The study of the role of serum TSH level in evaluating differentiated thyroid cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Jiacheng , JIAO Chengbin , ZHU Yongwei , Brahim HASSAN ADOUM , MEI Haoran ,  CHENG Zhuoxin

Department of General Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang 154002, P. R. China;

Corresponding?author：

CHENG Zhuoxin, Email: czx6892551@yeah.net

Keywords：

differentiated thyroid cancer; thyrotropin; thyroid imaging report and data system; diagnostic significance

DOI：

10.7507/1007-9424.201801039

Video：

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Objective To investigate the role of preoperative serum thyroid stimulating hormone (TSH) in evaluating differentiated thyroid cancer (DTC). Methods A total of 551 patients with thyroid nodules met the study criteria, who got treatment in the First Affiliated Hospital of Jiamusi University between Aug. 2017 and Dec. 2017. And the patients were divided into DTC group (n=110) and benign group (n=441) according to the postoperative pathological results. The difference of serum TSH level between the 2 groups was compared and then explored the diagnostic significance of serum TSH level, thyroid imaging report and data system (TI-RADS), and serum TSH combined withTI-RADS. Results The serum TSH level was higher in the DTC group than that of the benign group (Z=5.198, P<0.05). The sensitivity of preoperative serum TSH level in the diagnosis of DTC was 80.9% (89/110), the specificity was 74.4% (328/441), and the area under receiver operating characteristic (ROC) curve was 0.660 ［95%CI was (0.602, 0.719), P<0.05］. The sensitivity of TI-RADS in the diagnosis of DTC was 82.7% (91/110), the specificity was 73.5% (324/441), and the area under the ROC curve was 0.772 ［95%CI was (0.711, 0.823), P<0.05］. The sensitivity of preoperative serum TSH combined with TI-RADS in the diagnosis of DTC was 91.8% (101/110), the specificity was 87.5% (386/441), and the area under the ROC curve was 0.831 ［95%CI was (0.786, 0.876), P<0.05］. Conclusions Preoperative serum TSH level may be a potential risk factor for the occurrence of DTC. Preoperative serum TSH level combined with TI-RADS classification can improve the accuracy of preoperative diagnosis of DTC, not only to reduce the misdiagnosis of thyroid cancer, but also can avoid excessive treatment.

Citation： LI Jiacheng, JIAO Chengbin, ZHU Yongwei, Brahim HASSAN ADOUM, MEI Haoran, CHENG Zhuoxin. The study of the role of serum TSH level in evaluating differentiated thyroid cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(8): 959-963. doi: 10.7507/1007-9424.201801039 Copy

1.	吳毅. 關于甲狀腺結節診斷和治療的若干思考. 中國實用外科雜志, 2010, 30(10): 821-823.
2.	中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華內分泌代謝雜志, 2012, 28(10): 779-797.
3.	Haugen B, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
4.	Moon HJ, Son E, Kim EK, et al. The diagnostic values of ultrasound and ultrasound-guided fine needle aspiration in subcentimeter-sized thyroid nodules. Ann Surg Oncol, 2012, 19(1): 52-59.
5.	Choi SH, Han KH, Yoon JH, et al. Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf), 2011, 74(6): 776-782.
6.	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.
7.	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.
8.	Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf), 1995, 43(1): 55-68.
9.	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.
10.	董屹婕, 詹維偉. 超聲引導下細針穿刺在甲狀腺結節診斷和鑒別診斷中的價值. 中國實用外科雜志, 2015, 35(6): 613-319.
11.	田文, 郗洪慶. 甲狀腺癌病人生存現狀分析. 中國實用外科雜志, 2016, 36(5): 489-493.
12.	Pellegriti G, Frasca F, Regalbuto C, et al. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol, 2013, 2013: 965212.
13.	孫彤, 田晶, 李辰運, 等. 相關實驗室檢查和超聲特征在分化型甲狀腺癌與結節性甲狀腺腫鑒別診斷中的意義. 中國超聲醫學雜志, 2017, 33(10): 874-878.
14.	陳曉康, 陳少華, 呂國榮. 超聲 TI-RADS 分類對甲狀腺結節的診斷價值. 中國超聲醫學雜志, 2012, 28(12): 1066-1068.
15.	Liu B, Liang J, Zheng Y, et al. Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules: a prospective single-centre experience. Eur Radiol, 2015, 25(3): 624-634.
16.	Rahal A Junior, Falsarella PM, Rocha RD, et al. Correlation of Thyroid Imaging Reporting and Data System [TI-RADS] and fine needle aspiration: experience in 1, 000 nodules. Einstein (Sao Paulo), 2016, 14(2): 119-123.
17.	余小琴, 郭莉, 何惠麗, 等. TI-RADS 分類系統聯合超聲造影對甲狀腺結節良惡性鑒別診斷價值. 醫學影像學雜志, 2017, 27(6): 1056-1072.
18.	徐曉波, 劉文勇. 血清 TSH 濃度與結節性甲狀腺腫合并甲狀腺癌關系的研究. 中國普外基礎與臨床雜志, 2012, 19(1): 58-61.
19.	Williams ED. Mechanisms and pathogenesis of thyroid cancer in animals and man. Mutat Res, 1995, 333(1-2): 123-129.
20.	馬峻峰, 唐波, 李鐵漢, 等. 促甲狀腺激素抑制療法在分化型甲狀腺癌治療中的作用. 中國普外基礎與臨床雜志, 2009, 16(5): 348-350, 355.
21.	Haymart MR, Repplinger DJ, Leverson GE, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab, 2008, 93(3): 809-814.
22.	Onigata K, Szinnai G. Resistance to thyroid hormone. Endocr Dev, 2014, 26(3): 118-129.
23.	Azizi G, Keller JM, Lewis M, et al. Association of Hashimoto’s thyroiditis with thyroid cancer. Endocr Relat Cancer, 2014, 21(6): 845-852.
24.	龔衛東, 黃堃, 王南鵬, 等. 橋本甲狀腺炎合并甲狀腺癌的診斷與治療. 中國普外基礎與臨床雜志, 2013, 20(6): 643-647.
25.	Feldt-Rasmussen U, Rasmussen AK. Autoimmunity in differentiated thyroid cancer: significance and related clinical problems. Hormones (Athens), 2010, 9(2): 109-117.
26.	陳孝平, 汪建平. 外科學. 第8版. 北京: 人民衛生出版社, 2013: 237-250.

