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

Abstract

It has been known that thyroid stimulating hormone (TSH) stimulates the growth or development of thyroid malignancy and higher serum TSH has association with both thyroid cancer incidence and advanced tumor stage. However, the role of TSH in high-risk features of well-differentiated thyroid cancer was not fully evaluated especially in Asian population. The purpose of our study is to evaluate the association of preoperative serum TSH levels with the advance of differentiated thyroid cancer and its high-risk clinicopathological features in Korean patients. We evaluated 554 patients retrospectively who underwent thyroidectomy and diagnosed as differentiated thyroid cancer during a 3-year period at Pusan National University Hospital. The preoperative TSH levels were significantly higher in the patients with extrathyroidal extension (P = 0.002) and those with lateral lymph node metastasis (P = 0.007). As the increase of the serum TSH concentration, there were significant rising trends in the prevalence of extrathyroidal extension (P = 0.009). In the patients with TSH ≥ 2.5 mIU/L, the prevalences of extrathyroidal extension (P = 0.006) and lateral lymph node metastasis (P = 0.024) were also significantly higher. Using multiple logistic regression, preoperative TSH level was a predictive factor for the presence of extrathyroidal extension (P = 0.008) and lateral lymph node metastasis (P = 0.025). Hashimoto's thyroiditis itself was not associated with the status of extrathyroidal extension and lateral lymph node metastasis. In conclusion, preoperative TSH levels were associated with lateral lymph node matastasis, a novel finding, and extrathyroidal extension in well differentiated thyroid cancer and might be useful as a preoperative supplementary marker for determining the optimal extent of differentiated thyroid cancer surgery in Korean patients.

A Pilot Study of Serum Selenium, Vitamin D, and Thyrotropin Concentrations in Patients with Thyroid Cancer

“…The findings of higher TSH levels and advanced stage have been reported previously (24). A finding of higher TSH levels and the presence of lymph-node metastases has also been reported before (26,27,49). Our data also suggest that TSH concentrations are associated with the number of positive lymph nodes.…”

“…Not only are those individuals with higher TSH values more likely to have thyroid cancer than benign thyroid histology (22)(23)(24)(25), but also within those individuals with malignancy, higher TSH concentrations are associated with extrathyroidal extension (24,26) and lymph-node metastases (26,27). In contrast to the well-established link between TSH levels and thyroid malignancy, the little data concerning vitamin D levels and thyroid cancer are scant and inconsistent (28,29).…”

2013 ETA Guideline: Management of Subclinical Hypothyroidism

“…Studying 10,178 patients undergoing thyroid fine-needle aspiration with 942 thyroid nodules confirmed by histological evaluation, Fiore et al [43] established a positive correlation between serum TSH levels and risk of thyroid malignancy. This relationship is discernible at all ages and also appears to be associated with the histological stage of the disease [44,45]. Correspondingly, the large study of 27,914 patients showed that treatment with L -thyroxine was associated with a lower risk of cancer [43].…”

Serum TSH and Risk of Papillary Thyroid Cancer in Nodular Thyroid Disease

“…In the papers of Haymart et al (29,30) (65) have shown that preoperative TSH levels are a predictive factor for the presence of extrathyroidal extension (P ϭ 0.008) and lateral lymph node metastasis (P ϭ 0.025) in patients with thyroid cancer. These observations may be relevant for including thyroid function as one of the clinical parameters to consider in the evaluation of the risk of PTC in patients with nodular thyroid diseases.…”