Utility of pre-operative serum thyroid stimulating hormone in predicting thyroid malignancy
DOI:
https://doi.org/10.18203/2349-2902.isj20173421Keywords:
Thyroid nodule, Thyroid malignancy, Thyroid stimulating hormoneAbstract
Background: Thyroid cancer is the most common endocrine malignancy and its incidence continues to rise. Thyroid carcinoma in most cases presents clinically as a solitary nodule or as a dominant nodule within a multinodular thyroid gland. There are a number of well-established of predictors of malignancy in thyroid nodules. More recently studies have suggested that higher concentration of TSH, even within the normal range are associated with subsequent diagnosis of thyroid cancer in patients with thyroid nodules and even higher serum TSH levels have been found associated with advanced stages of thyroid cancer. The objective of this study was to determine the serum thyroid stimulating hormone (TSH) concentration before surgery in different thyroid malignancies and to compare serum TSH concentration after surgery in thyroid malignancy
Methods: A hospital based observational study was conducted in a tertiary care hospital for a period of 2 year. 120 patients presenting with thyroid nodule without an overt thyroid dysfunction during the study period were included in the study. Chi-square was used as test of significance. Independent t test was the test of significance for quantitative data between two groups.
Results: Mean serum TSH was higher in thyroid malignancies and significant difference was observed between solitary and multinodular goitre. Mean serum TSH concentrations was significantly high in papillary carcinoma and advanced stages of carcinoma. Mean serum TSH was high in stage III and stage IV (5.17±1.36 mIU/l) compared to stage I and II (4.03±1.87 mIU/l).
Conclusions: The study concludes that TSH levels were high in thyroid malignancies arising from multinodular goitre, majority of thyroid malignancies had high levels of serum TSH concentrations and TSH was high with advanced stage of thyroid cancer
Metrics
References
Pujol PA, Daures JP, Nsakala NI, Baldet LI, Bringer JA, Jaffiol CL. Degree of thyrotropin suppression as a prognostic determinant in differentiated thyroid cancer. J Clin Endocrinol Metabol. 1996;81(12):4318-23.
Papini E, Petrucci L, Guglielmi R, Panunzi C, Rinaldi R, Bacci V, et al. Long-term changes in nodular goiter: a 5-year prospective randomized trial of levothyroxine suppressive therapy for benign cold thyroid nodules. J Clin Endocrinol Metabol. 1998;83(3):780-3.
Nagataki S and Nystrom E. Epidemiology and primary prevention of thyroid cancer. Thyroid. 2002;12:.889-96.
Jonklaas J, Nsouli-Maktabi H, Soldin SJ. Endogenous thyrotropin and triiodothyronine concentrations in individuals with thyroid cancer. Thyroid. 2008;18(9):943-52.
Hegedus L, Bonnema SJ, Bennedbæk FN. Management of simple nodular goiter: current status and future perspectives. Endocrine reviews. 2003;24(1):102-32.
Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metabol. 2006;91(11):4295-301.
Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metabol. 2008;93(3):809-14.
Polyzos SA, Κita M, Efstathiadou Z, Poulakos P, Slavakis A, Sofianou D, et al. Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules. J Cancer Res Clin Oncol. 2008;134(9):953-60.
Ichikawa Y, Saito E, Abe Y, Homma M, Muraki T, Ito K. Presence of TSH receptor in thyroid neoplasms. J Clin Endocrinol Metabol. 1976;42(2):395-8.
Fiore E, Rago T, Provenzale MA, Scutari M, Ugolini C, Basolo F, et al. Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a protective role. Endocrine-Related Cancer. 2009;16(4):1251-60.
Kimura T, Van Keymeulen A, Golstein J, Fusco A, Dumont JE, Roger PP. Regulation of thyroid cell proliferation by TSH and other factors: a critical evaluation of in vitro models. Endocrine Reviews. 2001;22(5):631-56.
Gudmundsson J, Sulem P, Gudbjartsson DF, Jonasson JG, Sigurdsson A, Bergthorsson JT, et al. Common variants on 9q22. 33 and 14q13. 3 predispose to thyroid cancer in European populations. Nature Genetics. 2009;41(4):460-4.
Brewer C, Yeager N, Di Cristofano A. Thyroid-stimulating hormone-initiated proliferative signals converge in vivo on the mTOR kinase without Activating AKT. Cancer Res. 2007;67(17):8002-6.
Yeager N, Klein-Szanto A, Kimura S, Di Cristofano A. Pten loss in the mouse thyroid causes goiter and follicular adenomas: insights into thyroid function and Cowden disease pathogenesis. Cancer Res. 2007;67(3):959-66.