1. 吳毅. 關于甲狀腺結節診斷和治療的若干思考. 中國實用外科雜志, 2010, 30(10): 821-823.
2. 中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華內分泌代謝雜志, 2012, 28(10): 779-797.
3. Haugen B, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
4. Moon HJ, Son E, Kim EK, et al. The diagnostic values of ultrasound and ultrasound-guided fine needle aspiration in subcentimeter-sized thyroid nodules. Ann Surg Oncol, 2012, 19(1): 52-59.
5. Choi SH, Han KH, Yoon JH, et al. Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf), 2011, 74(6): 776-782.
6. 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.
7. 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.
8. Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf), 1995, 43(1): 55-68.
9. 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.
10. 董屹婕, 詹維偉. 超聲引導下細針穿刺在甲狀腺結節診斷和鑒別診斷中的價值. 中國實用外科雜志, 2015, 35(6): 613-319.
11. 田文, 郗洪慶. 甲狀腺癌病人生存現狀分析. 中國實用外科雜志, 2016, 36(5): 489-493.
12. Pellegriti G, Frasca F, Regalbuto C, et al. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol, 2013, 2013: 965212.
13. 孫彤, 田晶, 李辰運, 等. 相關實驗室檢查和超聲特征在分化型甲狀腺癌與結節性甲狀腺腫鑒別診斷中的意義. 中國超聲醫學雜志, 2017, 33(10): 874-878.
14. 陳曉康, 陳少華, 呂國榮. 超聲 TI-RADS 分類對甲狀腺結節的診斷價值. 中國超聲醫學雜志, 2012, 28(12): 1066-1068.
15. Liu B, Liang J, Zheng Y, et al. Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules: a prospective single-centre experience. Eur Radiol, 2015, 25(3): 624-634.
16. Rahal A Junior, Falsarella PM, Rocha RD, et al. Correlation of Thyroid Imaging Reporting and Data System [TI-RADS] and fine needle aspiration: experience in 1, 000 nodules. Einstein (Sao Paulo), 2016, 14(2): 119-123.
17. 余小琴, 郭莉, 何惠麗, 等. TI-RADS 分類系統聯合超聲造影對甲狀腺結節良惡性鑒別診斷價值. 醫學影像學雜志, 2017, 27(6): 1056-1072.
18. 徐曉波, 劉文勇. 血清 TSH 濃度與結節性甲狀腺腫合并甲狀腺癌關系的研究. 中國普外基礎與臨床雜志, 2012, 19(1): 58-61.
19. Williams ED. Mechanisms and pathogenesis of thyroid cancer in animals and man. Mutat Res, 1995, 333(1-2): 123-129.
20. 馬峻峰, 唐波, 李鐵漢, 等. 促甲狀腺激素抑制療法在分化型甲狀腺癌治療中的作用. 中國普外基礎與臨床雜志, 2009, 16(5): 348-350, 355.
21. Haymart MR, Repplinger DJ, Leverson GE, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab, 2008, 93(3): 809-814.
22. Onigata K, Szinnai G. Resistance to thyroid hormone. Endocr Dev, 2014, 26(3): 118-129.
23. Azizi G, Keller JM, Lewis M, et al. Association of Hashimoto’s thyroiditis with thyroid cancer. Endocr Relat Cancer, 2014, 21(6): 845-852.
24. 龔衛東, 黃堃, 王南鵬, 等. 橋本甲狀腺炎合并甲狀腺癌的診斷與治療. 中國普外基礎與臨床雜志, 2013, 20(6): 643-647.
25. Feldt-Rasmussen U, Rasmussen AK. Autoimmunity in differentiated thyroid cancer: significance and related clinical problems. Hormones (Athens), 2010, 9(2): 109-117.
26. 陳孝平, 汪建平. 外科學. 第8版. 北京: 人民衛生出版社, 2013: 237-250.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The study of the role of serum TSH level in evaluating differentiated thyroid cancer

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