Correlation between preoperative thyroid stimulating hormone level and the malignant risk of thyroid nodules_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SONG Chunfeng ¹ , LIU Manxiang ² , NI Chuandou ¹ , YANG Mingjun ¹ , XING Peng ¹ ,  ZHANG Wei ¹

1. Department of Hepatobiliary Surgery, General Hospital of Shenyang Military Command, Shenyang 110000, P. R. China;
2. The First Clinical Medical College, Lanzhou University, Lanzhou 73000, P. R. China;

Corresponding author：

ZHANG Wei, Email: zhang_wei_1980@163.com

Keywords：

thyroid nodule; thyroid stimulating hormone; thyroid papillary carcinoma

DOI：

10.7507/1007-9424.201802004

Video：

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Objective To study the correlation between preoperative serum thyroid stimulating hormone (TSH) level and the malignant risk of thyroid nodules. Methods This study retrospectively analyzed the medical records of 959 patients with thyroid nodules. Ststistical analysis was conducted by SPSS 17.0 software. Results There were 959 patients with thyroid nodules, of which 746 cases were benign, and 213 cases were diagnosed as thyroid papillary carcinoma (PTC). The preoperative TSH level of PTC patients was higher than that with benign nodules [(2.32±1.65) mU/L vs. (1.76±1.20) mU/L, P<0.001]. Moreover, the higher preoperative TSH level was, the higher risk of diagnosed as PTC would be. There was no correlation between the preoperative TSH level and tumor diameter, number of lesions, and lymph nodes metastasis in PTC (P>0.05). Logistic regression analysis showed that, the preoperative TSH level was an independent risk factor for PTC [OR=1.315, 95% CI was (1.171, 1.477), P<0.001]. The best critical value of TSH in the PTC diagnosis was 1.575 mU/L. At this point, the sensitivity was 62.0%, the specificity was 53.4%, and the area under the receiver operating characteristic (ROC) curve was 0.602 (P<0.001). Conclusion There is a certain correlation between preoperative TSH level and malignant risk of thyroid nodules, and the risk increases with the raise of preoperative TSH level.

Citation： SONG Chunfeng, LIU Manxiang, NI Chuandou, YANG Mingjun, XING Peng, ZHANG Wei. Correlation between preoperative thyroid stimulating hormone level and the malignant risk of thyroid nodules. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(9): 1060-1064. doi: 10.7507/1007-9424.201802004 Copy

