ]. We suggest that the mean serum TSH level is low in patients who undergo nonsuppressive thyroid hormone therapy [ 18 ]. We addressed whether nonsuppressive thyroid hormone therapy significantly decreases the rate of malignancy in category IV but not in category III.…”

Cancer screening activity results in overdiagnosis and overtreatment of papillary thyroid cancer: A 10-year experience at a single institution

“…Therefore, because of a sufficient supply, this factor did not have any influence on the increasing rate of TC diagnosis observed in the study period. Other risk factors, such as hormone supplementation, obesity, diet, environment and genetics, have also been reported; however, there is no evidence to confirm their real impact on the increasing rate of TC diagnosis, but these factors obviously cannot be definitively excluded [34]. In the current study, we did not perform an analysis with these factors.…”