Kristine Zøylner Swan1,2, Viveque Egsgaard Nielsen3, Christian Godballe4, Jens Faunø Thrane5,6, Marie Riis Mortensen7, Sten Schytte5, Henrik Baymler Pedersen6, Peer Christiansen8, Steen Joop Bonnema7. 1. Department of Oto-rhino-laryngology (ORL) Head & Neck Surgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark. kristineswan@dadlnet.dk. 2. Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark. kristineswan@dadlnet.dk. 3. Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark. 4. Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark. 5. Department of Oto-rhino-laryngology (ORL) Head & Neck Surgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark. 6. Department of ORL Head & Neck Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. 7. Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark. 8. Department of Plastic and Breast surgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
Abstract
PURPOSE: To investigate the association between the pre-operative serum TSH (s-TSH) level and differentiated thyroid carcinoma (DTC) in a mildly iodine-deficient area. METHODS: Patients undergoing surgery for thyroid nodular disease (TND) were included from three tertiary surgical departments. Data were collected from a national thyroid surgery database (THYKIR) and from patient charts. Individuals with overtly coexisting thyroid disorders were excluded for subgroup analyses. Patients were compared with the Danish background population, employing previous data from DanThyr, a study initiated to monitor the iodine fortification program in Denmark. RESULTS: Nine-hundred ninety-eight patients [cases/controls: 265/733; female/male: 794/204; age (mean ± SD): 51 ± 15 years] were included. S-TSH was significantly higher in the DTC group [median (IQR): 1.3 (0.9-1.9 mIU/L)] compared with the benign TND group [0.9 (0.6-1.5 mIU/L)] (p < 0.0001). The median s-TSH in the background population was similar to that found among DTC patients (p = 1.00), but markedly higher than the s-TSH level in the benign TND group (p < 0.0001). There was no association between s-TSH and DTC disease stage (p = 0.08-0.87). CONCLUSIONS: s-TSH was significantly higher in patients with DTC than in those with benign TND. However, this difference can be explained by abnormally lower s-TSH level in the latter group, probably caused by subtle nodular functional autonomy. Due to the huge overlap and the small difference in median s-TSH between patients with benign and malignant TND, s-TSH is not suitable as a biomarker of DTC in a clinical setting.
PURPOSE: To investigate the association between the pre-operative serum TSH (s-TSH) level and differentiated thyroid carcinoma (DTC) in a mildly iodine-deficient area. METHODS:Patients undergoing surgery for thyroid nodular disease (TND) were included from three tertiary surgical departments. Data were collected from a national thyroid surgery database (THYKIR) and from patient charts. Individuals with overtly coexisting thyroid disorders were excluded for subgroup analyses. Patients were compared with the Danish background population, employing previous data from DanThyr, a study initiated to monitor the iodine fortification program in Denmark. RESULTS: Nine-hundred ninety-eight patients [cases/controls: 265/733; female/male: 794/204; age (mean ± SD): 51 ± 15 years] were included. S-TSH was significantly higher in the DTC group [median (IQR): 1.3 (0.9-1.9 mIU/L)] compared with the benign TND group [0.9 (0.6-1.5 mIU/L)] (p < 0.0001). The median s-TSH in the background population was similar to that found among DTCpatients (p = 1.00), but markedly higher than the s-TSH level in the benign TND group (p < 0.0001). There was no association between s-TSH and DTC disease stage (p = 0.08-0.87). CONCLUSIONS: s-TSH was significantly higher in patients with DTC than in those with benign TND. However, this difference can be explained by abnormally lower s-TSH level in the latter group, probably caused by subtle nodular functional autonomy. Due to the huge overlap and the small difference in median s-TSH between patients with benign and malignant TND, s-TSH is not suitable as a biomarker of DTC in a clinical setting.
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