title: Preoperative TSH level and risk of thyroid cancer in patients with nodular thyroid disease: nodule size contribution.
abstract: BACKGROUND
  Many reports have supported the relationship between high preoperative TSH levels and risk of thyroid cancer in nodular thyroid disease (NTD).
  
  
  OBJECTIVE
  We investigated whether TSH levels are related to the risk of differentiated thyroid carcinoma (DTC) in patients who have undergone total thyroidectomy for NTD. The relationship between TSH and size of malignant nodule was investigated. Finally, we assessed whether TSH levels are related to DTC and presence of additional benign nodules.
  
  
  METHODS
  A retrospective study of 980 patients was conducted. Variables included age at diagnosis, TSH level, nodule size, gender, final histology (benign versus DTC), and type of malignancy.
  
  
  RESULTS
  Malignancy was present in 261 (26.6%) patients. These patients had higher median TSH levels as compared to those with no malignancy (1.61 mU/L (0.9-2.5) versus 0.9 mU/L (0.3-1.6); p-value<0.001). TSH was higher in patients with DTC in whom the largest nodule was malignant than in patients in whom the largest nodule was benign (1.80 mU/L (1.1-2.6) versus 1.38 mU/L (0.7-2.1) respectively; p-value=0.025). A significant correlation was seen between malignant nodule size and TSH level, but not between TSH levels and size of the largest benign nodule.
  
  
  CONCLUSIONS
  Our study supported an association between preoperative TSH levels and risk of DTC in patients with NTD. There was also a direct relationship between malignant nodule size and TSH levels. By contrast, no relationship was found between the size of benign nodules and TSH levels.
authors: Department of Endocrinology, Hospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain. Electronic address: 26276czl@comb.cat.
authors: Carles
authors: C
authors: Zafón
authors: Department of Endocrinology, Hospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain.
authors: Gabriel
authors: G
authors: Obiols
authors: Department of Endocrinology, Hospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain.
authors: Jordi
authors: J
authors: Mesa
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000097:blood* / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006044:Goiter, Nodular / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000097:blood* / Q000473:pathology*; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy; D013972:Thyrotropin / Q000097:blood*
chemical_list: D013972:Thyrotropin
keywords: Cáncer de tiroides; Enfermedad nodular tiroidea; Hormona paratiroidea; Nodular thyroid disease; TSH; Thyroid cancer