1.	Wong CK, Wheeler MH. Thyroid nodules: rational management. World J Surg, 2000, 24(8): 934-941.
2.	Cibas ES. Fine-needle aspiration in the work-up of thyroid nodules. Otolaryngol Clin North Am, 2010, 43(2): 257-271.
3.	Sherman SI. Thyroid carcinoma. Lancet, 2003, 361(9356): 501-511.
4.	Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA, 2006, 295(18): 2164-2167.
5.	Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev, 2003, 24(1): 102-132.
6.	李进, 滕理送, 王伟斌. 分化型甲状腺癌中血清 TSH 与 VEGF 表达的相关性. 肿瘤防治研究, 2013, 40(5): 455-458.
7.	Hoelting T, Goretzki PE, Duh QY. Follicular thyroid cancer cells: a model of metastatic tumor in vitro (review). Oncol Rep, 2001, 8(1): 3-8.
8.	Kebebew E, Clark OH. Differentiated thyroid cancer: " complete” rational approach. World J Surg, 2000, 24(8): 942-951.
9.	Liu TR, Su X, Qiu WS, et al. Thyroid-stimulating hormone receptor affects metastasis and prognosis in papillary thyroid carcinoma. Eur Rev Med Pharmacol Sci, 2016, 20(17): 3582-3591.
10.	Liu R, Hao S, Zhang H, et al. Correlation of thyroid stimulating hormone receptor mRNA expression levels in peripheral blood with undesirable clinicopathological features in papillary thyroid carcinoma patients. Oncotarget, 2017, 8(43): 74129-74138.
11.	滕卫平. 甲状腺结节与分化型甲状腺癌//滕卫平. 内科学. 第8 版. 北京: 人民卫生出版社, 2013: 699-702.
12.	Nieto H, Boelaert K. Women in cancer thematic review: thyroid-stimulating hormone in thyroid cancer: does it matter? Endocr Relat Cancer, 2016, 23(11): T109-T121.
13.	McLeod DS, Watters KF, Carpenter AD, et al. Thyrotropin and thyroid cancer diagnosis: a systematic review and dose-response meta-analysis. J Clin Endocrinol Metab, 2012, 97(8): 2682-2692.
14.	Boelaert K, Horacek J, Holder RL, et al. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab, 2006, 91(11): 4295-4301.
15.	黄静, 李燕萍, 薛刚, 等. 血清VEGF-C、VEGF-D及VEGFR-3联合TSH检测在甲状腺乳头状癌诊断中的价值. 南方医科大学学报, 2014, 34(12): 1814-1817.
16.	何强. 促甲状腺激素抑制治疗对分化型甲状腺癌术后的疗效及安全性分析. 实用癌症杂志, 2017, 32(3): 511-513.
17.	Satta MA, De Rosa G, Testa A, et al. Thyroid cancer in suppressed contralateral lobe of patients with hot thyroid nodule. Eur J Cancer, 1993, 29A(8): 1190-1192.
18.	Danilovic DL, Ferraz-de-Souza B, Fabri AW, et al. 25-hydroxyvitamin D and TSH as risk factors or prognostic markers in thyroid carcinoma. PLoS One, 2016, 11(10): e0164550.
19.	Hoelting T, Tezelman S, Siperstein AE, et al. Thyrotropin stimulates invasion and growth of follicular thyroid cancer cells via PKC- rather than PKA-activation. Biochem Biophys Res Commun, 1993, 195(3): 1230-1236.
20.	Haymart MR, Glinberg SL, Liu J, et al. Higher serum TSH in thyroid cancer patients occurs independent of age and correlates with extrathyroidal extension. Clin Endocrinol (Oxf), 2009, 71(3): 434-439.
21.	Boelaert K. The association between serum TSH concentration and thyroid cancer. Endocr Relat Cancer, 2009, 16(4): 1065-1072.
22.	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. Endocrine, 2011, 39(3): 259-265.
23.	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. Endocr Relat Cancer, 2009, 16(4): 1251-1260.
24.	Khan MA, Malik N, Khan KH, et al. Association of preoperative serum thyroid-stimulating hormone levels with thyroid cancer in patients with nodular thyroid disease. World J Nucl Med, 2017, 16(3): 202-205.
25.	Jin J, Machekano R, McHenry CR. The utility of preoperative serum thyroid-stimulating hormone level for predicting malignant nodular thyroid disease. Am J Surg, 2010, 199(3): 294-297.
26.	陈兴, 郭智华, 罗辉遇, 等. 甲状腺激素与甲状腺结节良恶性的关系. 天津医药, 2014, 42(7): 687-689.
27.	Rinaldi S, Plummer M, Biessy C, et al. Thyroid-stimulating hormone, thyroglobulin, and thyroid hormones and risk of differentiated thyroid carcinoma: the EPIC study. J Natl Cancer Inst, 2014, 106(6): dju097.
28.	Chung KW, Yang SK, Lee GK, et al. Detection of BRAF^V600E mutation on fine needle aspiration specimens of thyroid nodule refines cyto-pathology diagnosis, especially in BRAF^V600E mutation-prevalent area. Clin Endocrinol (Oxf), 2006, 65(5): 660-666.
29.	其阿米西·别孜尔见, 哈力木拉提·木尔提扎, 哈尔满·阿吉汉, 等. 术前血清 TSH 水平与甲状腺微小乳头状癌发生的相关性研究. 中国普外基础与临床杂志, 2017, 24(1): 64-69.

