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. 2008 Sep;134(9):953-60.
doi: 10.1007/s00432-008-0373-7. Epub 2008 Mar 8.

Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules

Stergios A Polyzos  1 , Marina Kita, Zoe Efstathiadou, Pavlos Poulakos, Aristidis Slavakis, Danae Sofianou, Nikolaos Flaris, Maria Leontsini, Anargyros Kourtis, Avraam Avramidis
Affiliations

Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules

Stergios A Polyzos et al. J Cancer Res Clin Oncol. 2008 Sep.

Abstract

Purpose: Serum thyrotropin (TSH) is a well-established growth factor for thyroid nodules and suppression of TSH concentrations by administering exogenous thyroxine may interfere with the growth of established nodules as well as the formation of new thyroid nodules. The aim of this study was to investigate whether serum TSH at presentation is a predictor of thyroid malignancy in patients with thyroid nodules.

Methods: A total of 565 patients without overt thyroid dysfunction, who presented with palpable thyroid nodule(s) between 1988 and 2004 and underwent at least one fine-needle aspiration biopsy, were retrospectively evaluated.

Results: The final diagnostic outcome was established after surgery (n = 122) or after a minimum of 1-year clinical follow-up period. Higher rates of malignancy were observed in patients with serum TSH in the upper tertile of the normal range (P = 0.026). Binary logistic regression analysis revealed significantly increased adjusted odds ratios for the diagnosis of malignancy in patients with serum TSH 1.5-4.0 mIU/l when compared to those with either TSH 0.4-0.8 mIU/l (P = 0.005) or TSH 0.9-1.4 mIU/l (P = 0.007).

Conclusions: The risk of malignancy in thyroid nodules increases in parallel with TSH concentrations within the normal range. TSH concentration at presentation is an independent predictor of thyroid malignancy.

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Figures

Fig. 1
Fig. 1
Flow of the patients through the study up to the final diagnostic outcome. [The number of patients (n) who were included in the final diagnostic outcome is in bold type .]
Fig. 2
Fig. 2
Prevalence of thyroid malignancy according to patients’ age. The total number of patients (n) in each group is given beneath the graph. *P = 0.022 compared to age group ≥70 years
Fig. 3
Fig. 3
Prevalence of thyroid malignancy in the final diagnostic outcome according to the serum TSH concentration measured at presentation. Subjects with TSH measurements within the normal range were divided into tertiles of similar size. The total number of patients (n) in each group is given beneath the graph. *P = 0.047; **P = 0.004; ***P = 0.041 compared to TSH 1.5–4 mIU/l
Fig. 4
Fig. 4
Prevalence of thyroid malignancy in the histological results according to the serum TSH concentration measured at presentation. Subjects with TSH measurements within the normal range were divided into tertiles of similar size. The total number of patients (n) in each group is given beneath the graph. *P = 0.021; **P = 0.002; ***P = 0.005 compared to TSH 1.5–4 mIU/l
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