Département d'endocrinologie diabétologie nutrition, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
Ann Endocrinol (Paris). 2011 Dec;72(6):513-21. doi: 10.1016/j.ando.2011.07.032. Epub 2011 Nov 23.
Suppression therapy of thyreostimulin (TSH) using thyroid hormones improves survival of subjects operated for differentiated thyroid cancer. The TSH level might be different depending on the type of nodule. The objective of this study was to compare retrospectively the TSH level between two groups of subjects who underwent total thyroidectomy for a nodule, matched on sex, ethnicity, age and biological method of TSH measurement, one whose final histology was benign and one malignant. There was no significant difference between the two groups in terms of age, sex, family history of thyroid disease or thyroid autoimmunity. The subjects, whose final histology was malignant, had a mean TSH level significantly higher than subjects with benign disease (1.55 mU/l versus 0.96 mU/l, P=0.003). Cancer risk was greater when the TSH was in the upper tertile of normal range. There was no correlation between the risk of thyroid cancer and age, sex, family history of thyroid disease, or menopausal status. The relative risk of having thyroid carcinoma was higher when the margins of nodules were blurred or in the presence of microcalcifications. These data confirm a trend toward baseline values of TSH higher in subjects with a thyroid-differentiated cancer. However, we could not define a preoperative threshold that would reliably determine the malignant or benign nature of the nodule.
使用甲状腺激素抑制促甲状腺素（TSH）治疗可改善分化型甲状腺癌患者的生存。TSH 水平可能因结节类型而异。本研究的目的是回顾性比较两组接受甲状腺全切除术治疗结节的患者的 TSH 水平，两组患者在性别、种族、年龄和 TSH 测量的生物学方法上相匹配，一组患者的最终组织学为良性，另一组为恶性。两组患者在年龄、性别、甲状腺疾病或自身免疫性甲状腺病史方面无显著差异。最终组织学为恶性的患者 TSH 水平明显高于良性疾病患者（1.55mU/L 比 0.96mU/L，P=0.003）。当 TSH 在正常范围的上三分之一时，癌症风险更大。甲状腺癌的风险与年龄、性别、甲状腺疾病家族史或绝经状态无关。当结节边缘模糊或存在微钙化时，甲状腺癌的风险更高。这些数据证实了分化型甲状腺癌患者的 TSH 基础值呈上升趋势。然而，我们无法确定术前的阈值可以可靠地确定结节的良恶性。
