Clinical implications of preoperative thyrotropin serum concentrations in patients who underwent thyroidectomy for nonfunctioning nodule(s)

Development and validation of the nomogram based on ultrasound, thyroid stimulating hormone, and inflammatory marker in papillary thyroid carcinoma: a case-control study

Background

The increase in the number of thyroid cancer cases in recent years has increased not only the medical burden but also the potential for overtreatment. Therefore, it is crucial to distinguish papillary thyroid cancer from benign thyroid nodules before surgery when treating thyroid nodules.

Methods

The patients were divided into two groups: 117 patients made up the validation cohort and 414 patients made up the primary cohort. As a result of the primary cohort, a preoperative prediction model was developed, which was then validated externally in the validation cohort. Preoperative thyrotropin (thyroid stimulating hormone, TSH), systemic immune-inflammation index (SII), lymphocyte-to-monocyte ratio (LMR), and ultrasonographic features were recorded in both groups.

Results

As predictors for the model, the preoperative blood levels of TSH, SII, LMR, echogenicity, margin, calcification, composition, taller-than-wide, and age were chosen. This was the regression equation: Y = -0.070 × (age) + 1.511 × (echogenicity) + 1.664 × (margin) + 1.003 × (calcification) + 0.939 × (composition) + 2.964 × (tall than wide) + 0.305 × (TSH) + 0.558 × (SII) - 1.271 × (LMR) + 0.327. Papillary thyroid carcinoma (PTC) was predicted positively with values of Y ≥0.808. The prediction model's accuracy, sensitivity, and specificity were 88.2%, 85.1%, and 94.9%, respectively. The area under the receiver operating characteristic (ROC) curve was 0.961. The model's external validation produced satisfactory results with accuracy, sensitivity, and specificity of 85.5%, 90.9%, and 75.5%, respectively.

Conclusions

Using the preoperative TSH, SII, LMR, and ultrasonographic characteristics, a straightforward and accurate preoperative prediction model for PTC has been developed and validated. The preoperative assessment of PTC in clinical application is enhanced by this approach.

Association between preoperative serum TSH and tumor status in patients with papillary thyroid microcarcinoma

Thyroid-stimulating hormone (TSH) is a growth factor affecting the initiation or progression of papillary thyroid cancer (PTC). However, the relationship between preoperative serum TSH and papillary thyroid microcarcinoma (PTMC) remains controversial. To investigate the relationship between preoperative serum TSH and tumor status of PTMC, a multicentered retrospective study was performed from January 2014 to December 2016. The cohort of this study consisted of 1997 patients who underwent thyroid surgery. Serum TSH concentrations were measured and PTMC was diagnosed based on the post-operation pathological report. Results showed that the preoperative serum TSH concentration was not related to age and gender but was positively associated with tumor size. Furthermore, higher TSH level was associated with extra-thyroidal extension and lymph node metastasis (LNM). These results indicated that TSH might not be involved in the development of PTMC but may be associated with PTMC progression. Preoperative serum TSH concentration should be considered as risk predictor for tumor progression in patients with PTMC.

The Relationship of Clinicopathological Factors of the Tumor with Preoperative TSH Level in Papillary Thyroid Cancers

Objective

Thyroid-stimulating hormone/thyrotropin (TSH) is known to induce malignancies and tissue growth of the thyroid gland. While the relationship of higher levels of TSH with advanced stages of cancer had been published in previous studies, the relationship of the tumor with the clinicopathological factors had not been completely evaluated. The aim of the present study was to evaluate the relationship between highly risky clinicopathological factors with preoperative high levels of TSH.

Materials and Methods

The records of 89 patients (67 females and 22 males) who underwent surgery for differentiated thyroid cancer between 2011 and 2013 were reviewed. The relationship of preoperative TSH between tumor size, multicentricity, lymphovascular invasion, extrathyroidal extension, central neck metastasis, and lateral neck metastasis was evaluated.

Results

The preoperative TSH levels were high in patients with multicentricity (p=0.022), lymphovascular invasion (p=0.018), and central neck metastasis (p=0.002). The prevalence of extrathyroidal extension (p=0.41), lymphovascular invasion (p=0.020), and central metastasis (p=0.009) was significantly high in patients with a TSH level ≥2.5 mIU/L. The preoperative TSH levels were determined as an independent predictive risk factor for central neck metastases (p=0.012) and extrathyroidal extension (p=0.041) in multinomial logistical regression analysis.

