Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage

Academic Article


  • 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. Copyright © 2008 by The Endocrine Society.
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    Author List

  • Haymart MR; Repplinger DJ; Leverson GE; Elson DF; Sippel RS; Jaume JC; Chen H
  • Start Page

  • 809
  • End Page

  • 814
  • Volume

  • 93
  • Issue

  • 3