ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
ORIGINAL ARTICLE

Ratio of Thyrotropin to Thyroglobulin as a Novel Marker for Differentiating Between Benign and Malignant Thyroid Nodules within Different Bethesda Categories
Benign ve Malign Tiroid Nodüllerinin Ayrımında ve Farklı Bethesda Kategorilerinde Yeni bir Belirteç Olarak Tirotropin Tiroglobulin Oranı
Doi: 10.25179/tjem.2017-58803 - Makale Dili: EN
Turk J Endocrinol Metab 2018;22:21-31
ABSTRACT
Objective: We aimed to determine whether the ratio of thyrotropin (TSH) to thyroglobulin (Tg) (TSH/Tg) would be able to asist in predicting malignancy in thyroid nodules. Material and Methods: Euthyroid patients operated between the year 2007 and 2014 were retrospectively reviewed. Patients who previously had thyroid disease or surgery and those with increased levels of anti-thyroglobulin antibodies were excluded from this study. Clinicopathological features, as well as serum TSH, Tg, and TSH/Tg were compared between histopathologically benign and malignant groups. Results: Data related to 370 (60.3%) benign and 244 (39.7%) malignant patients were analyzed. The malignant patients exhibited significantly higher TSH, TSH/Tg, and total thyroid volume, and a lower Tg compared to the benign patients (p<0.001 for each). There were 924 (74.2%) benign and 321 (25.8%) malignant nodules. Cytological distribution of the nodules was observed to be as follows: 343 (27.6%) nondiagnostic, 637 (51.2%) benign, 121 (9.7%) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 39 (3.1%) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 64 (5.1%) suspicious for malignancy (SM), and 41 (3.3%) malignant. TSH, Tg, and TSH/Tg were significantly different in different Bethesda categories (p<0.001 for each). Median TSH/Tg was the lowest in benign (0.013), and highest in SM (0.054) and malignant (0.086) cytologies. TSH/Tg was significantly higher in the malignant nodules compared to benign nodules, in AUS/FLUS, FN/SFN, and SM categories (p=0.001, p<0.001, and p=0.003, respectively). In the regression analysis, TSH/Tg demonstrated higher diagnostic performance compared to TSH and Tg (p<0.001). Discussion: Preoperative TSH/Tg could be used as a novel marker for differentiating between benign and malignant thyroid nodules. It could also assist in the prediction of risk of malignancy and management decisions when the cytology is indeterminate.
ÖZET
Amaç: Malign ve benign tiroid nodüllerinin ayırımında yeni bir prediktif markır olarak tirotropin (TSH) tiroglobulin (Tg) oranını araştırmayı amaçladık. Gereç ve Yöntemler: 2007 ve 2014 arasında opere edilen ötiroid hastalar retrospektif olarak değerlendirildi. Tiroid hastalığı veya cerrahi öyküsü olanlar ve artmış anti-tiroglobulin antikorları olanlar dışlandı.Histopatolojik olarak benign ve malign gruplar klinikopatolojik özellikler ve serum TSH, Tg, TSH/Tg oranı açısından karşılaştırıldı. Bulgular: 370 (%60.3) benign ve 244 (%39.7) malign hasta vardı.Benign hastalara göre malign hastalarda anlamlı olarak yüksek TSH, TSH/Tg ve total tiroid hacmi ve düşük Tg vardı (her biri için, p<0.001). (%74.2) benign ve 321 (%25.8) malign nodül vardı. Sitopatalojik dağılım şöyleydi; 343 (%27.6) nondiagnostik, 637 (%51.2) benign, 121 (%9.7) önemi belirlenemeyen atipi/önemi belirlenemeyen folliküler lezyon (ÖBA/ÖBFL), 39 (%3.1) folliküler neoplazi/folliküler neoplazi şüphesi (FN/FNŞ), 64 (%5.1) malignite şüphesi (MŞ) ve 41 (%3.3) malign. TSH, Tg ve TSH/Tg Bethesda kategorilerinde anlamlı olarak farklıydı (her biri için p<0.001). Median TSH/Tg benignde (0.013) en düşük ve MŞ (0.054) ve malign sitolojilerde (0.086) en yüksekti. ÖBA/ÖBFL, FN/FNŞ ve MŞ kategorilerinde, TSH/Tg oranı malign nodüllerde benign nodüllere göre yüksek bulundu (sırasıyla, p=0.001, p<0.001 ve p=0.003). Regresyon analizinde TSH/Tg; TSH ve Tg'ye göre daha yüksek tanısal performansa sahipti (p<0.001). Tartışma: TSH/Tg ameliyat öncesinde benign ve malign tiroid nodüllerinin ayırımında yeni bir marker olarak kullanılabilir. Ayrıca indetermine sitolojisi olan nodüllerde malignite riskinin belirlenmesine ve yönetimine yardımcı olabilir.