Conclusion

The power of radiological imaging for the identification of central neck metastases in preoperative evaluation is limited. The preoperative high level of TSH is an independent predictive factor for central metastases and extrathyroidal extension. It can help to predict tumor staging. Furthermore, related with multicentricity and lymphovascular invasion, it can affect the high risk characteristics of the tumor except the stage. The preoperative TSH level can be considered for the probability of preoperative metastases and can contribute to plan the extent of surgery.

The increasing prevalence of chronic lymphocytic thyroiditis in papillary microcarcinoma

Although the incidence of some malignancy has decreased over the recent years, this is not the case of papillary thyroid microcarcinoma (PTMC), whose incidence has increased worldwide. Most PTMC are found incidentally after histological examination of specimens from surgery for benign thyroid disease. Hashimoto's thyroiditis, whose incidence has also increased, coexists in about one in three PTMC patients. Three different mechanisms have been proposed to clarify the association between chronic lymphocytic thyroiditis and PTMC, namely tumor development/growth by: (i) TSH stimulation, (ii) expression of certain proto-oncogenes, (iii) chemokines and other molecules produced by the lymphocytic infiltrate. Whether Hashimoto's thyroiditis protects against lymph node metastasis is debated. Overall, autommune thyroiditis seems to contribute to the favorable prognosis of PTMC. Major limitations of the studies so far performed include: (i) retrospective design, (ii) limited statistical power, (iii) high risk of selection bias, (iv) and predominant Asian ethnicity of patients. Full genetic profiling of both diseases and identification of environmental factors capable to trigger them, as well as well-powered prospective studies on different ethnical groups, may help understand their causal association and why their frequencies are continuing raising.

The Effect of Thyroid-Stimulating Hormone on Tumor Size in Differentiated Thyroid Carcinoma

We evaluated the correlation between serum thyroid-stimulating hormone (TSH) levels and tumor size and other invasiveness parameters of tumor in patients with differentiated thyroid carcinoma (DTC). Several clinical studies have reported that TSH may also have a role as a regulator of the development and function of the thyroid gland. It is currently not clear whether TSH is involved in the existence of thyroid cancer or progression of thyroid cancer or both. Patients with DTC who underwent thyroid surgery between 2003 and 2008 were included this study. Preoperative serum T3, T4, and TSH levels were compared with the size and invasiveness of cancer, retrospectively. DTC was observed in 110 patients over the 5-year period. Seventy-seven (70 %) of them were euthyroid and classified as the "normal-TSH group" (NTG), and 33 (30 %) have an overt or subclinical hyperthyroidism, classified as the "low-TSH group" (LTG). The mean tumor diameter in the LTG was found to be 8.91 ± 8.03 mm; however, it was found to be 18.19 ± 16.24 mm in the NTG. There were significantly differences among the groups related to the diameter of tumor (p = 0.001). Microcarcinoma was determined in 36 patients (46.8 %) in the NTG and 23 patients (69.7 %) in the LTG (p = 0.027). Although there were no significant differences, tumor capsule invasion (33.8 vs. 18.2 %, p = 0.099) and lymphovascular invasion (16.9 vs. 6.1 %, p = 0.130) rates were higher in the NTG. These findings suggest that TSH has effects on growing and proliferation of not only normal thyroid cells but also cancer cells in DTC. This study revealed that serum TSH level can be explored as an important factor that affects the size and invasiveness of tumor in DTC.

Retrospective evaluation of the incidental finding of 403 papillary thyroid microcarcinomas in 2466 patients undergoing thyroid surgery for presumed benign thyroid disease

Background

The aim of our study was to investigate the incidence of papillary thyroid microcarcinoma (PTMC) in patients operated for benign thyroid diseases (BTD) and its relation to age, sex, extent of surgery and type of BTD.

Methods

Retrospective study of 2466 patients who underwent thyroid surgery for BTD from 2008 to 2013. To determine independent predictors for PTMC we used three separate multivariate logistic regression models (MLR).

