Serum TSH levels as a predictor of malignancy in thyroid nodules: A prospective study

Abstract

BackgroundThe role of serum TSH concentrations as a predictor of malignancy of thyroid nodule remains unclear.ObjectiveTo prospectively evaluate the usefulness of serum TSH levels as a predictor of malignancy in thyroid nodules.MethodsPatients with thyroid nodule(s) who underwent fine-needle aspiration biopsy under ultrasonographic guidance in a tertiary, university-based hospital were consecutively evaluated. Patients with known thyroid cancer and/or patients receiving thyroid medication were excluded. Serum TSH levels were measured by two differents methodologies, chemiluminescent (CLIA) and electrochemiluminscent immunoassay (ECLIA). Anatomopathological exam of tissue samples obtained at thyroidectomy was considered the gold standard for the diagnosis of thyroid cancer.ResultsA total of 615 patients participated in the study. The mean age was 55.9±14.7 years, and 544(88.5%) were female. The median TSH values were 1.48 and 1.55 μU/mL, using CLIA and ECLIA, respectively. One-hundred-sixty patients underwent thyroidectomy and the final diagnoses were malignant in 47(29.4%) patients. TSH levels were higher in patients with malignant than in those with benign nodules in both TSH assays: 2.25 vs. 1.50; P = 0.04 (CLIA) and 2.33 vs. 1.27; P = 0.03 (ECLIA). Further analysis using binary logistic regression identified elevated TSH levels, a family history of thyroid cancer, the presence of microcalcifications, and solitary nodule on US as independent risk factors for malignancy in patients with thyroid nodules. Additional analyses using TSH levels as a categorical variable, defined by ROC curve analysis, showed that the risk of malignancy was approximately 3-fold higher in patients with TSH levels ≥2.26 μU/mL than in patients with lower TSH levels (P = 0.00).ConclusionsHigher serum TSH levels are associated with an increased risk of thyroid cancer in patients with thyroid nodules. Using TSH levels as an adjunctive diagnostic test for stratifying the risk of malignancy associated with a thyroid nodule may help on defining the best therapeutic approaches.

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

“…e role of serum thyreotropin levels in the development and/or progression of thyroid cancer remains controversial. Indeed, it is well known that TSH is a major thyroid cell growth factor and that thyreotropin-activated signaling pathways play a role in thyroid tumorigenesis [9,23]. In addition, TSH suppression is a crucial therapeutic tool in, at least some, patients affected by differentiated thyroid cancer [4].…”

“…In addition, TSH suppression is a crucial therapeutic tool in, at least some, patients affected by differentiated thyroid cancer [4]. On the other hand, several studies have evaluated the usefulness of serum TSH levels as a predictor of malignancy in thyroid nodules in the last years with conflicting results [9,[24][25][26][27][28]. Recently, Golbert et al have shown, in a large series of patients, that higher thyreotropin levels are associated with an increased risk of thyroid cancer [9].…”

“…Recently, the usefulness of serum thyreotropin (TSH) levels has been evaluated as a predictor of malignancy in thyroid nodules, demonstrating that higher serum TSH levels are associated with an increased risk of thyroid cancer [9]. is simple and free of adjunctive costs test for stratifying the risk of malignancy associated with a thyroid nodule was not previously evaluated in thyroid nodules with indeterminate cytology.…”

Thyroid Nodule: Approach and Management

“…However, positive anti-TPO does not obviate the need for a cytopathological evaluation, as a coexisting malignancy needs to be ruled out. A raised or even a normal TSH is associated with an increased risk of malignancy, as well as a more advanced stage of differentiated thyroid cancer [23,24].…”

The Role of Polybrominated Diphenyl Ethers in Thyroid Carcinogenesis: Is It a Weak Hypothesis or a Hidden Reality? From Facts to New Perspectives

“…A number of studies showed a positive association between elevated serum levels of TSH and subsequent diagnosis of PTC [ 71 , 73 ]. The major limit of most of these investigations, however, was the cross-sectional design that did not permit to demonstrate the role of causation of TSH in thyroid cancer pathogenesis neither exclude the possibility of reverse causality or treatment effect [ 19 ].…”