School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, Institute of Biomedical Research, University of Birmingham, IBR Building 2nd Floor, Birmingham, UK.
Endocr Relat Cancer. 2009 Dec;16(4):1065-72. doi: 10.1677/ERC-09-0150. Epub 2009 Jul 20.
There is mounting evidence that the serum concentration of TSH is an independent predictor for the diagnosis of thyroid malignancy in patients with nodular thyroid disease. Furthermore, preoperative serum TSH concentrations are higher in patients with more aggressive tumours, suggesting a potential role for TSH in the progression of differentiated thyroid cancer. Based on these observations, patients with higher serum TSH concentrations and borderline cytological results may require more aggressive investigation and treatment when compared with those with lower baseline TSH levels. The mechanisms underlying the finding of higher serum TSH in patients with thyroid cancer remain unexplained. In this issue of Endocrine-Related Cancer, Fiore et al. have analysed the relationship between serum TSH and diagnosis of papillary thyroid cancer in 10 178 patients with nodular thyroid disease who were investigated by fine-needle aspiration biopsy. They found significantly higher TSH concentrations in patients who were subsequently diagnosed with thyroid cancer compared with those with benign disease. In addition, they found that the development of autonomous thyroid function (TSH<0.4 muU/ml) was associated with a reduction in the risk of papillary thyroid carcinoma. In this commentary, the evidence regarding the association between serum TSH and thyroid cancer is discussed placing these new findings into context.
越来越多的证据表明，甲状腺结节疾病患者的血清促甲状腺激素（TSH）浓度是甲状腺恶性肿瘤诊断的独立预测因子。此外，术前血清 TSH 浓度在侵袭性更强的肿瘤患者中更高，提示 TSH 在分化型甲状腺癌的进展中可能发挥作用。基于这些观察结果，与 TSH 基线水平较低的患者相比，血清 TSH 浓度较高且细胞病理学结果为临界值的患者可能需要更积极的检查和治疗。甲状腺癌患者血清 TSH 升高的机制尚不清楚。在本期《内分泌相关癌症》杂志中，Fiore 等人分析了 10178 例接受细针穿刺活检的甲状腺结节疾病患者的血清 TSH 与甲状腺乳头状癌诊断之间的关系。他们发现，与良性疾病患者相比，随后被诊断为甲状腺癌的患者的 TSH 浓度显著升高。此外，他们发现自主甲状腺功能（TSH<0.4 muU/ml）的发展与降低甲状腺乳头状癌的风险相关。在这篇评论中，讨论了血清 TSH 与甲状腺癌之间的关联证据，并将这些新发现置于上下文中。
