Clinicopathological correlation of serum TSH level in patients with thyroid nodule—a study of 100 cases

Abstract

Background: Thyroid nodules and goiter are very common lesions. Rare chance of carcinoma occurs in thyroid nodules. A higher thyroid stimulating hormone (TSH) level in the case of thyroid nodule is associated with an increased risk of carcinoma. A combined approach of cytology and serum TSH level will help in an early detection. Objective: To assess the relationship of TSH with thyroid carcinoma in thyroid nodule. A combined approach of serum TSH and FNAC finding will increase the specificity to the diagnosis of thyroid nodular lesions. Materials and Methods: A study was undertaken among the patients with nodular lesions of thyroid gland during the period from January 2011 to December 2013. Clinically, thyroid nodules confirmed by high resolution ultrasonography underwent serum TSH estimation and FNAC of the nodules. Finally, the outcome of histopathological examination of received thyroid specimens were analyzed whenever it was possible. Result: A total of 100 patients with thyroid nodules were included in this study. Twenty-eight patients belonged to the age group of 31–40 years and 22 belonged to 41–50 years; 86 of them were women, and 14 of them were men. Fine needle aspiration cytology (FNAC) showed colloid goiter in 57 patients, papillary carcinoma in 2 patients, and follicular adenoma in 6 patients. Final histopathological report showed four cases of papillary carcinoma, four cases of follicular carcinoma, six cases of follicular adenoma, five cases of thyroiditis, and the rest being colloid goiter. Serum TSH level is divided into 2 limits: 2.50 µIU/mL. Forty-five cases revealed values more than 2.50 µIU/mL, and 15 cases presented values less than 0.39 µIU/mL. The mean TSH value was higher when compared with colloid goiter. The incidence of malignancy in nodular goiter is rising. Conclusion: FNAC is the first choice of investigation in any case of thyroid nodule. The FNAC finding together with a high level of serum TSH increase the susceptibility of carcinoma. To assess the risk of malignancy, serum TSH is a very good screening tool.