Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Clin Endocrinol Metab. 2018 Feb 1;103(2):446-451. doi: 10.1210/jc.2017-01775.
Thyroid-stimulating hormone (TSH) is a growth factor affecting initiation or progression of papillary thyroid cancer (PTC), which supports TSH suppressive therapy in patients with PTC. In patients with papillary thyroid microcarcinoma (PTMC) during active surveillance, however, the association between serum TSH level and growth of PTMC has not been demonstrated.
We analyzed 127 PTMCs in 126 patients under active surveillance with serial serum TSH measurement and ultrasonography.
The patients were categorized into groups with the highest, middle, and lowest time-weighted average of TSH (TW-TSH). PTMC progression was defined as a volume increase of ≥50% compared with baseline. Kaplan-Meier survival analysis according to TW-TSH groups and Cox proportional hazard modeling was performed. We identified the cutoff point for TSH level by using maximally selected log-rank statistics.
During a median follow-up of 26 months, PTMC progression was detected in 28 (19.8%) patients. Compared with the lowest TW-TSH group, the adjusted hazard ratio (HR) for PTMC progression in the highest TW-TSH group was significantly higher [HR 3.55; 95% confidence interval (CI), 1.22 to 10.28; P = 0.020], but that in the middle TW-TSH group was not (HR 1.52; 95% CI, 0.46 to 5.08; P = 0.489). The cutoff point for the serum TSH level for PTMC progression was 2.50 mU/L.
Sustained elevation of serum TSH levels during active surveillance is associated with PTMC progression. Maintaining a low-normal TSH range with levothyroxine treatment during active surveillance of PTMC might be considered in future studies.
促甲状腺激素（TSH）是一种影响甲状腺乳头状癌（PTC）起始或进展的生长因子，支持对 PTC 患者进行 TSH 抑制治疗。然而，在主动监测期间的甲状腺微小乳头状癌（PTMC）患者中，血清 TSH 水平与 PTMC 生长之间的关系尚未得到证实。
我们分析了 126 例接受主动监测的患者的 127 个 PTMC，这些患者进行了连续的血清 TSH 测量和超声检查。
将患者分为 TSH 时间加权平均值（TW-TSH）最高、中、最低三组。PTMC 进展定义为与基线相比体积增加≥50%。根据 TW-TSH 组进行 Kaplan-Meier 生存分析和 Cox 比例风险模型分析。我们通过最大选择对数秩统计确定 TSH 水平的截止点。
在中位随访 26 个月期间，28 例（19.8%）患者检测到 PTMC 进展。与最低 TW-TSH 组相比，最高 TW-TSH 组的 PTMC 进展调整后的危险比（HR）显著更高[HR 3.55；95%置信区间（CI），1.22 至 10.28；P = 0.020]，但中间 TW-TSH 组的 HR 则无统计学意义[HR 1.52；95% CI，0.46 至 5.08；P = 0.489]。血清 TSH 水平用于预测 PTMC 进展的截止点为 2.50 mU/L。
主动监测期间血清 TSH 水平持续升高与 PTMC 进展相关。在未来的研究中，在 PTMC 主动监测期间使用左甲状腺素治疗维持正常低值 TSH 范围可能是值得考虑的。
