Department of Endocrinology and Metabolism, Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey.
Department of Surgery, Ataturk Training and Research Hospital, Ankara, Turkey.
Endocrine. 2018 Mar;59(3):565-572. doi: 10.1007/s12020-018-1523-6. Epub 2018 Jan 27.
We aimed to investigate the relation between preoperative serum thyrotrophin (TSH) and clinicopathological features in patients with papillary thyroid carcinoma (PTC) and microcarcinoma (PTMC).
Patients who underwent thyroidectomy and diagnosed to have benign nodular disease or PTC/PTMC in our clinic were evaluated retrospectively. Patients with a previous history of thyroid surgery, patients using antithyroid medications or thyroid hormone and patients with tumors known to be unresponsive to TSH were excluded.
Data of 1632 patients were analyzed. Histopathological diagnosis was benign in 969 (59.4%) and malignant in 663 (40.6%) patients. Preoperative median serum TSH was significantly higher in malignant compared to benign group (1.41 IU/dL vs. 0.98 IU/dL, p < 0.001). Malignancy risk increased gradually as going from hyperthyroidism to euthyroidism and hypothyroidism (20, 40.6, and 59.1%, respectively, p < 0.05). Serum TSH was lowest in benign nodular disease, higher in PTMC and highest in PTC (p < 0.001). This was also true when patients with positive antithyroid peroxidase/antithyroglobulin and with lymphocytic thyroiditis were excluded from the analysis (p < 0.001). Serum TSH was higher in patients with bilateral tumor, capsular invasion and lymph node metastasis (LNM) compared to patients with unilateral tumor, without capsule invasion and without LNM, respectively (p = 0.036, p = 0.002, and p = 0.001, respectively). Patients with aggressive variant PTC had higher serum TSH than nonaggressive ones (p < 0.05).
Preoperative serum TSH is associated with PTMC, PTC and LNM. Serum TSH seems to be related with thyroid cancer regardless of autoimmunity. With the present study, for the first time, we showed an association between serum TSH and aggressive variants of PTC.
我们旨在研究术前血清促甲状腺激素（TSH）与甲状腺乳头状癌（PTC）和微小癌（PTMC）患者临床病理特征之间的关系。
我们对在我院接受甲状腺切除术并诊断为良性结节性疾病或 PTC/PTMC 的患者进行回顾性评估。排除既往甲状腺手术史、使用抗甲状腺药物或甲状腺激素的患者，以及已知对 TSH 无反应的肿瘤患者。
共分析了 1632 例患者的数据。组织病理学诊断为良性 969 例（59.4%），恶性 663 例（40.6%）。恶性组患者术前血清 TSH 中位数显著高于良性组（1.41IU/dL 比 0.98IU/dL，p<0.001）。从甲状腺功能亢进到甲状腺功能正常再到甲状腺功能减退，恶性风险逐渐增加（分别为 20%、40.6%和 59.1%，p<0.05）。良性结节性疾病患者的血清 TSH 最低，PTMC 患者次之，PTC 患者最高（p<0.001）。当排除抗甲状腺过氧化物酶/抗甲状腺球蛋白阳性和淋巴细胞性甲状腺炎患者后，也得出了相同的结果（p<0.001）。与单侧肿瘤、无包膜侵犯和无淋巴结转移（LNM）的患者相比，双侧肿瘤、包膜侵犯和 LNM 的患者血清 TSH 分别更高（p=0.036、p=0.002 和 p=0.001）。侵袭性变异型 PTC 患者的血清 TSH 高于非侵袭性变异型（p<0.05）。
术前血清 TSH 与 PTMC、PTC 和 LNM 相关。血清 TSH 似乎与甲状腺癌有关，而与自身免疫无关。通过本研究，我们首次发现血清 TSH 与 PTC 的侵袭性变异型之间存在关联。
