Correlation of serum thyroid stimulating hormone level to predict benign or malignant nature of thyroid swelling

Authors

  • Sabi Rana Department of ENT and HNS, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
  • Meera Bista Department of ENT and HNS, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
  • Akriti Shrestha Department of ENT and HNS, Kulhudhuffushi Regional Hospital, Maldives
  • Property Bhandari Department of ENT and HNS, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
  • Sagar Devkota Department of Anesthesiology and Critical Care, Kulhudhuffushi Regional Hospital, Maldives
  • Sujan Pradhan Department of ENT and HNS, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
  • Saurav Sharma Department of ENT and HNS, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20240053

Keywords:

Fine needle aspiration biopsy, Histopathological examination, Malignancy, Thyroid swelling., Serum thyroid stimulating hormone

Abstract

Background: Thyroid enlargement is a common clinical problem encountered in ENT practice, thyroid cancer, by contrast is less common. Several imaging modalities, FNAB and biomarkers are available but a simple clinical or biochemical diagnostic criterion is still lacking. Serum TSH is a well- established growth factor for thyroid nodules and thus can be used as a simple and reliable test to predict the risk of having a thyroid malignancy in a patient with thyroid swelling. Objectives were to correlate serum TSH level with benign or malignant nature of thyroid swelling and to evaluate the use of TSH level in predicting thyroid malignancy.

Methods: This was a prospective observational study conducted over a period of one year at department of otorhinolaryngology and head and neck surgery of a tertiary care center in Nepal involving a total of 61 patients with thyroid swelling who underwent thyroid surgery. Pre-operative serum TSH level was measured and correlated with final HPE diagnosis.

Results: The study included 61 patients of which 30 (49.2%) were malignant on histopathology report. The mean TSH level for benign cases was 1.97 mIU/l±0.99 and that for malignant cases was 3.85 mIU/l±1.20 (p=0.000), thus showing higher level of mean serum TSH in malignant group and also more in differentiated thyroid cancer.

Conclusions: Patients with higher range of TSH levels were more likely to have thyroid malignancy as compared to lower range even within normal value. Hence, serum TSH level can be a reliable marker to predict malignancy in thyroid swelling.

References

Pellitteri P, Ing S, Jameson B. Disorders of the Thyroid Gland. In: Cummings Otolaryngology Head and Neck Surgery. 6th ed. Philadelphia: Elsevier Saunders; 2015:2;1884.

Dean D, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22(6): 901-11.

Vander JB, Gaston EA, Dawber TR. The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann Int Med. 1968;69(3):537-40.

Tunbridge W, Evered D, Hall R. The spectrum of thyroid disease in a community: The Whickham Survey. Clin Endocrinol. 1977;7(6):481-93.

Eng C. Familial Papillary Thyroid Cancer-Many Syndromes, Too Many Genes?. J Clin Endocrinol Metab. 2000;85(5):1755-7.

Moorthy R, Kumar S, Warfiled AT. Thyroid and Parathyroid Gland Pathology. In: Watkinson JC, Clarke RW, eds. Scott-Brown’s Otorhinolaryngology Head and Neck surgery. 8th ed. Broca Raton: Taylor and Francis group; 2018:1;651-701.

Jones C, Boelaert K. Benign thyroid disease. In: Watkinson JC, Clarke RW, eds. Scott-Brown’s Otorhinolaryngology Head and Neck surgery. 8th ed. Broca Raton: Taylor and Francis group; 2018:1;742-3.

Nikiforov Y, Ohori N, Hodak S. Impact of Mutational Testing on the Diagnosis and Management of Patients with Cytologically Indeterminate Thyroid Nodules: A Prospective Analysis of 1056 FNA Samples. J Clin Endocrinol Metab. 2011;96(11):3390-7.

Cantara S, Capezzone M, Marchisotta S. Impact of Proto-Oncogene Mutation Detection in Cytological Specimens from Thyroid Nodules Improves the Diagnostic Accuracy of Cytology. J Clin Endocrinol Metab. 2010;95(3):1365-9.

McIver B, Castro M, Morris J, et al. An Independent Study of a Gene Expression Classifier (Afirma) in the Evaluation of Cytologically Indeterminate Thyroid Nodules. J Clin Endocrinol Metab. 2014;99(11):4069-77.

