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Correlation between serum TSH and malignancy potential of thyroid nodules

Mira Siderova, Kiril Hristozov, Ivan Krasnaliev, Mila Boyadzieva, Yana Bocheva, Radoslav Radev, Rumen Nenkov



Recent studies have reported that higher levels of TSH are associated with an increased incidence of thyroid malignancy in patients with nodular thyroid disease. However, different conditions may affect TSH concentration. The aim of our study was to correlate serum TSH levels in patients with thyroid nodules with cytological and histological results.


1483 consecutive patients (1339 women and 144 men) with nodular thyroid disease were evaluated by ultrasound-guided fine needle aspiration biopsy (FNAB) with cytological results classified as nondiagnostic, benign, follicular lesion, suspicious or malignant. Serum levels of TSHwere measured at presentation by chemiluminescent immunoassay. 390 of the patients were operated and final histology proved 83 carcinomas.


The overall sensitivity and specificity of FNAB in predicting malignancy were 90,32% and 81,11%, respectively. Mean TSH in cytologically benign nodules was 1,7032,569 mU/l, in follicular lesions 2,3934,119 mU/l, in suspicious nodules 2,3262,317 mU/l and in malignant on cytology nodules 3,0452,781 mU/l. Although in the reference range TSH levels in malignant cytologies were significantly higher that those in benign cases (p<0,0001). This relationship was confirmed among operated cases where mean preoperative TSH was significantly higher in histologically malignant than benign nodules (TSH 3,387 vs. 1,613 mU/l; p<0,0001). In order to eliminate the factors influencing TSH concentration, we excluded all patients with thyroid autonomy, Hashimoto`s thyroiditis (positive antibodies, US appearance, lymphocytic infiltration on histology) and those on levothyroxin or thyrostatic treatment. Among the rest of the patients, mean TSH value remained significantly lower in benign than malignant cases (1,370 vs. 2,805 mU/l; p<0,0001).


Our results suggest a direct relationship between serum TSH and risk of malignancy in thyroid nodules both in cytological and histological series after excluding the influence of different thyroid diseases and medication.


thyroid stimulating hormone (TSH); thyroid nodules; nodular goiter; thyroid carcinoma; malignancy

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