Department of Internal Medicine, Pusan National University Hospital, Busan, 602-739, Korea.
Endocrine. 2011 Jun;39(3):259-65. doi: 10.1007/s12020-010-9430-5. Epub 2010 Dec 14.
It has been known that thyroid stimulating hormone (TSH) stimulates the growth or development of thyroid malignancy and higher serum TSH has association with both thyroid cancer incidence and advanced tumor stage. However, the role of TSH in high-risk features of well-differentiated thyroid cancer was not fully evaluated especially in Asian population. The purpose of our study is to evaluate the association of preoperative serum TSH levels with the advance of differentiated thyroid cancer and its high-risk clinicopathological features in Korean patients. We evaluated 554 patients retrospectively who underwent thyroidectomy and diagnosed as differentiated thyroid cancer during a 3-year period at Pusan National University Hospital. The preoperative TSH levels were significantly higher in the patients with extrathyroidal extension (P = 0.002) and those with lateral lymph node metastasis (P = 0.007). As the increase of the serum TSH concentration, there were significant rising trends in the prevalence of extrathyroidal extension (P = 0.009). In the patients with TSH ≥ 2.5 mIU/L, the prevalences of extrathyroidal extension (P = 0.006) and lateral lymph node metastasis (P = 0.024) were also significantly higher. Using multiple logistic regression, preoperative TSH level was a predictive factor for the presence of extrathyroidal extension (P = 0.008) and lateral lymph node metastasis (P = 0.025). Hashimoto's thyroiditis itself was not associated with the status of extrathyroidal extension and lateral lymph node metastasis. In conclusion, preoperative TSH levels were associated with lateral lymph node matastasis, a novel finding, and extrathyroidal extension in well differentiated thyroid cancer and might be useful as a preoperative supplementary marker for determining the optimal extent of differentiated thyroid cancer surgery in Korean patients.
已知促甲状腺激素（TSH）刺激甲状腺恶性肿瘤的生长或发展，较高的血清 TSH 与甲状腺癌的发病率和晚期肿瘤分期都有关。然而，TSH 在分化型甲状腺癌高危特征中的作用尚未得到充分评估，尤其是在亚洲人群中。我们的研究目的是评估术前血清 TSH 水平与韩国患者分化型甲状腺癌的进展及其高危临床病理特征的关系。我们回顾性评估了 554 例在釜山国立大学医院接受甲状腺切除术并在 3 年内被诊断为分化型甲状腺癌的患者。甲状腺外侵犯患者（P=0.002）和侧方淋巴结转移患者（P=0.007）的术前 TSH 水平显著升高。随着血清 TSH 浓度的增加，甲状腺外侵犯的发生率呈显著上升趋势（P=0.009）。在 TSH≥2.5mIU/L 的患者中，甲状腺外侵犯（P=0.006）和侧方淋巴结转移（P=0.024）的发生率也显著升高。多因素逻辑回归分析显示，术前 TSH 水平是甲状腺外侵犯（P=0.008）和侧方淋巴结转移（P=0.025）的预测因素。桥本甲状腺炎本身与甲状腺外侵犯和侧方淋巴结转移的状态无关。总之，术前 TSH 水平与韩国分化型甲状腺癌的侧方淋巴结转移和甲状腺外侵犯有关，可能作为术前补充标志物，有助于确定韩国患者分化型甲状腺癌手术的最佳范围。
