The utility of preoperative serum thyroid-stimulating hormone level for predicting malignant nodular thyroid disease.
BACKGROUND
The aim of this study was to assess whether serum thyroid-stimulating hormone (TSH) levels are of value in predicting malignancy in patients with nodular thyroid disease (NTD).


METHODS
Patients with NTD and a preoperative TSH level who underwent thyroidectomy between 1990 and 2008 were identified from a prospective database. Age, sex, TSH concentration, nodule size, and pathology were evaluated. Logistic regression analysis was used to determine which factors were predictive of malignancy.


RESULTS
Six hundred fifty-three patients were analyzed. The overall rate of malignancy was 20%; the rate was highest in patients<30 years (32%). The mean TSH level was higher in the malignant group (5.5 microIU/mL vs 1.4 microIU/mL, P<.0001). The rate of malignancy was 65% in patients with TSH levels>5.5 microIU/mL. Logistic regression analysis revealed that TSH level was the only significant risk factor for malignancy.


CONCLUSIONS
The serum TSH level may be useful in predicting the probability of cancer and optimizing the extent of thyroidectomy in patients with NTD.
Department of Surgery, MetroHealth Medical Center, 2500 Metrohealth Drive, Cleveland, OH 44109-1998, USA.
Judy
J
Jin
Rhoderick
R
Machekano
Christopher R
CR
McHenry
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D016606:Thyroid Nodule / Q000097:blood / Q000175:diagnosis / Q000601:surgery; D013972:Thyrotropin / Q000097:blood*
D015415:Biomarkers; D013972:Thyrotropin