Serum Thyrotropin Concentration as a Novel Predictor of Malignancy in Thyroid Nodules Investigated by Fine-Needle Aspiration

Abstract

The risk of malignancy in a thyroid nodule increases with serum TSH concentrations within the normal range. In addition to patient's gender, age, and goiter type, the serum TSH concentration at presentation is an independent predictor of the presence of thyroid malignancy. We propose that these simple clinical and biochemical factors can serve as an adjunct to FNAB in predicting risk of malignancy.

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

“…In agreement with these observations, we found a significantly higher TSH level in PTC compared with BTNDs in a subgroup of patients submitted to surgery, in whom the cytological diagnosis had been validated by histology. These findings confirm the results reported by Boelaert et al (2006), who found an increased risk of thyroid malignancy in patients with higher TSH levels. However, in this study different thyroid cancers were considered together, including thyroid lymphomas and medullary thyroid cancers which are not supposed to be TSH dependent.…”

“…Recently it has been reported that in patients with nodular thyroid diseases, the risk of malignancy increases with serum TSH concentrations and, even within normal ranges, higher TSH values are associated with a significantly greater likelihood of thyroid cancer (Boelaert et al 2006, Jonklaas et al 2008, Polyzos et al 2008. 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).…”

“…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. 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.…”

Usefulness of serum thyrotropin for risk prediction of differentiated thyroid cancers does not apply to microcarcinomas: results of 1,870 Chinese patients with thyroid nodules

“…Encouragingly, several studies discovered an association of serum TSH and thyroid malignancy [12][13][14][15][16][17][24][25][26][27][28][29]. This should not have been surprising, because TSH used to be thought…”

“…However, so far only six studies of this type have enrolled more than 1,000 patients [12][13][14][15][16][17]. Among them, most did not have final diagnoses based on sur-gery, 1 patient (0.04%) who had been exposed to high levels of radiation, 32 patients (1.3%) were pregnant or lactating or taking estrogen replacement therapy, and 156 patients (6.2%) who were missing serum TSH data.…”