Are endogenously lower serum thyroid hormones new predictors for thyroid malignancy in addition to higher serum thyrotropin?
ABSTRACT It is well known that TSH plays a major role in the secretion of thyroid hormones, maintenance of thyroid specific gene expression, and gland growth. In this study, we aimed to evaluate association between tests of thyroid functions (fT3, fT4, TSH) and differentiated thyroid carcinoma. 441 patients operated for nodular goiter between 2005 and 2008 were analyzed. Thyroid functions were studied in the period of 1-30 days prior to surgery. In postoperative histopathological examination, differentiated thyroid carcinoma and benign thyroid disease were detected in 166 (37.6%) and 275 (62.4%) patients, respectively. Patients with thyroid malignancy had significantly lower serum fT3 (P = 0.001), lower fT4 (P = 0.022), and higher TSH levels (P < 0.001) compared to patients with benign disease, although all analytes were within the normal range. We subdivided by quartile serum fT3, fT4, and TSH in normal limits into three groups. The odds ratio (ORs) for the risk of thyroid cancer with a serum TSH between 0.63 and 1.67 μIU/ml and 1.68-4.00 μIU/ml, compared with a serum TSH between 0.40 and 0.62 μIU/ml were calculated as 2.60 (95% CIs 1.49-4.54) and 6.50 (95% CIs 3.51-12.03), respectively. There was also a greater risk of thyroid cancer in patients with fT3 levels of 1.57-3.00 pg/ml, compared with patients with fT3 levels of 3.89-4.71 pg/ml (OR 2.95, 95% CIs 1.68-5.20). For fT4, OR for the risk of thyroid cancer between 0.85 and 1.17 ng/dl compared with 1.48-1.78 ng/dl was 2.14 (95% CIs 1.22-3.74). In conclusion, lower fT3, fT4, and higher TSH concentrations within normal limits were related with increased thyroid cancer independent from sex and nodule type. Particularly, the association between lower fT3, fT4 levels and a diagnosis of thyroid cancer is a novel finding.
- International journal of dermatology 08/2013; · 1.18 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Background: Recently, it has been reported that the risk of thyroid malignancy increases with increasing concentrations of serum TSH. The aim of study was to determine whether or not serum TSH can be a predictor for thyroid malignancy, when considering the relevant US features and clinical risk factors. Methods: This retrospective study included 1200 euthyroid patients with 1269 thyroid nodules who underwent ultrasound-guided fine-needle aspiration biopsy between January and June 2009. Serum TSH, US feature, and clinical parameters were compared according to final diagnosis. Subgroup analyses were performed according to nodule size. Results: Serum TSH did not show a positive association with malignancy for all nodules and micronodule subgroup in multivariate analysis, although they showed significant association with thyroid malignancy for macronodule subgroup. For all nodules and the two subgroups, suspicious US features and younger age were significantly associated with malignancy in univariate and multivariate analyses. Conclusions: Our study suggests that TSH alone is not as useful as US features in deciding whether or not to perform FNA in patients with micronodules. Head Neck, 2014.Head & Neck 01/2014; · 2.83 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: TSH is the major growth factor for thyrocytes and may have a causative role in thyroid cancer. The objective of the study was to systematically assess the association between serum TSH and thyroid cancer. The MEDLINE and EMBASE databases were searched using synonyms for TSH and thyroid cancer, supplemented with reference list searches and author contact. Prospective cohort, case-control, and cross-sectional studies were identified with TSH the exposure and thyroid cancer the outcome. Three reviewers independently extracted data. Studies reporting odds ratio (OR) for TSH levels and thyroid cancer were analyzed via meta-analysis and generalized least-squares trend estimation for dose-response relationships. Data extracted from 28 studies included a total of 42,032 subjects and 5,786 thyroid cancer cases. Dose-response spline analysis revealed a nonlinear relationship (P < 0.001). For TSH levels less than 1 mU/liter, the OR for thyroid cancer was 1.72 (1.42, 2.07) per milliunits per liter. However, the relationship changed for TSH levels 1 mU/liter and greater, with the OR thereafter being 1.16 (1.12, 1.21) per milliunits per liter. Studies controlling for autoimmunity reported the lowest OR [TSH below 2.5 mU/liter, OR 1.23 (1.02-1.47) per milliunits per liter; TSH 2.5 mU/liter or greater, OR 0.98 (0.89-1.09) per milliunits per liter]. Six groups assessed serum TSH in relation to markers of poor thyroid cancer prognosis, with three showing significant positive relationships. Higher serum TSH concentration is associated with an increased risk of thyroid cancer. Thyroid autoimmunity may partially explain the association, but further epidemiological assessment is required. Future clinical research should investigate the validity of including serum TSH in diagnostic nomograms, its prognostic importance, and the potential for therapeutic TSH suppression in thyroid cancer prevention.The Journal of Clinical Endocrinology and Metabolism 05/2012; 97(8):2682-92. · 6.31 Impact Factor