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.
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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
- International journal of dermatology 08/2013; · 1.23 Impact Factor
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ABSTRACT: Abstract Objective: This prospective study investigates the relationship between Hashimoto's Thyroiditis (HT) and thyroid cancer (TC) in patients with thyroid nodules (TNs). Methods: We prospectively examined 2100 patients with 2753 TNs between January 5, 2010 and August 15, 2013. A total of 2023 patients with 2669 TNs met the inclusion criteria of TN >5 mm and age >18 years (y). Each patient had blood drawn prior to fine-needle aspiration biopsy (FNAB) for the following measurements: TSH, free T4, free T3, thyroid peroxidase antibody (TPO Ab), and antithyroglobulin antibody (TgAb). Diagnosis of TC was based on pathology analysis of thyroidectomy tissue. Associations of TC with the independent variables were determined by univariate and multivariate logistic regression analysis and reported as adjusted odds ratio (OR) with 95% confidence interval (CI). Results: 248 malignant nodules were found in 233 patients. There was an association of TC with both increased serum TgAb concentration and age <45y. An elevated serum TgAb concentration was found in 10.2% of patients (182 of 1790) with benign nodules as compared to 20.6% of patients (48 of 233) with malignant nodules (p=<0.0001). TgAb (OR=2.24: CI=1.57, 3.19) and TSH >1 uIU/ml (OR (95% CI)) OR: 1.49 (1.09, 2.03) were significant predictors of TC in multivariate analysis controlling for age and gender. TC was not associated with serum concentrations of TPO Ab. Conclusion: In patients with TN, elevated serum concentration of TgAb and TSH >1 uIU/ml are independent predictors for TC. The association between HT and TC is antibody specific.Endocrine Related Cancer 09/2014; · 4.91 Impact Factor