Mondal Hari Pada, Sen Sanjay, Sasmal Surajit, Ghosal Pradip Kr, Mukhopadhyay Surajit Kr, Mukhopadhyay Mrityunjay
Department of Surgery, Medical College, Kolkata 700073.
J Indian Med Assoc. 2011 May;109(5):330, 335, 338.
Thyroid nodules and goitre are common. Carcinoma occurs in 5% of thyroid nodules. Early detection and treatment is beneficial to prolonged survival. Higher thyroid stimulating hormone (TSH) level in patient with thyroid nodule is associated with greater risk of differentiated thyroid carcinoma. To assess relationship of TSH with thyroid carcinoma in nodular goitre and usefulness of this marker in predicting likelihood of thyroid malignancy, a study was undertaken among patients with nodular goitre enrolled prospectively during the period 2007 to 2009. Clinically thyroid nodules, confirmed by high resolution USG underwent serum TSH estimation and FNAC of the the nodules. Finally outcome of histopathological examination of resected thyroid specimen were analysed. Overall 33 patients with thyroid nodules were included in this study. Fifteen patients belonged to age group of 31 to 40 years, 13 belonged to 21 to 30 years; 29 were women, 4 were men. Majority of nodules were in right lobe and firm or hard. Fifteen nodules were > 4cm in size. FNAC showed colloid goitre in 24 patients, 7 patients had papillary carcinoma, 2 patients had follicular nodule. Final histopathological report showed 9 papillary carcinoma, 1 medullary carcinoma, 1 follicular carcinoma, 2 follicular adenoma and rest being colloid goitre. Mean TSH value for colloid goitre was 1.8987 mlU/l, for papillary carcinoma it was 2.2400 mlU/l, for follicular carcinoma it was 2.8900 mlU/l, for medullat carcinoma it was 0.8500 mlU/l and for follicular adenoma it was 4.4200 mlU/l. In differentiated thyroid carcinoma TSH value is raised more than in colloid goitre (p = 0.687). Incidence of malignancy in nodular goitre was 30% (11 carcinoma out of 33) in this study. Incidence of malignancy in nodular goitre is rising. Firm to hard nodules, male sex, 3-4 cm sized nodules are mainly susceptible. There is an obvious trend towards cancer risk with higher TSH value. TSH may, therefore, be used as a supportive screening test to predict malignancy in patients with thyroid nodule.
甲状腺结节和甲状腺肿很常见。5%的甲状腺结节会发生癌变。早期发现和治疗有利于延长生存期。甲状腺结节患者甲状腺刺激激素（TSH）水平较高与分化型甲状腺癌风险增加有关。为了评估TSH与结节性甲状腺肿中甲状腺癌的关系以及该标志物在预测甲状腺恶性肿瘤可能性方面的作用，对2007年至2009年期间前瞻性纳入的结节性甲状腺肿患者进行了一项研究。对经高分辨率超声证实的临床甲状腺结节进行血清TSH测定和结节细针穿刺活检（FNAC）。最后分析切除的甲状腺标本的组织病理学检查结果。本研究共纳入33例甲状腺结节患者。15例患者年龄在31至40岁之间，13例在21至30岁之间；29例为女性，4例为男性。大多数结节位于右叶，质地坚硬。15个结节直径大于4厘米。细针穿刺活检显示24例为胶样甲状腺肿，7例为乳头状癌，2例为滤泡性结节。最终组织病理学报告显示9例乳头状癌、1例髓样癌、1例滤泡癌、2例滤泡性腺瘤，其余为胶样甲状腺肿。胶样甲状腺肿的平均TSH值为1.8987 mIU/l，乳头状癌为2.2400 mIU/l，滤泡癌为2.8900 mIU/l，髓样癌为0.8500 mIU/l，滤泡性腺瘤为4.4200 mIU/l。在分化型甲状腺癌中，TSH值升高幅度大于胶样甲状腺肿（p = 0.687）。本研究中结节性甲状腺肿的恶性肿瘤发生率为30%（33例中有11例癌）。结节性甲状腺肿的恶性肿瘤发生率正在上升。质地坚硬的结节、男性、直径3 - 4厘米的结节主要易感。TSH值越高，癌症风险有明显上升趋势。因此，TSH可作为一种辅助筛查试验，用于预测甲状腺结节患者的恶性肿瘤。
