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Article: Megan Rist Haymart, Daniel John Repplinger, Glen E. Leverson, Diane F. Elson, Rebecca S. Sippel, Juan Carlos Jaume, and Herbert Chen Higher Serum TSH Level in Thyroid Nodule Patients is Associated with Greater Risks of Differentiated Thyroid Cancer and Advanced Tumor Stage J Clin Endocrinol Metab 2007; 0: jc.2007-2215v1 [Abstract]

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Is higher serum TSH level associated with greater risk of differentiated thyroid cancer?

Nikola Besic, Janez Zgajnar, and Marko Hocevar, Zaloska 2, 1000 Ljubljana, Slovenia   (12 February 2008)

Is higher serum TSH level associated with greater risk of differentiated thyroid cancer? 12 February 2008
Nikola Besic, Janez Zgajnar, and Marko Hocevar, Surgical Oncology Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia Send letter to journal: Re: Is higher serum TSH level associated with greater risk of differentiated thyroid cancer? nbesic{at}onko-i.si Nikola Besic, Janez Zgajnar, and Marko Hocevar, et al.	In the December 2007 issue of JCEM, Haymart and colleagues reported that, in addition to preoperative TSH level being predictive of differentiated thyroid carcinoma (DTC), male gender, younger age and smaller nodular size were also independent predictors of malignancy (1). Their finding that a smaller tumor is at higher risk of carcinoma than a larger one is not in agreement with common sense and previous data from the literature. Unfortunately, Haymart and colleagues did not provide more data about indications for surgical procedures. Furthermore, they have not correlated these data neither with the age of patients nor with the size of carcinoma. We assume that their statistical results might have been skewed also by the inclusion of incidentalomas and preoperatively diagnosed microcarcinomas in the analysis. Therefore, we are very skeptical if really relevant factors were included in their statistical analysis; so, the conclusions by Haymart and colleagues could be as such misleading. Haymart and colleagues also reported that higher TSH was associated with the advanced stage of DTC (1), but reported only about the levels of TSH in the patients with stage I or II and those with stage III and IV regardless of their age. More than half of stage I or II patients reported by Haymart and colleagues were younger than 45 years of age, and it is well known that older patients tend to have higher TSH levels (2). We believe that the comparison of TSH levels in the patients older than 45 years of age with stage I or II versus those with stage III or IV should be performed in order to demonstrate that higher TSH is associated with the advanced stage of DTC. Haymart and colleagues (1) did not provide these data. We completely agree with Haymart and colleagues (1) that further studies are needed in order to examine the relationship between preoperative TSH and differentiated thyroid carcinoma. However, all other relevant data should be taken into account to analyze accurately the possible correlation between the level of serum TSH and development of thyroid carcinoma. References 1. Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, Chen H. 2007 Higher Serum TSH Level in Thyroid Nodule Patients is Associated with Greater Risks of Differentiated Thyroid Cancer and Advanced Tumor Stage. J Clin Endocrinol Metab Dec 26, 2007 [Epub ahead of print] 2. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. 2002 Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 87:489-499