1. Wong CK, Wheeler MH. Thyroid nodules: rational management. World J Surg, 2000, 24(8): 934-941.
2. Cibas ES. Fine-needle aspiration in the work-up of thyroid nodules. Otolaryngol Clin North Am, 2010, 43(2): 257-271.
3. Sherman SI. Thyroid carcinoma. Lancet, 2003, 361(9356): 501-511.
4. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA, 2006, 295(18): 2164-2167.
5. Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev, 2003, 24(1): 102-132.
6. 李进, 滕理送, 王伟斌. 分化型甲状腺癌中血清 TSH 与 VEGF 表达的相关性. 肿瘤防治研究, 2013, 40(5): 455-458.
7. Hoelting T, Goretzki PE, Duh QY. Follicular thyroid cancer cells: a model of metastatic tumor in vitro (review). Oncol Rep, 2001, 8(1): 3-8.
8. Kebebew E, Clark OH. Differentiated thyroid cancer: " complete” rational approach. World J Surg, 2000, 24(8): 942-951.
9. Liu TR, Su X, Qiu WS, et al. Thyroid-stimulating hormone receptor affects metastasis and prognosis in papillary thyroid carcinoma. Eur Rev Med Pharmacol Sci, 2016, 20(17): 3582-3591.
10. Liu R, Hao S, Zhang H, et al. Correlation of thyroid stimulating hormone receptor mRNA expression levels in peripheral blood with undesirable clinicopathological features in papillary thyroid carcinoma patients. Oncotarget, 2017, 8(43): 74129-74138.
11. 滕卫平. 甲状腺结节与分化型甲状腺癌//滕卫平. 内科学. 第8 版. 北京: 人民卫生出版社, 2013: 699-702.
12. Nieto H, Boelaert K. Women in cancer thematic review: thyroid-stimulating hormone in thyroid cancer: does it matter? Endocr Relat Cancer, 2016, 23(11): T109-T121.
13. McLeod DS, Watters KF, Carpenter AD, et al. Thyrotropin and thyroid cancer diagnosis: a systematic review and dose-response meta-analysis. J Clin Endocrinol Metab, 2012, 97(8): 2682-2692.
14. Boelaert K, Horacek J, Holder RL, et al. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab, 2006, 91(11): 4295-4301.
15. 黄静, 李燕萍, 薛刚, 等. 血清VEGF-C、VEGF-D及VEGFR-3联合TSH检测在甲状腺乳头状癌诊断中的价值. 南方医科大学学报, 2014, 34(12): 1814-1817.
16. 何强. 促甲状腺激素抑制治疗对分化型甲状腺癌术后的疗效及安全性分析. 实用癌症杂志, 2017, 32(3): 511-513.
17. Satta MA, De Rosa G, Testa A, et al. Thyroid cancer in suppressed contralateral lobe of patients with hot thyroid nodule. Eur J Cancer, 1993, 29A(8): 1190-1192.
18. Danilovic DL, Ferraz-de-Souza B, Fabri AW, et al. 25-hydroxyvitamin D and TSH as risk factors or prognostic markers in thyroid carcinoma. PLoS One, 2016, 11(10): e0164550.
19. Hoelting T, Tezelman S, Siperstein AE, et al. Thyrotropin stimulates invasion and growth of follicular thyroid cancer cells via PKC- rather than PKA-activation. Biochem Biophys Res Commun, 1993, 195(3): 1230-1236.
20. Haymart MR, Glinberg SL, Liu J, et al. Higher serum TSH in thyroid cancer patients occurs independent of age and correlates with extrathyroidal extension. Clin Endocrinol (Oxf), 2009, 71(3): 434-439.
21. Boelaert K. The association between serum TSH concentration and thyroid cancer. Endocr Relat Cancer, 2009, 16(4): 1065-1072.
22. 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. Endocrine, 2011, 39(3): 259-265.
23. 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. Endocr Relat Cancer, 2009, 16(4): 1251-1260.
24. Khan MA, Malik N, Khan KH, et al. Association of preoperative serum thyroid-stimulating hormone levels with thyroid cancer in patients with nodular thyroid disease. World J Nucl Med, 2017, 16(3): 202-205.
25. Jin J, Machekano R, McHenry CR. The utility of preoperative serum thyroid-stimulating hormone level for predicting malignant nodular thyroid disease. Am J Surg, 2010, 199(3): 294-297.
26. 陈兴, 郭智华, 罗辉遇, 等. 甲状腺激素与甲状腺结节良恶性的关系. 天津医药, 2014, 42(7): 687-689.
27. Rinaldi S, Plummer M, Biessy C, et al. Thyroid-stimulating hormone, thyroglobulin, and thyroid hormones and risk of differentiated thyroid carcinoma: the EPIC study. J Natl Cancer Inst, 2014, 106(6): dju097.
28. Chung KW, Yang SK, Lee GK, et al. Detection of BRAF^V600E mutation on fine needle aspiration specimens of thyroid nodule refines cyto-pathology diagnosis, especially in BRAF^V600E mutation-prevalent area. Clin Endocrinol (Oxf), 2006, 65(5): 660-666.
29. 其阿米西·别孜尔见, 哈力木拉提·木尔提扎, 哈尔满·阿吉汉, 等. 术前血清 TSH 水平与甲状腺微小乳头状癌发生的相关性研究. 中国普外基础与临床杂志, 2017, 24(1): 64-69.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Correlation between preoperative thyroid stimulating hormone level and the malignant risk of thyroid nodules

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