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

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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.	史良鳳，關海霞，李玉姝，等.術前血清促甲狀腺素水平與甲狀腺結節良惡性關系的研究[J].中華內分泌代謝雜志， 2010， 26(3)：213-214．.
11.	戴珺，王瑛. 老年性疾病患者TSH、T3、T4、FT3、FT4測定的臨床應用[J].放射免疫學雜志， 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.	曹學民，王文艷．甲狀腺球蛋白及抗體測定對結節性甲狀腺腫及甲狀腺癌的鑒別診斷意義 [J]．中國地方病防治雜志，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．甲狀腺球蛋白在甲狀腺疾病中臨床意義的系統評價 [J]．華西醫學， 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.	劉翔，高明．促甲狀腺素抗氧化傳導通路與甲狀腺乳頭狀癌侵襲力的關系 [J]．中華耳鼻咽喉頭頸外科雜志，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.	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 [J]．中國普外基礎與臨床雜志，2009，16(5)：348-350，355．.
26.	高明．國內分化型甲狀腺癌診療方向和對策 [J]．中國實用外科雜志， 2011， 31(5)：376-379．.
27.	鄭冬梅，鹿寧，陳青，等．甲狀腺結節的臨床分析 [J]．山東大學學報：醫學版，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. 史良鳳，關海霞，李玉姝，等.術前血清促甲狀腺素水平與甲狀腺結節良惡性關系的研究[J].中華內分泌代謝雜志， 2010， 26(3)：213-214．.
11. 戴珺，王瑛. 老年性疾病患者TSH、T3、T4、FT3、FT4測定的臨床應用[J].放射免疫學雜志， 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. 曹學民，王文艷．甲狀腺球蛋白及抗體測定對結節性甲狀腺腫及甲狀腺癌的鑒別診斷意義 [J]．中國地方病防治雜志，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．甲狀腺球蛋白在甲狀腺疾病中臨床意義的系統評價 [J]．華西醫學， 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. 劉翔，高明．促甲狀腺素抗氧化傳導通路與甲狀腺乳頭狀癌侵襲力的關系 [J]．中華耳鼻咽喉頭頸外科雜志，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. 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 [J]．中國普外基礎與臨床雜志，2009，16(5)：348-350，355．.
26. 高明．國內分化型甲狀腺癌診療方向和對策 [J]．中國實用外科雜志， 2011， 31(5)：376-379．.
27. 鄭冬梅，鹿寧，陳青，等．甲狀腺結節的臨床分析 [J]．山東大學學報：醫學版，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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