Sharma R, Mathur DR. Diagnostic accuracy of fine needle aspiration cytology (FNAC) of the thyroid gland lesions. Int J Health Sci Res. 2012;2(8):1-7.

Stocker DJ, Burch HB. Thyroid cancer yield in patients with Grave’s disease. Minerva Endocrinol. 2003;28(3):205-12.

Shi Y, Zou M, Farid N. Expression of thyrotrophin receptor gene in thyroid carcinoma is associated with a good prognosis. Clin Endocrinol. 1993;39(3):269-74.

Derwahl M. Thyrotropin may not be the dominant growth factor in benign and malignant thyroid tumors. J Clin Endocrinol Metab. 1999;84(3):829-34.

Mazzaferri MD. Thyroid cancer and graves' disease: the controversy ten years later. Endocr Pract. 2000; 6(2):221-5.

Fiore E, Vitti P. Serum TSH and Risk of Papillary Thyroid Cancer in Nodular Thyroid Disease. J Clin Endocrinol Metab. 2012;97(4):1134-45.

Jonklaas J, Sarlis N, Litofsky D. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006;16(12):1229-42.

Braga M, Ringel M, Cooper D. Sudden Enlargement of Local Recurrent Thyroid Tumor after Recombinant Human TSH Administration. J Clin Endocrinol Metab. 2001;86(11):5148-51.

Jin J, Machekano R, McHenry C. The utility of preoperative serum thyroid-stimulating hormone level for predicting malignant nodular thyroid disease. Am J Surg. 2010;199(3):294-8.

Kimura T, Van Keymeulen A, Golstein J, Fusco A, Dumont J, Roger P. Regulation of Thyroid Cell Proliferation by TSH and Other Factors: A Critical Evaluation of in Vitro Models. Endocrine Rev. 2001; 22(5):631-56.

Papini E, Petrucci L, Guglielmi R. Long-Term Changes in Nodular Goiter: A 5-Year Prospective Randomized Trial of Levothyroxine Suppressive Therapy for Benign Cold Thyroid Nodules. J Clin Endocrinol Metab. 1998;83(3):780-3.

Mazzaferri E, Young R, Oertel J, Kemmerer W, Page C. Papillary Thyroid Carcinoma. Medicine. 1977; 56(3):171-96

Cooper D, Specker B, Ho M. Thyrotropin Suppression and Disease Progression in Patients with Differentiated Thyroid Cancer: Results from the National Thyroid Cancer Treatment Cooperative Registry. Thyroid. 1998;8(9):737-44.

Haymart M, Glinberg S, Liu J, Sippel R, Jaume J, Chen H. Higher serum TSH in thyroid cancer patients occurs independent of age and correlates with extrathyroidal extension. Clin Endocrinol. 2009; 71(3):434-9.

Boelaert K, Horacek J, Holder R. Serum Thyrotropin Concentration as a Novel Predictor of Malignancy in Thyroid Nodules Investigated by Fine-Needle Aspiration. J Clin Endocrinol Metab. 2006;91(11): 4295-301.

Mussa A, Salerno M, Bona G, et al. Serum Thyrotropin Concentration in Children with Isolated Thyroid Nodules. J Pediatr. 2013;163(5):1465-70.

Hamdi K, Ghadhban B, Ali T, Sulaiman T. Pre-operative serum TSH level estimation for predicting malignant nodular thyroid disease. J Faculty Med. 2017;59(3):213-6.

Chandrika M, Nayana L, Hardik M, Jayesh J, Ashok A. Clinicopathological correlation of serum TSH level in patients with thyroid nodule-a study of 100 cases. Int J Med Sci Public Health. 2016;5(2):322-6.

Golbert L, de Cristo A, Faccin C. Serum TSH levels as a predictor of malignancy in thyroid nodules: A prospective study. Plos One. 2017;12(11):e0188123.

McLeod D, Watters K, Carpenter A, Ladenson P, Cooper D, Ding E. Thyrotropin and Thyroid Cancer Diagnosis: A Systematic Review and Dose-Response Meta-Analysis. J Clin Endocrinol Metab. 2012;97(8): 2682-92.

Prasad C, Kumar SYT. Comparative study on association between serum TSH concentration and Thyroid cancer. Int Surg J. 2017;4(8):2800.

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Published

2024-01-25

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Original Research Articles