Relationship Between Preoperative Serum TSH Concentration and Thyroid Carcinoma in Patients with Nodular Goiter_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Xiaobo ,  LIU Wenyong.

Department of General Surgery， Shanghai Ninth People’s Hospital Affiliated to Shanghai JiaoTong University School of Medicine， Shanghai 200011， China;

Corresponding author：

LIU Wenyong., Email: liuwenyongyy@yahoo.com.cn

Keywords：

Nodular goiter; Thyroid carcinoma; Thyrotropic stimulating hormone

Video：

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Objective 　To investigate the association between preoperative serum TSH concentration and thyroid carcinoma in patients with nodular goiter.
Methods 　Data of 632 patients with nodular goiter from January 2004 to December 2010 were analyzed retrospectively.
Results 　Preoperative serum TSH in nodular goiter with thyroid carcinoma was higher than that without thyroid carcinoma，which was （2.10±1.38）mU/L and （1.51±0.98）mU/L，respectively （P＜0.000 1）.The risk of malignancy increased as serum level of TSH rose in nodular goiter patients （P=0.023 5），the ratios were 9.91% （0.3-0.9mU/L），12.37% （0.9-1.7mU/L）， 20.09% （1.7-4.8mU/L），and 27.27%（＞4.8mU/L）.The TSH level of stageⅢ-Ⅳ patients higher than that stageⅠ-Ⅱ patients （P=0.030 6）.The diameter of tumor ＞4 cm had highest mean TSH level， and which ≤ 2cm had lowest mean TSH level（P=0.018 6）.
Conclusion 　Preoperative serum TSH level perhaps is a risk predictor for nodular goiter with thyroid carcinoma.

Citation： XU Xiaobo,LIU Wenyong.. Relationship Between Preoperative Serum TSH Concentration and Thyroid Carcinoma in Patients with Nodular Goiter. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(1): 58-61. doi: Copy

