Higher Serum TSH in Thyroid Nodule Patients Is Associated with Greater Risks of Differentiated Thyroid Cancer and Advanced Tumor Stage

    loading  Checking for direct PDF access through Ovid

Abstract

Context:

TSH is a known thyroid growth factor, but the pathogenic role of TSH in thyroid oncogenesis is unclear.

Objective:

The aim was to examine the relationship between preoperative TSH and differentiated thyroid cancer (DTC).

Design:

The design was a retrospective cohort.

Setting, Participants:

Between May 1994 and January 2007, 1198 patients underwent thyroid surgery at a single hospital. Data from the 843 patients with preoperative serum TSH concentration were recorded.

Main Outcome Measures:

Serum TSH concentration was measured with a sensitive assay. Diagnoses of DTC vs. benign thyroid disease were based on surgical pathology reports.

Results:

Twenty-nine percent of patients (241 of 843) had DTC on final pathology. On both univariate and multivariable analyses, risk of malignancy correlated with higher TSH level (P = 0.007). The likelihood of malignancy was 16% (nine of 55) when TSH was less than 0.06 mIU/liter vs. 52% (15 of 29) when 5.00 mIU/liter or greater (P = 0.001). When TSH was between 0.40 and 1.39 mIU/liter, the likelihood of malignancy was 25% (85 of 347) vs. 35% (109 of 308) when TSH was between 1.40 and 4.99 mIU/liter (P = 0.002). The mean TSH was 4.9 ± 1.5 mIU/liter in patients with stage III/IV disease vs. 2.1 ± 0.2 mIU/liter in patients with stage I/II disease (P = 0.002).

Conclusions:

The likelihood of thyroid cancer increases with higher serum TSH concentration. Even within normal TSH ranges, a TSH level above the population mean is associated with significantly greater likelihood of thyroid cancer than a TSH below the mean. Shown for the first time, higher TSH level is associated with advanced stage DTC.

Related Topics

    loading  Loading Related Articles