Service of Endocrinology and Diabetology, EOC Ospedale Regionale di Lugano, Lugano, Switzerland -
Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland -
Minerva Endocrinol (Torino). 2024 Jun;49(2):125-131. doi: 10.23736/S2724-6507.24.04207-6.
Thyroid Imaging Reporting and Data Systems (TIRADSs) have demonstrated high performance in risk stratification of thyroid nodules (TNs). However, further improvements are needed in view of the ongoing project of an international TIRADS. Even if thyroid-stimulating hormone (TSH) measurement is traditionally used to assess the thyroid function, several papers have reported that higher TSH levels are associated with the presence of differentiated thyroid carcinoma (DTC). The present study aimed to investigate the role of TSH levels as improvement factor of American College of Radiology (ACR-), European Thyroid Association (EU-), and Korean Society (K-)TIRADS.
Patients undergoing thyroidectomy were reviewed and TNs were re-assessed according to TIRADSs. Different TSH subgroups were attained. Histology was the reference standard. DTC risk of relapse was assessed according to American Thyroid Association guidelines.
The study series included 97 patients with 39.2% cancer prevalence. ACR-, EU-, and K-TIRADS indicated fine-needle aspiration cytology (FNAC) in 78.9%, 81.6%, and 92.1% of cases, respectively. All high-risk DTC had FNAC indication according to the three TIRADSs. The cancer rate was significantly lower in patients with TSH<0.4 mIU/L (P=0.04). The receiver operating characteristic (ROC) curve analysis showed that the best TSH cut-off to detect DTC patient was >1.3 mIU/L with Area Under the Curve (AUC)=0.70. Combining TSH data with TIRADS, the sensitivity of ACR-, EU-, and K-TIRADS increased to 92.1% 89.5%, and 94.7%, respectively. Conversely, the rate of unnecessary FNAC raised. At multivariate analysis, gender, TSH, and TIRADS were independent predictors of cancer.
Even if TIRADSs are strongly reliable to stratify the risk of malignancy of TNs, measuring TSH can further improve our sensitivity in detecting DTC.
甲状腺影像报告和数据系统（TIRADS）在甲状腺结节（TNs）的风险分层方面表现出了很高的性能。然而，鉴于国际 TIRADS 项目的持续进行，需要进一步改进。尽管甲状腺刺激激素（TSH）测量传统上用于评估甲状腺功能，但有几篇论文报告称，较高的 TSH 水平与分化型甲状腺癌（DTC）的存在相关。本研究旨在探讨 TSH 水平作为美国放射学院（ACR）、欧洲甲状腺协会（EU）和韩国学会（K）-TIRADS 改良因素的作用。
回顾性分析接受甲状腺切除术的患者，并根据 TIRADS 重新评估 TNs。获得不同的 TSH 亚组。组织学是参考标准。根据美国甲状腺协会指南评估 DTC 复发风险。
本研究系列包括 97 例患者，癌症患病率为 39.2%。ACR、EU 和 K-TIRADS 分别在 78.9%、81.6%和 92.1%的病例中指示细针穿刺细胞学检查（FNAC）。根据这三种 TIRADS，所有高危 DTC 均有 FNAC 指征。TSH<0.4 mIU/L 的患者癌症发生率明显较低（P=0.04）。受试者工作特征（ROC）曲线分析显示，检测 DTC 患者的最佳 TSH 截断值为>1.3 mIU/L，曲线下面积（AUC）为 0.70。将 TSH 数据与 TIRADS 相结合，ACR、EU 和 K-TIRADS 的敏感性分别提高到 92.1%、89.5%和 94.7%。相反，不必要的 FNAC 率增加。多变量分析显示，性别、TSH 和 TIRADS 是癌症的独立预测因子。
尽管 TIRADS 对 TNs 恶性风险分层具有很强的可靠性，但测量 TSH 可以进一步提高我们检测 DTC 的敏感性。