1.	Jin J， Machekano R， Mchenry CR.The utility of preoperative serum thyroid-stimulating hormone level for predicting malignant nodular thyroid disease[J].Am J Surg， 2010， 199(3)：294-297.
2.	Gerschpacher M， Göbl C， Anderwald C， et al.Thyrotropin serum concentrations in patients with papillary thyroid microcancers[J].Thyroid， 2010， 20(4)：389-392.
3.	Haymart MR， Glinberg SL， Liu J， et al.Higher serum TSH in thyroid cancer patients occurs independent of age and correlates with extrathyroidal extension[J].Clin Endocrinol (Oxf)， 2009， 71(3)：434-439.
4.	Fiore E， Rago T， Provenzale MA， et al.Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease：thyroid autonomy may play a protective role[J].Endocr Relat Cancer， 2009， 16(4)：1251-1260.
5.	Boelaert K. The association between serum TSH concentration and thyroid cancer[J]. Endocr Relat Cancer， 2009， 16(4)：1065-1072.
6.	Polyzos SA， Kita M， Efstathiadou Z， et al.Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules[J].J Cancer Res Clin Oncol， 2008， 134(9)：953-960.
7.	Kim SS， Lee BJ， Lee JC， et al.Preoperative serum thyroid stimulating hormone levels in well-differentiated thyroid carcinoma is a predictive factor for lateral lymph node metastasis as well as extrathyroidal extension in Korean patients：a single-center experience[J].Endocrine， 2011， 39(3)：259-265.
8.	National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology：thyroid carcinoma.Ⅵ.2011 [EB/OL].http：//www.nccn.org/professionals/physician_gls/pdf/thyroid. pdf.
9.	Rago T， Fiore E， Scutari M， et al.Male sex， single nodularity， and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease[J].Eur J Endocrinol， 2010， 162(4)：763-770.
10.	史良凤，关海霞，李玉姝，等.术前血清促甲状腺素水平与甲状腺结节良恶性关系的研究[J].中华内分泌代谢杂志， 2010， 26(3)：213-214．.
11.	戴珺，王瑛. 老年性疾病患者TSH、T3、T4、FT3、FT4测定的临床应用[J].放射免疫学杂志， 2006， 19(3)：248-250．.
12.	Hollowell JG， Staehling NW， Flanders WD， et al.Serum TSH， T(4)，and thyroid antibodies in the United States population (1988 to 1994)：National Health and Nutrition Examination Survey (NHANESⅢ) [J].J Clin Endocrinol Metab， 2002， 87(2)：489-499.
13.	Aoki Y， Belin RM， Clickner R， et al.Serum TSH and total T4 in the United States population and their association with participant characteristics：National Health and Nutrition Examination Survey (NHANES 1999-2002)[J].Thyroid， 2007， 17(12)：1211-1223.
14.	Surks MI， Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population：implications for the prevalence of subclinical hypothyroidism[J].J Clin Endocrinol Metab， 2007， 92(12)：4575-4582.
15.	Singh B， Shaha AR， Trivedi H， et al.Coexistent hashimoto’s thyroiditis with papillary thyroid carcinoma：impact on presentation， management， and outcome[J].Surgery， 1999， 126(6)：1070-1076.
16.	Fiore E， Rago T， Latrofa F， et al.Hashimoto’s thyroiditis is associated with papillary thyroid carcinoma：role of TSH and of treatment with L-thyroxine[J].Endocr Relat Cancer， 2011， 18(4)： 429-437.
17.	Kim KW， Park YJ， Kim EH， et al. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto’s thyroiditis[J]. Head Neck， 2011， 33(5)： 691-695.
18.	曹学民，王文艳．甲状腺球蛋白及抗体测定对结节性甲状腺肿及甲状腺癌的鉴别诊断意义 [J]．中国地方病防治杂志，2011， 26(1)：78-79．.
19.	Sands NB，Karls S，Rivera J，et al. Preoperative serum thyroglobulin as an adjunct to fine-needle aspiration in predicting well-differentiated thyroid cancer [J]. J Otolaryngol Head Neck Surg，2010，39(6)： 669-673.
20.	Spencer CA，Takeuchi M，Kazarosyan M，et al. Serum thyroglobulin autoantibodies： prevalence， influence on serum thyroglobulin measurement， and prognostic significance in patients with differentiated thyroid carcinoma [J]. J Clin Endocrinol Metab，1998，83(4)： 1121-1127.
21.	高杰，安振梅．甲状腺球蛋白在甲状腺疾病中临床意义的系统评价 [J]．华西医学， 2009，24(11)： 2907-2910．.
22.	Yeager N，Klein-Szanto A，Kimura S，et al. Pten loss in the mouse thyroid causes goiter and follicular adenomas： insights into thyroid function and Cowden disease pathogenesis [J]. Cancer Res， 2007， 67(3)： 959-966.
23.	刘翔，高明．促甲状腺素抗氧化传导通路与甲状腺乳头状癌侵袭力的关系 [J]．中华耳鼻咽喉头颈外科杂志，2009，44(4)：287-291．.
24.	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer，Cooper DS，Doherty GM，et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer [J]. Thyroid， 2009， 19(11)： 1167-1214.
25.	马峻峰，唐波，李铁汉，等．促甲状腺激素抑制疗法在分化型甲状腺癌治疗中的作用 [J]．中国普外基础与临床杂志，2009，16(5)：348-350，355．.
26.	高明．国内分化型甲状腺癌诊疗方向和对策 [J]．中国实用外科杂志， 2011， 31(5)：376-379．.
27.	郑冬梅，鹿宁，陈青，等．甲状腺结节的临床分析 [J]．山东大学学报：医学版，2009，47(8)：14-17，20．.
28.	Hurtado-Lopez LM，Monroy-Lozano BE，Martinez-Duncker C. TSH alone is not sufficient to exclude all patients with a functioning thyroid nodule from undergoing testing to exclude thyroid cancer [J]. Eur J Nucl Med Mol Imaging， 2008， 35(6)： 1173-1178.

1. 　Jin J， Machekano R， Mchenry CR.The utility of preoperative serum thyroid-stimulating hormone level for predicting malignant nodular thyroid disease[J].Am J Surg， 2010， 199(3)：294-297.
2. Gerschpacher M， Göbl C， Anderwald C， et al.Thyrotropin serum concentrations in patients with papillary thyroid microcancers[J].Thyroid， 2010， 20(4)：389-392.
3. Haymart MR， Glinberg SL， Liu J， et al.Higher serum TSH in thyroid cancer patients occurs independent of age and correlates with extrathyroidal extension[J].Clin Endocrinol (Oxf)， 2009， 71(3)：434-439.
4. Fiore E， Rago T， Provenzale MA， et al.Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease：thyroid autonomy may play a protective role[J].Endocr Relat Cancer， 2009， 16(4)：1251-1260.
5. Boelaert K. The association between serum TSH concentration and thyroid cancer[J]. Endocr Relat Cancer， 2009， 16(4)：1065-1072.
6. Polyzos SA， Kita M， Efstathiadou Z， et al.Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules[J].J Cancer Res Clin Oncol， 2008， 134(9)：953-960.
7. Kim SS， Lee BJ， Lee JC， et al.Preoperative serum thyroid stimulating hormone levels in well-differentiated thyroid carcinoma is a predictive factor for lateral lymph node metastasis as well as extrathyroidal extension in Korean patients：a single-center experience[J].Endocrine， 2011， 39(3)：259-265.
8. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology：thyroid carcinoma.Ⅵ.2011 [EB/OL].http：//www.nccn.org/professionals/physician_gls/pdf/thyroid. pdf.
9. Rago T， Fiore E， Scutari M， et al.Male sex， single nodularity， and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease[J].Eur J Endocrinol， 2010， 162(4)：763-770.
10. 史良凤，关海霞，李玉姝，等.术前血清促甲状腺素水平与甲状腺结节良恶性关系的研究[J].中华内分泌代谢杂志， 2010， 26(3)：213-214．.
11. 戴珺，王瑛. 老年性疾病患者TSH、T3、T4、FT3、FT4测定的临床应用[J].放射免疫学杂志， 2006， 19(3)：248-250．.
12. Hollowell JG， Staehling NW， Flanders WD， et al.Serum TSH， T(4)，and thyroid antibodies in the United States population (1988 to 1994)：National Health and Nutrition Examination Survey (NHANESⅢ) [J].J Clin Endocrinol Metab， 2002， 87(2)：489-499.
13. Aoki Y， Belin RM， Clickner R， et al.Serum TSH and total T4 in the United States population and their association with participant characteristics：National Health and Nutrition Examination Survey (NHANES 1999-2002)[J].Thyroid， 2007， 17(12)：1211-1223.
14. Surks MI， Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population：implications for the prevalence of subclinical hypothyroidism[J].J Clin Endocrinol Metab， 2007， 92(12)：4575-4582.
15. Singh B， Shaha AR， Trivedi H， et al.Coexistent hashimoto’s thyroiditis with papillary thyroid carcinoma：impact on presentation， management， and outcome[J].Surgery， 1999， 126(6)：1070-1076.
16. Fiore E， Rago T， Latrofa F， et al.Hashimoto’s thyroiditis is associated with papillary thyroid carcinoma：role of TSH and of treatment with L-thyroxine[J].Endocr Relat Cancer， 2011， 18(4)： 429-437.
17. Kim KW， Park YJ， Kim EH， et al. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto’s thyroiditis[J]. Head Neck， 2011， 33(5)： 691-695.
18. 曹学民，王文艳．甲状腺球蛋白及抗体测定对结节性甲状腺肿及甲状腺癌的鉴别诊断意义 [J]．中国地方病防治杂志，2011， 26(1)：78-79．.
19. Sands NB，Karls S，Rivera J，et al. Preoperative serum thyroglobulin as an adjunct to fine-needle aspiration in predicting well-differentiated thyroid cancer [J]. J Otolaryngol Head Neck Surg，2010，39(6)： 669-673.
20. Spencer CA，Takeuchi M，Kazarosyan M，et al. Serum thyroglobulin autoantibodies： prevalence， influence on serum thyroglobulin measurement， and prognostic significance in patients with differentiated thyroid carcinoma [J]. J Clin Endocrinol Metab，1998，83(4)： 1121-1127.
21. 高杰，安振梅．甲状腺球蛋白在甲状腺疾病中临床意义的系统评价 [J]．华西医学， 2009，24(11)： 2907-2910．.
22. Yeager N，Klein-Szanto A，Kimura S，et al. Pten loss in the mouse thyroid causes goiter and follicular adenomas： insights into thyroid function and Cowden disease pathogenesis [J]. Cancer Res， 2007， 67(3)： 959-966.
23. 刘翔，高明．促甲状腺素抗氧化传导通路与甲状腺乳头状癌侵袭力的关系 [J]．中华耳鼻咽喉头颈外科杂志，2009，44(4)：287-291．.
24. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer，Cooper DS，Doherty GM，et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer [J]. Thyroid， 2009， 19(11)： 1167-1214.
25. 马峻峰，唐波，李铁汉，等．促甲状腺激素抑制疗法在分化型甲状腺癌治疗中的作用 [J]．中国普外基础与临床杂志，2009，16(5)：348-350，355．.
26. 高明．国内分化型甲状腺癌诊疗方向和对策 [J]．中国实用外科杂志， 2011， 31(5)：376-379．.
27. 郑冬梅，鹿宁，陈青，等．甲状腺结节的临床分析 [J]．山东大学学报：医学版，2009，47(8)：14-17，20．.
28. Hurtado-Lopez LM，Monroy-Lozano BE，Martinez-Duncker C. TSH alone is not sufficient to exclude all patients with a functioning thyroid nodule from undergoing testing to exclude thyroid cancer [J]. Eur J Nucl Med Mol Imaging， 2008， 35(6)： 1173-1178.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Relationship Between Preoperative Serum TSH Concentration and Thyroid Carcinoma in Patients with Nodular Goiter

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