Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.
Service of Pathology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.
Horm Cancer. 2020 Aug;11(3-4):200-204. doi: 10.1007/s12672-020-00384-4. Epub 2020 Apr 8.
Fine needle aspiration biopsy does not permit to distinguish between benign and malignant follicular thyroid lesions (category IV in the Bethesda Cytopathology System). Some reports have suggested an association between increased serum TSH levels and thyroid cancer, so the aim of this study was to investigate the association between TSH levels and malignancy in patients with follicular thyroid nodules. Therefore, we conducted a retrospective study of all subjects who underwent surgical treatment for Bethesda IV thyroid nodules in a single center (years 2012-2017). A total of 127 patients were analyzed, and malignancy was present in 38.6% of the patients. Using ROC analysis, the best TSH cut-off point to differentiate benign from malignant disease was 2.1 mU/l and the age cut-off with better sensitivity and specificity was 47 years. The proportion of subjects with TSH ≥ 2.1 mU/l was greater among subjects with cancer than in those with benign diseases (65.3 vs 44.9%, P = 0.029). The concurrence of both cut-off points (TSH ≥ 2.1 mU/l and age ≥ 47 years) showed a higher diagnostic accuracy than either of the two variables separately. Therefore, the present study supports an association between serum concentrations of TSH and risk of malignancy among subjects with Bethesda IV thyroid nodules. TSH levels could modify the diagnostic and therapeutic approach of patients with Bethesda IV nodules.
细针抽吸活检无法区分良性和恶性滤泡性甲状腺病变（Bethesda 细胞学系统中的 IV 类）。一些报告表明，血清 TSH 水平升高与甲状腺癌之间存在关联，因此本研究旨在调查滤泡性甲状腺结节患者 TSH 水平与恶性肿瘤之间的关系。因此，我们对单中心（2012-2017 年）接受手术治疗的所有 Bethesda IV 甲状腺结节患者进行了回顾性研究。共分析了 127 例患者，其中恶性肿瘤占 38.6%。通过 ROC 分析，区分良性和恶性疾病的最佳 TSH 截断值为 2.1mU/L，敏感性和特异性更好的年龄截断值为 47 岁。与良性疾病患者相比，癌症患者 TSH≥2.1mU/L 的比例更高（65.3%比 44.9%，P=0.029）。两个截断值（TSH≥2.1mU/L 和年龄≥47 岁）同时出现的诊断准确性高于两个变量中的任何一个单独出现的诊断准确性。因此，本研究支持 Bethesda IV 甲状腺结节患者 TSH 浓度与恶性肿瘤风险之间存在关联。TSH 水平可能会改变 Bethesda IV 结节患者的诊断和治疗方法。
