Muhanhali Dilidaer, Deng Lingxin, Ai Zhilong, Ling Yan
Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Endocrine. 2024 Mar;83(3):659-670. doi: 10.1007/s12020-023-03508-2. Epub 2023 Sep 5.
The association of thyroid hormone sensitivity with papillary thyroid carcinoma (PTC) is unclear. This study investigated the relationship between the thyroid hormone sensitivity indices and the risk of PTC and the influence of thyroid hormone sensitivity on the aggressive clinicopathologic features of PTC.
This retrospective study recruited 1225 PTC patients and 369 patients with benign nodules undergoing surgery in Zhongshan Hospital in 2020. The thyroid hormone sensitivity indices were thyroid feedback quantile-based index (TFQI), TSH index (TSHI) and thyrotropin thyroxine resistance index (TT4RI). We employed logistic regression models to explore the correlation between the thyroid hormone sensitivity indices and the risk of PTC and its cervical lymph node metastasis (LNM).
PTC patients had significantly higher levels of TSH, TFQI, TSHI and TT4RI compared to the patients with benign nodules, but thyroid hormone levels did not differ significantly between the two groups. Logistic regression analysis revealed that the higher levels of TFQI, TSHI, and TT4RI were associated with an increased risk of PTC after adjustment for multiple risk factors (TFQI: OR = 1.92, 95% CI: 1.39-2.65, P < 0.001; TSHI: OR = 2.33, 95% CI:1.67-3.26, P < 0.001; TT4RI: OR = 2.41, 95% CI:1.73-3.36, P < 0.001). In addition, patients with decreased thyroid hormone sensitivity had a higher risk of cervical LNM in multiple logistic regression analysis (TFQI: OR = 1.38, 95% CI:1.03-1.86, P = 0.03; TSHI: OR = 1.37, 95% CI:1.02-1.84, P = 0.04; TT4RI: OR = 1.41, 95% CI:1.05-1.89, P = 0.02).
Impaired sensitivity to thyroid hormone was associated with an increased risk of PTC, and it is also associated with a higher risk of cervical LNM in PTC patients.
甲状腺激素敏感性与甲状腺乳头状癌（PTC）之间的关联尚不清楚。本研究调查了甲状腺激素敏感性指标与PTC风险之间的关系，以及甲状腺激素敏感性对PTC侵袭性临床病理特征的影响。
本回顾性研究纳入了2020年在中山医院接受手术的1225例PTC患者和369例良性结节患者。甲状腺激素敏感性指标为基于甲状腺反馈分位数的指数（TFQI）、促甲状腺激素指数（TSHI）和促甲状腺素甲状腺素抵抗指数（TT4RI）。我们采用逻辑回归模型来探讨甲状腺激素敏感性指标与PTC风险及其颈部淋巴结转移（LNM）之间的相关性。
与良性结节患者相比，PTC患者的促甲状腺激素、TFQI、TSHI和TT4RI水平显著更高，但两组之间的甲状腺激素水平无显著差异。逻辑回归分析显示，在调整多个风险因素后，TFQI、TSHI和TT4RI水平较高与PTC风险增加相关（TFQI：OR = 1.92，95%CI：1.39 - 2.65，P < 0.001；TSHI：OR = 2.33，95%CI：1.67 - 3.26，P < 0.001；TT4RI：OR = 2.41，95%CI：1.73 - 3.36，P < 0.001）。此外，在多因素逻辑回归分析中，甲状腺激素敏感性降低的患者发生颈部LNM的风险更高（TFQI：OR = 1.38，95%CI：1.03 - 1.86，P = 0.03；TSHI：OR = 1.37，95%CI：1.02 - 1.84，P = 0.04；TT4RI：OR = 1.41，95%CI：1.05 - 1.89，P = 0.02）。
甲状腺激素敏感性受损与PTC风险增加相关，并且也与PTC患者颈部LNM风险较高相关。
