Higher Serum Thyroid Stimulating Hormone Level in Thyroid Nodule Patients Is Associated with Greater Risks of Differentiated Thyroid Cancer and Advanced Tumor Stage

• Published in: The journal of clinical endocrinology and metabolism 2008-03, Vol.93 (3), p.809-814
• Main Authors: Haymart, Megan Rist, Repplinger, Daniel John, Leverson, Glen E., Elson, Diane F., Sippel, Rebecca S., Jaume, Juan Carlos, Chen, Herbert
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Biopsy, Needle; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Male; Medical sciences; Middle Aged; Mutation; Neoplasm Staging; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Original; Receptors, Thyrotropin - genetics; Retrospective Studies; Risk; Thyroid Neoplasms - etiology; Thyroid Nodule - blood; Thyroid Nodule - complications; Thyroid Nodule - pathology; Thyroid. Thyroid axis (diseases); Thyrotropin - blood; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2007-2215

Context: TSH is a known thyroid growth factor, but the pathogenic role of TSH in thyroid oncogenesis is unclear. Objective: The aim was to examine the relationship between preoperative TSH and differentiated thyroid cancer (DTC). Design: The design was a retrospective cohort. Setting, Participants: Between May 1994 and January 2007, 1198 patients underwent thyroid surgery at a single hospital. Data from the 843 patients with preoperative serum TSH concentration were recorded. Main Outcome Measures: Serum TSH concentration was measured with a sensitive assay. Diagnoses of DTC vs. benign thyroid disease were based on surgical pathology reports. Results: Twenty-nine percent of patients (241 of 843) had DTC on final pathology. On both univariate and multivariable analyses, risk of malignancy correlated with higher TSH level (P = 0.007). The likelihood of malignancy was 16% (nine of 55) when TSH was less than 0.06 mIU/liter vs. 52% (15 of 29) when 5.00 mIU/liter or greater (P = 0.001). When TSH was between 0.40 and 1.39 mIU/liter, the likelihood of malignancy was 25% (85 of 347) vs. 35% (109 of 308) when TSH was between 1.40 and 4.99 mIU/liter (P = 0.002). The mean TSH was 4.9 ± 1.5 mIU/liter in patients with stage III/IV disease vs. 2.1 ± 0.2 mIU/liter in patients with stage I/II disease (P = 0.002). Conclusions: The likelihood of thyroid cancer increases with higher serum TSH concentration. Even within normal TSH ranges, a TSH level above the population mean is associated with significantly greater likelihood of thyroid cancer than a TSH below the mean. Shown for the first time, higher TSH level is associated with advanced stage DTC.