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

The Relationship Between TSH Level and Stage of Differentiated Thyroid Carcinoma
Diferansiye Tiroid Karsinomunun Evresi ile TSH Düzeyi Arasındaki İlişki
Received Date : 18 Apr 2020
Accepted Date : 25 Jun 2020
Available Online : 21 Jul 2020
Doi: 10.25179/tjem.2020-74747 - Makale Dili: EN
Turk J Endocrinol Metab. 2020;24:230-236
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: The aim of this study was to determine whether thyroid-stimulating hormone (TSH) levels during the diagnosis of patients with differentiated thyroid carcinoma could be used for the prediction of cancer behavior. Material and Methods: The records of 329 patients with differentiated thyroid carcinoma who did not use levothyroxine at the time of diagnosis were reviewed retrospectively. The demographic and clinical characteristics of the cases and serum TSH levels were recorded at the time of diagnosis and statistically analyzed. Results: A total of 329 cases with 322 papillary carcinomas and 7 follicular carcinomas were included in the study. The median age of the participants at the time of diagnosis was 45 (17-76) years. Eighty-three percent of the cases were diagnosed in stage 1, 6.7% in stage 2, 3.3% in stage 3, and 7.0% in stage 4. The median serum TSH level at the time of diagnosis of the cases was 1.34 (0.01- 9.97) mIU/mL. We did not observe any statistically significant relationship between the serum TSH level and the stage of differentiated thyroid carcinoma, although higher serum TSH level was associated with lymph node metastasis and higher risk group in the American Thyroid Association (ATA) classification. Conclusion: The relationship between serum TSH level and thyroid cancer has not been clearly determined, but high TSH levels at the time of diagnosis were found to be associated with lymph node metastasis and medium-high ATA risk score.
ÖZET
Amaç: Bu çalışmanın amacı, diferansiye tiroid karsinomlu hastaların tanı anındaki tiroid stimüle edici hormon (TSH) düzeylerinin kanser davranışını tahmin etmek için kullanılıp kullanılamayacağını belirlemekti. Gereç ve Yöntemler: Çalışmada tanı anında levotiroksin kullanmayan diferansiye tiroid karsinomlu 329 hastanın kayıtları retrospektif olarak incelendi. Olguların demografik ve klinik özellikleri ile tanı anındaki serum TSH düzeyleri kaydedildi ve istatistiksel olarak analiz edildi. Bulgular: Çalışmaya, toplam 329 (322'si papiller, 7'si foliküler karsinomlu) olgu dâhil edildi. Katılımcıların tanı anındaki ortanca yaşı 45 (17-76) yıl idi. Olguların %83'ü evre 1, %6,7'si evre 2, %3,3'ü evre 3 ve %7,0'ı evre 4 olarak teşhis edildi. Olguların tanı anında medyan serum TSH düzeyi 1,34 (0,01-9,97) mIU/mL idi. Serum TSH düzeyi ile diferansiye tiroid karsinomunun evresi arasında istatistiksel olarak anlamlı bir ilişki gözlemlemedik, ancak yüksek serum TSH düzeyi, "American Thyroid Association (ATA)" sınıflandırmasına göre lenf nodu metastazı ile ilişkili bulunmuştur. Sonuç: Serum TSH düzeyi ile tiroid kanseri arasındaki ilişki net olarak belirlenmemiştir, ancak tanı anındaki yüksek TSH düzeyleri lenf nodu metastazı ve orta-yüksek ATA risk skoru ile ilişkili bulunmuştur.
KAYNAKLAR
  1. Burinicardi FC. Schwartz's principels of surgery. In: Lal G, Clark HO, eds. Thyroid, Parathyroid, Adrenal. (9th ed). Newyork: McGraw Hill Company; 2010:1343-1408.
  2. Şencan İ, Keskinkılıç B. Türkiye Kanser İstatistikleri. Ankara: T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu; 2017. p.48.
  3. Jameson JL, De Groot LJ. Endocrinology. (6th ed). Philadelphia: Elsevier Health Sciences; 2010. p.3064.
  4. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differantiated thyroid cancer. Thyroid. 2009;19:1167-1214. [Crossref]  [PubMed] 
  5. Jameson JL, Weetman AP. Thyroid cancer. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison's Principles of Internal Medicine. (15th ed). St. Louis: McGraw-Hill; 2001:2079-2083.
  6. Bulotta S, Celano M, Costante G, Russo D. Emerging strategies for managing differentiated thyroid cancers refractory to radioiodine. Endocrine. 2016;52:214-221. [Crossref]  [PubMed] 
  7. Schneider AB, Ron E. Carcinoma of follicular epithelium. In: Braverman LE, Utiger RD, eds. Werner and Ingbar's the Thyroid: A Fundamental and Clinical Text. (8th ed). Philadelphia: Lippincott Williams and Wilkins; 2000:878-886.
