The association between serum TSH concentration and thyroid cancer

Abstract

There is mounting evidence that the serum concentration of TSH is an independent predictor for the diagnosis of thyroid malignancy in patients with nodular thyroid disease. Furthermore, preoperative serum TSH concentrations are higher in patients with more aggressive tumours, suggesting a potential role for TSH in the progression of differentiated thyroid cancer. Based on these observations, patients with higher serum TSH concentrations and borderline cytological results may require more aggressive investigation and treatment when compared with those with lower baseline TSH levels. The mechanisms underlying the finding of higher serum TSH in patients with thyroid cancer remain unexplained. In this issue of Endocrine-Related Cancer, Fiore et al. have analysed the relationship between serum TSH and diagnosis of papillary thyroid cancer in 10 178 patients with nodular thyroid disease who were investigated by fine-needle aspiration biopsy. They found significantly higher TSH concentrations in patients who were subsequently diagnosed with thyroid cancer compared with those with benign disease. In addition, they found that the development of autonomous thyroid function (TSH!0.4 mU/ml) was associated with a reduction in the risk of papillary thyroid carcinoma. In this commentary, the evidence regarding the association between serum TSH and thyroid cancer is discussed placing these new findings into context.

WOMEN IN CANCER THEMATIC REVIEW: Thyroid-stimulating hormone in thyroid cancer: does it matter?

“…Fiore and coworkers demonstrated significant age-dependent development of thyroid autonomy (serum TSH <0.4 IU/L) in patients with benign thyroid disease, but this was less evident in those with papillary thyroid cancer and in patients with multi-nodular goitre. The frequency of thyroid autonomy was higher and the risk of papillary thyroid cancer was lower than in those with solitary nodules, consistent with a protective effect of lower serum TSH concentrations on thyroid cancer development or progression (Boelaert 2009, Fiore et al 2009.…”

“…Several studies have indicated an association between thyroid autoimmunity and thyroid malignancy (Haymart et al 2008, Boelaert 2009, McLeod et al 2012). There is an increased incidence of thyroid cancer in patients with Hashimoto's disease.…”

“…There is no consensus on why serum TSH is raised in differentiated thyroid cancer nor do we fully understand the cause and effect relationship (Boelaert 2009). Iodine deficiency causes a consequent rise in serum TSH concentrations, and chronic iodine deficiency is a well-established risk factor for the development of goitre and follicular thyroid cancer (Lind et al 1998, FeldtRasmussen 2001, Nagataki & Nystrom 2002.…”

“…Although current tumour staging systems are unable to guide therapy in papillary microcarcinomas, the potential for use of TSH to assist in assessing prognosis is appealing. (Lu, et al 2010;Shi, et al 2016;Suzuki, et al 2002;Zheng, et al 2016) Thyroid (micro)carcinoma TSH as a carcinoma propagator (Fiore, et al 2009;Haymart, et al 2008;McLeod, et al 2014;Shi et al 2016) TSH receptor TSH Autoantibody TSH stimulation and thyroid tumourigenesis in auto-immunity (Boelaert 2009;Haymart et al 2008;McLeod, et al 2012) …”

MECHANISMS IN ENDOCRINOLOGY: The crosstalk between thyroid gland and adipose tissue: signal integration in health and disease

“…The mechanisms underlying this hypothetical association remain largely unclear, but the increased serum level of TSH, frequently observed in obese patients, might play a role. Indeed, TSH is a growth factor for thyroid cells and a predictor of malignancy in thyroid nodules (147,148). As such, a recent meta-analysis showed that, in patients with nodular disease, higher concentrations of TSH, even within the normal range, are associated with higher odds of thyroid cancer (149).…”