Results

There were 2128 (86.3%) females and 338 (13.7%) males. PTMC was diagnosed in 345 (16.2%) females and 58 (17.2%) males. Age ranged from 14 to 85 years (mean 54 years). Sex and age were not related to the incidence of PTMC. The overall incidence of PTMC was 16.3%. The highest incidence was in Hashimoto thyroiditis (22.7%, χ² = 10.80, p < 0.001); and in patients with total/near-total thyroidectomy (17.7%, χ² = 7.05, p < 0.008). The lowest incidence (6.6%, χ² = 9.96, p < 0.001) was in a solitary hyperfunctional thyroid nodule (SHTN). According to MLR, Hashimoto thyroiditis (OR 1.54, 95% CI 1.15-2.05, p < 0.003) and SHTN (OR 0.43, 95% CI 0.21-0.87, p < 0.019) are independent predictors. Since the extent of surgery was an independent predictor (OR 1.45, 95% CI 1.10-1.92, p = 0.009) for all BTD, and sex and age were not; when the MLR model was adjusted for them, Graves disease (OR 0.72, 95% CI 0.53-0.99, p < 0.041) also proved to be an independent predictor.

Conclusions

Sex and age are not statistically related to the incidence of PTMC in BTD. The incidence of PTMC is higher in Hashimoto thyroiditis and patients with total/near-total thyroidectomy; and lower in patients with a SHTN and Graves disease.

Clinical significance of BRAF V600E mutation in 154 patients with thyroid nodules

The aim of the present study was to investigate the prevalence of the BRAF V600E mutation in papillary thyroid carcinoma (PTC) patients from eastern coastal China and to determine whether it is correlated with the clinicopathological features of PTCs with or without current Hashimoto thyroiditis (HT). The BRAF V600E mutation status was analyzed in 206 thyroid nodules of 154 patients undergoing thyroidectomy using polymerase chain reaction and bi-directional sequencing. Multivariate analysis was performed to investigate the association of the BRAF V600E mutation with clinicopathological features. Thyroid nodules were classified as PTC, nodular goiter (NG), adenomatoid nodule, adenoma and HT. The BRAF V600E mutation was observed in 61.5% of PTCs analyzed; it was also detected in one normal tissue adjacent to PTC and one NG. One patient exhibited double mutations in the BRAF gene; the BRAF V600E mutation in the PTC lesion and the BRAF K601E mutation in the contralateral NG lesion. Patients harboring the BRAF V600E mutation had higher thyroid stimulating hormone levels (2.453±1.464 vs. 1.966±1.296 mIU/l), a reduced occurrence of papillary thyroid microcarcinoma (55.0 vs. 88%), and a higher occurrence of lymph node metastasis (LNM; 42.5 vs. 16.0%) compared with those with wild-type BRAF (all P<0.05). Binary logistic regression analysis revealed that the BRAF V600E mutation was associated with LNM of PTC (hazard ratio, 5.051; 95% confidence interval, 1.068-23.893; P=0.041). Conversely, no association was identified between the BRAF V600E mutation and HT (38.5 vs. 67.3%, χ2=3.656, P=0.056). Thus, in regional PTCs, the BRAF V600E mutation was prevalent, suggesting that it may be an early and phenotypically defining molecular event in PTC, and may represent an independent factor that predicts LNM.

The Neutrophil-to-Lymphocyte Ratio Correlates with Age in Patients with Papillary Thyroid Carcinoma

AIM

The aim of this study is to explore the relationship between the neutrophil-to-lymphocyte ratio (NLR) and clinicopathological features in patients with papillary thyroid carcinoma (PTC).

METHODS

We performed an analysis of 843 patients, including 321 patients with PTC, 83 patients with thyroid adenoma and 439 patients with nodular goiter (NG). Thyroglobulin and thyrotropin were measured in each patient. Neutrophils, lymphocytes, and platelets were counted. Statistical analysis was used to correlate the NLR with demographic and histopathologic characteristics of the patients.

RESULT

Age correlated with NLR and lymphocyte number in patients with PTC and NG. In patients aged >45 years, those with PTC had a higher NLR and a lower lymphocyte count than those with NG. Patients with PTC aged <45 years had a higher leukocyte count and a lower NLR than those aged ≥45 years. Patients with clinical stage I/II PTC had a lower NLR and a higher lymphocyte count than patients with stage III/IV.

CONCLUSIONS

Younger patients with PTC had a higher lymphocyte count but a lower NLR than older patients with PTC. The NLR and lymphocyte counts were associated with the clinical stage. Thus, a higher NLR and a lower lymphocyte count may be prognostic for stratifying patients with thyroidal goiters and are risk factors of PTC for older patients.