Abstract
Background Serum TSH levels in the upper-normal range were reported to be associated with increased risk of thyroid malignancy. However, measurement of TSH levels is currently not recommended for assessing the risk of malignancy in patients with newly diagnosed thyroid nodules. Objective To evaluate a possible relationship between the serum levels of TSH and the histological outcome of patients undergoing thyroidectomy for thyroid nodules with indeterminate cytology. Materials and Methods We collected the clinical data of all patients who had performed ultrasound-guided FNA of thyroid nodules with cytological diagnosis of indeterminate lesions (TIR3A and TIR3B) and serum TSH levels within the normal range. All patients had been submitted to thyroid surgery (hemi or thyroidectomy, as appropriate), and histological diagnosis had been performed. Results A histological diagnosis of thyroid malignancy was rendered in 74/378 (19.6%) nodules. Patients with histologically proven thyroid malignancy were characterized by higher serum levels of TSH as compared to patients with histologically proven benign nodules (3.03 ± 1.16 vs. 2.37 ± 1.19 mIU/L, p < 0.001). To further analyze the role of serum TSH in predicting thyroid cancer, patients were stratified in 4 groups according to quartiles of TSH concentrations. The prevalence of malignancy was 12.2% for the first quartile and 50.0% for the last quartile. ROC curve analysis identified that a serum TSH level of ≥2.7 mIU/L predicted thyroid malignancy with a sensitivity of 61% and a specificity of 65%. Conclusions TSH levels in the upper-normal range are associated with an increased risk of thyroid malignancy in patients affected by thyroid nodules with indeterminate cytology at FNA. The measurement of serum TSH levels represents an easily performed additional tool for decision-making in patients with indeterminate cytological findings.
Highlights
Recent surveys adopting ultrasound images showed thyroid nodule(s) in up to 70% of randomly selected subjects with higher frequencies in women and elderly patients, making it the most frequent endocrine disease today [1, 2]. e two objectives in thyroid nodule management are as follows: first, to evaluate if its presence is associated with or is the cause of thyroid function alteration; second, to exclude malignancy [3]
The usefulness of serum thyreotropin (TSH) levels has been evaluated as a predictor of malignancy in thyroid nodules, demonstrating that higher serum TSH levels are associated with an increased risk of thyroid cancer [9]. is simple and free of adjunctive costs test for stratifying the risk of malignancy associated with a thyroid nodule was not previously evaluated in thyroid nodules with indeterminate cytology
We reviewed the medical records of patients who had ultrasound-guided fine needle aspiration cytology (FNA) of thyroid nodules at our department between September 2014 and February 2018
Summary
Serum TSH levels in the upper-normal range were reported to be associated with increased risk of thyroid malignancy. To evaluate a possible relationship between the serum levels of TSH and the histological outcome of patients undergoing thyroidectomy for thyroid nodules with indeterminate cytology. We collected the clinical data of all patients who had performed ultrasound-guided FNA of thyroid nodules with cytological diagnosis of indeterminate lesions (TIR3A and TIR3B) and serum TSH levels within the normal range. All patients had been submitted to thyroid surgery (hemi or thyroidectomy, as appropriate), and histological diagnosis had been performed. A histological diagnosis of thyroid malignancy was rendered in 74/378 (19.6%) nodules. TSH levels in the upper-normal range are associated with an increased risk of thyroid malignancy in patients affected by thyroid nodules with indeterminate cytology at FNA. TSH levels in the upper-normal range are associated with an increased risk of thyroid malignancy in patients affected by thyroid nodules with indeterminate cytology at FNA. e measurement of serum TSH levels represents an performed additional tool for decision-making in patients with indeterminate cytological findings
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