This Article Full Text Full Text (PDF) Submit a related Letter to the Editor View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Haymart, M. R. Articles by Chen, H. Search for Related Content PubMed PubMed Citation Articles by Haymart, M. R. Articles by Chen, H. Related Collections Thyroid Endocrine Oncology

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

Division of Endocrinology, Diabetes, and Metabolism (M.R.H., D.F.E., J.C.J.), Department of Medicine, and Section of Endocrine Surgery (D.J.R., G.E.L., R.S.S., H.C.), Department of Surgery, and Paul P. Carbone Comprehensive Cancer Center (M.R.H., H.C.), University of Wisconsin, Madison, Wisconsin 53792

Address all correspondence and requests for reprints to: Megan R. Haymart, M.D., Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin, H4/568 Clinical Science Center, 600 Highland Avenue, Madison, Wisconsin 53792.

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.

This article has been cited by other articles:

				M. R. Haymart Understanding the Relationship Between Age and Thyroid Cancer Oncologist, March 1, 2009; 14(3): 216 - 221. [Abstract] [Full Text] [PDF]

				E. K. Alexander Approach to the Patient with a Cytologically Indeterminate Thyroid Nodule J. Clin. Endocrinol. Metab., November 1, 2008; 93(11): 4175 - 4182. [Abstract] [Full Text] [PDF]

eLetters: