Department of Internal Medicine III, Medical University of Vienna , Vienna, Austria .
Thyroid. 2010 Apr;20(4):389-92. doi: 10.1089/thy.2009.0139.
Recent studies have shown that elevated serum thyrotropin (thyroid-stimulating hormone [TSH]) concentrations are associated with an increased risk of differentiated thyroid cancers in patients with nodular goiter. Therefore, the measurement of TSH concentrations might support the clinical estimation of cancer risk, especially in patients with thyroid nodules that are too small for fine-needle aspiration biopsies. Thus, the objective of this study was to compare preoperative serum TSH concentrations in patients with papillary thyroid microcarcinoma (PTMC) and individuals in whom the presence of even small differentiated thyroid cancers was excluded by thorough histological examination of the thyroid after total thyroidectomy because of medullary thyroid carcinoma or c-cell hyperplasia.
The study was a retrospective cross-sectional analysis. Thirty-three patients with PTMC who had undergone a hemi- or total thyroidectomy and 54 subjects with medullary thyroid carcinoma or c-cell hyperplasia in whom a total thyroidectomy had been performed between 1994 and 2008 were included. Exclusion criteria were the intake of medication that might affect thyroid function and previous thyroid cancer or thyroid surgery.
The mean TSH value was comparable between patients with PTMCs (1.40 +/- 0.92 mLU/L, 95% CI = 1.07-1.72) and the control group (1.43 +/- 1.44 mLU/L; 95% CI = 1.04-1.82, p = 0.912). There was a positive trend in correlation between nodule size and TSH levels in patients with PTMC (p = 0.066).
TSH is not elevated in subjects with PTMCs, indicating that it is not likely involved in the de novo oncogenesis of these small cancers. However, TSH might rather play a role in the progression of preexisting PTMCs.
最近的研究表明，在结节性甲状腺肿患者中，升高的血清促甲状腺激素（甲状腺刺激激素 [TSH]）浓度与分化型甲状腺癌的风险增加有关。因此，TSH 浓度的测量可能支持对癌症风险的临床评估，尤其是在甲状腺结节太小而无法进行细针抽吸活检的患者中。因此，本研究的目的是比较乳头状甲状腺微小癌（PTMC）患者和因髓样甲状腺癌或 C 细胞增生而在全甲状腺切除术后通过彻底的甲状腺组织学检查排除存在任何小的分化型甲状腺癌的个体之间的术前血清 TSH 浓度。
本研究为回顾性横断面分析。纳入了 33 例接受半甲状腺或全甲状腺切除术的 PTMC 患者和 54 例因髓样甲状腺癌或 C 细胞增生而接受全甲状腺切除术的患者，这些患者的手术时间在 1994 年至 2008 年之间。排除标准为可能影响甲状腺功能的药物治疗和既往甲状腺癌或甲状腺手术史。
PTMC 患者的平均 TSH 值与对照组相似（1.40 ± 0.92 mIU/L，95%CI = 1.07-1.72）（1.43 ± 1.44 mIU/L；95%CI = 1.04-1.82，p = 0.912）。PTMC 患者的结节大小与 TSH 水平之间呈正相关趋势（p = 0.066）。
TSH 在 PTMC 患者中并未升高，这表明它不太可能参与这些小癌症的新发致癌作用。然而，TSH 可能在现有 PTMC 的进展中起作用。
