Abstract
To investigate the correlation between serum thyroid-stimulating hormone (TSH) concentration and nodule nature in pediatric patients with thyroid nodules, with the aim of identifying a marker able to differentiate benign and malignant nodules. This was a retrospective analysis of serum TSH concentrations in a multicentric case series of 125 pediatric patients with benign and malignant thyroid nodules. Of the 125 patients, 99 had benign thyroid nodules and 26 had differentiated thyroid cancer (24 papillary and 2 follicular). Final diagnosis was based on surgery in 57 cases and on a benign cytology plus clinical follow-up in 68 cases. Serum TSH concentration was significantly higher in patients with thyroid cancer compared with those with benign nodules (3.23 ± 1.59 mU/L vs 1.64 ± 0.99 mU/L; P < .001). Binary logistic regression analysis revealed that serum TSH was the sole predictor of malignancy (P < .001). Dividing the patient cohort into 5 groups based on serum TSH quintiles (TSH cutoffs 0.40, 1.00, 1.50, 1.80, and 2.80 mU/L), we observed that cancer prevalence increased in parallel with serum TSH (P < .001), with respective rates of 0%, 4%, 16%, 32%, and 52% in the 5 quintile groups. Because cases with malignant nodules are most likely seen in the upper normal serum TSH range (ie,>2.8 mU/L), serum TSH concentration can serve as a predictor of thyroid cancer in pediatric patients with thyroid nodules and can inform the decision of when to submit patients to further investigation by cytology.
Highlights
Clinical observations point to a correlation between thyroid cancer and serum thyroid-stimulating hormone (TSH) concentration
Several previous investigations of adults with thyroid nodules have shown that a TSH concentration in the upper end of the reference range is correlated with an increased likelihood of thyroid cancer; serum TSH concentrations are higher in patients with differentiated thyroid cancer compared with those with benign thyroid nodules.[6]
Patients with nodular goiter have lower serum TSH concentrations and a lower frequency of papillary thyroid cancer when treated with levothyroxine.[7]
Summary
In this multicenter retrospective study of 125 patients with thyroid nodules diagnosed in childhood or adolescence, data were collected from a series of consecutive cases diagnosed and followed-up between 2006 and 2012 in 9 centers in the Study Group for Thyroid Diseases of the Italian Society for Pediatric Endocrinology and Diabetology. The referring clinicians were asked to apply the following exclusion criteria: (1) cases treated for any other childhood cancer or exposed to radiation before the diagnosis of thyroid nodules (n = 32); (2) cases with autoimmune thyroiditis confirmed by thyroid antibody detection or an ultrasound pattern consistent with thyroiditis (inhomogenous and hypoechogenic) (n = 79); (3) cases in which levothyroxine was administered before nodule diagnosis (n = 11); (4) cases with hyperthyroidism (defined as TSH
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