title: Higher TSH can be used as an additional risk factor in prediction of malignancy in euthyroid thyroid nodules evaluated by cytology based on Bethesda system.
abstract: Recently, it has been suggested that thyrotropin (TSH) concentration can be used as a marker for prediction of thyroid malignancy. In this study, we aimed to investigate the association between TSH levels and prediction of malignancy in euthyroid patients with different Bethesda categories. The data of 1433 euthyroid patients with 3206 thyroid nodules who underwent thyroidectomy were screened retrospectively. The preoperative cytology results, thyroid function tests, thyroid autoantibodies, and presence of histopathological Hashimoto's thyroiditis (HT) were recorded. Of the 1433 patients, 585 (40.8 %) had malignant and 848 (59.2 %) had benign histopathology. Malignant group had smaller nodule size, elevated TSH levels, and higher rate of presence of HT compared to benign group (p < 0.001, all). Cytology results of 3206 nodules were as follows: 832 nondiagnostic (ND), 1666 benign, 392 atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 68 follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 133 suspicious for malignancy (SM), and 115 malignant. Both SM and malignant cytology groups had higher TSH levels than other 4 Bethesda categories (p < 0.05, all). Benign cytology group had significantly lower TSH levels compared to other cytology groups (p < 0.05, all). Patients with malignant final histopathology in ND and AUS/FLUS cytology groups had significantly higher TSH levels compared to patients with benign final histopathology (p < 0.05, all). Moreover, TSH levels showed to increase from Bethesda categories II to VI. In addition to cytology, higher TSH levels can be used as a supplementary marker in prediction of malignancy in certain Bethesda categories.
authors.affiliation: Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey. drhusniyebaser@yahoo.com.tr.
authors.forename: Husniye
authors.initials: H
authors.lastname: Baser
authors.affiliation: Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Oya
authors.initials: O
authors.lastname: Topaloglu
authors.affiliation: Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Abbas Ali
authors.initials: AA
authors.lastname: Tam
authors.affiliation: Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey.
authors.forename: Berna
authors.initials: B
authors.lastname: Evranos
authors.affiliation: Department of Biostatistics, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Afra
authors.initials: A
authors.lastname: Alkan
authors.affiliation: Department of Pathology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Nuran
authors.initials: N
authors.lastname: Sungu
authors.affiliation: Department of General Surgery, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Ersin Gurkan
authors.initials: EG
authors.lastname: Dumlu
authors.affiliation: Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Reyhan
authors.initials: R
authors.lastname: Ersoy
authors.affiliation: Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Bekir
authors.initials: B
authors.lastname: Cakir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D044963:Biopsy, Fine-Needle; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000097:blood / Q000473:pathology*; D016606:Thyroid Nodule / Q000097:blood / Q000473:pathology*; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine
keywords: Bethesda categories; Cytology; Thyroid malignancy; Thyrotropin