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Higher serum thyrotropin concentrations are a risk factor for thyroid cancer in patients with thyroid nodules
The background of the study. Most thyroid nodules are benign, but a few are cancers; they are usually distinguished from one another by cytologic evaluation of cells obtained by fine-needle aspiration of the nodule. This study was done to examine the possibility that some clinical or biochemical factors might predict that a thyroid nodule is a cancer.
How the study was done. The study subjects were 1500 patients (1304 women, 196 men; average age, 48 years) seen at a thyroid clinic. Based on palpation, 861 (58 percent) had a single thyroid nodule, 456 (30 percent) a multinodular goiter, and 183 (12 percent) a diffuse goiter. All the patients underwent fine-needle aspiration of the thyroid. Additional second aspirations were done in 479 patients (32 percent) in whom the aspirates were inadequate or the nodule later enlarged. Serum thyrotropin (TSH) was measured in 1183 patients.
The results of the study. The cytologic diagnosis was benign nodule in 1086 patients (72 percent), follicular tumor in 291 (20 percent), and suspicious for or diagnostic of cancer in 30 (2 percent). The aspirate was inadequate in 257 patients (17 percent).
Surgery was performed in 553 patients, of whom 120 (22 percent) had a thyroid cancer (8 percent of the entire cohort). Thyroid cancer was more common in men, in older years, and in patients with a solitary nodule. Serum TSH, measured in 1183 patients, was abnormal in 209 (18 percent). The frequency of cancer was lowest in those with low serum TSH values and highest in those with high values (Table).
| Table. Frequency of Thyroid Cancer in Relation to Serum TSH Concentration in 1183 Patients with Thyroid Nodules or Goiter. | ||
| Serum TSH (mU/L)* | No. | No. with Cancer |
| <0.4 | 182 | 5 (3%) |
| 0.4 to 0.9 | 322 | 9 (4%) |
| 1.0 to 1.7 | 336 | 28 (8%) |
| 1.8 to 5.5 | 316 | 39 (12%) |
| >5.5 | 27 | 8 (30%) |
| *Normal values, 0.4 to 5.5 mU/L. | ||
The conclusions of the study. Among patients with thyroid nodules or goiter, higher serum TSH concentrations are associated with a higher chance of cancer.
The original article. Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab 2006;91:4295-301.
Next Article: Ultrasonography of the neck may reveal thyroid nodules including cancers in patients with primary hyperparathyroidism |
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| Thyroid Digest Index | | | March 2007 Thyroid Digest |