  8. McLeod DSA, Cooper DS, Ladenson PW, Ain KB, Brierley JD, Fein HG, Haugen BR, Jonklaas J, Magner J, Ross DS, Skarulis MC, Steward DL, Maxon HR, Sherman SI; The National Thyroid Cancer Treatment Cooperative Study Group. Prognosis of differentiated thyroid cancer in relation to serum thyrotropin and thyroglobulin antibody status at time of diagnosis. Thyroid. 2014;24:35-42. [Crossref]  [PubMed]  [PMC] 
  9. Mazurat A, Torroni A, Hendrickson-Rebizant J, Benning H, Nason RW, Pathak KA. The age factor in survival of a population cohort of well-differentiated thyroid cancer. Endocr Connect. 2013;2:154-160. [Crossref]  [PubMed]  [PMC] 
  10. Johnston LE, Cao HST, Chang DC, Bouvet M. Sociodemographic predictors of survival in differentiated thyroid cancer: results from the SEER database. ISRN Endocrinol. 2012;2012:384707. [Crossref]  [PubMed]  [PMC] 
  11. Merhy J, Driscoll HK, Leidy JW, Chertow BS. Increasing incidence and characteristics of differentiated thyroid cancer in Huntington, West Virginia. Thyroid. 2001;11:1063-1069. [Crossref]  [PubMed] 
  12. Calò PG, Medas F, Pisano G, Boi F, Baghino G, Mariotti S, Nicolosi A. Differentiated thyroid cancer: indications and extent of central neck dissection--our experience. Int J Surg Oncol. 2013;2013:625193. [Crossref]  [PubMed]  [PMC] 
  13. Conzo G, Docimo G, Pasquali D, Mauriello C, Gambardella C, Esposito D, Tartaglia E, Della Pietra C, Napolitano S, Rizzuto A, Santini L. Predictive value of nodal metastases on local recurrence in the management of differentiated thyroid cancer. Retrospective clinical study. BMC Surgery. 2013;13:S3. [Crossref]  [PubMed]  [PMC] 
  14. Pelizzo MR, Boschin IM, Toniato A, Piotto A, Bernante P, Pagetta C, Rampin L, Rubello D. Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. Eur J Surg Oncol. 2006;32:1144-1148. [Crossref]  [PubMed] 
  15. Chow SM, Law SCK, Chan JKC, Au SK, Yau S, Lau WH. Papillary microcarcinoma of the thyroid-prognostic significance of lymph node metastasis and multifocality. Cancer. 2003;98:31-40. [Crossref]  [PubMed] 
  16. Guo K, Wang Z. Risk factors influencing the recurrence of papillary thyroid carcinoma: a systematic review and meta-analysis. Int J Clin Exp Pathol. 2014;7:5393-5403. [PubMed] 
  17. Kocak M, Koseoglu R, Sonmez B, Turkyilmaz S, Dogan I, Ersoz HO, Erem C. Evaluatıon of recurrence risk in differentiated thyroid cancer after treatment. In: Arlt W, Visser J, Beuschlein F, eds. Dublin: Bioscientifica; Endocrine Abstracts. 2015. p.416. [Crossref] 
  18. Karacavus S, Caglayan K, Sahin S, Sipahi M, Bal A, Arslan E, Seckin S, Suher M. Yozgat bölgesinde diferansiye tiroid kanseri nedeniyle takip edilen hastaların klinik ve demografik özellikleri. Bozok Med J. 2014;4:26-30. [Crossref] 
  19. Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, Brokhin M, Omry G, Fagin JA, Shaha A. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid. 2010;20:1341-1349. [Crossref]  [PubMed]  [PMC] 
  20. Tuna MM, Başaran MN, Karakılıç E, Ayçicek Doğan B, Arduç A, Işık S, Berker D, Güler S. Diagnostic and prognostic value of TSH levels in differentiated thyroid cancers. Turk Jem. 2014;1:1-4. [Crossref] 
  21. Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, Chen H. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab. 2008;93:809-814. [Crossref]  [PubMed]  [PMC] 
  22. Haymart MR, Glinberg SL, Liu J, Sippel RS, Jaume JC, Chen H. Higher serum TSH in thyroid cancer patients occurs independent of age and correlates with extrathyroidal extension. Clin Endocrinol (Oxf). 2009;71:434-439. [Crossref]  [PubMed]  [PMC] 
  23. Kim HS, Lee SJ, Park JK, Jo CH, Shon HS, Jung ED. Association between serum thyroid stimulating hormone level and papillary thyroid microcarcinoma in Korean euthyroid patients. Endocrinol Metab. 2011;26:297-302. [Crossref] 
  24. Kim KW, Park YJ, Kim EH, Park SY, Park DJ, Ahn SH, Park DJ, Jang HC, Cho BY. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto's thyroiditis. Head Neck. 2011;33:691-695. [Crossref]  [PubMed]