Private Practice, Patras, Greece.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine and Center for Diabetes and Endocrine Research (CeDER), ProMedica Health System/University of Toledo, Toledo, Ohio.
J Clin Endocrinol Metab. 2020 Jul 1;105(7). doi: 10.1210/clinem/dgaa237.
Higher-but-within-normal thyrotropin (thyroid-stimulating hormone, TSH) is associated with higher risk for differentiated thyroid cancer (DTC) in surgical series. Our recent clinical observations suggest that this is not the case in the presence of autoimmune thyroid disease (AITD). We designed the present study to clarify this controversy.
We analyzed our prospectively collected database of patients referred for thyroid surgery at 2 tertiary care referral centers in Greece and the United States. We collected data for preoperative TSH, postoperative pathology, and thyroid peroxidase (TPO) antibodies titers. Subjects were subdivided into 2 groups, those with AITD (i.e., lymphocytic thyroiditis) and non-AITD. We excluded subjects with Graves disease, abnormal TSH (< 0.40 or > 4.50 mIU/mL), or recent use of levothyroxine. We compared the serum TSH among different groups using the Mann-Whitney test.
A total of 3973 subjects were screened; 1357 met exclusion criteria. After all exclusions, data from 1731 non-AITD subjects and 329 AITD subjects were included in the analysis. AITD subjects had higher TSH than non-AITD subjects (2.09 vs 1.48; P < 0.0001). TSH values were higher in DTC compared with benign histology only in non-AITD subjects (1.65 vs 1.40; P < 0.0001). Progressively higher TSH was associated with higher incidence of DTC only in non-AITD subjects (P < 0.0001). In AITD subjects, TSH was similar between groups with or without DTC (2.02 vs 2.14; P = 0.21).
TSH concentrations are not associated with the risk of developing DTC in the presence of thyroid autoimmunity, even though this seems to be the case for all other patients.
在手术系列中，较高但在正常范围内的促甲状腺激素（甲状腺刺激激素，TSH）与分化型甲状腺癌（DTC）的风险增加相关。我们最近的临床观察表明，在存在自身免疫性甲状腺疾病（AITD）的情况下并非如此。我们设计了本研究来澄清这一争议。
我们分析了我们在希腊和美国的 2 个三级保健转诊中心前瞻性收集的甲状腺手术患者数据库中的数据。我们收集了术前 TSH、术后病理和甲状腺过氧化物酶（TPO）抗体滴度的数据。受试者分为 2 组，一组有 AITD（即淋巴细胞性甲状腺炎），另一组无 AITD。我们排除了患有格雷夫斯病、TSH 异常（<0.40 或>4.50 mIU/mL）或最近使用左甲状腺素的患者。我们使用 Mann-Whitney 检验比较了不同组之间的血清 TSH。
共筛选了 3973 名受试者，有 1357 名符合排除标准。排除所有排除标准后，共有 1731 名非 AITD 受试者和 329 名 AITD 受试者的数据纳入分析。AITD 受试者的 TSH 高于非 AITD 受试者（2.09 对 1.48；P<0.0001）。仅在非 AITD 受试者中，DTC 与良性组织学相比，TSH 值更高（1.65 对 1.40；P<0.0001）。仅在非 AITD 受试者中，TSH 值越高，DTC 的发生率越高（P<0.0001）。在 AITD 受试者中，DTC 组与无 DTC 组之间的 TSH 相似（2.02 对 2.14；P=0.21）。
即使在存在甲状腺自身免疫的情况下，TSH 浓度与发展为 DTC 的风险无关，尽管这似乎适用于所有其他患者。
