title: 25-Hydroxyvitamin D and TSH as Risk Factors or Prognostic Markers in Thyroid Carcinoma.
abstract: OBJECTIVE
  The increasing incidence of thyroid nodules demands identification of risk factors for malignant disease. Several studies suggested the association of higher TSH levels with cancer, but influence of 25-hydroxyvitamin D (25OHD) is controversial. This study aimed to identify the relationship of thyroid cancer with higher TSH levels and hypovitaminosis D and to evaluate their influence on prognostic characteristics of papillary thyroid carcinomas (PTC).
  
  
  METHODS
  We retrospectively evaluated 433 patients submitted to thyroidectomy for thyroid nodules. Patients were categorized according to quartiles of TSH and 25OHD levels. Clinicopathological features were analyzed.
  
  
  RESULTS
  Subjects with thyroid carcinomas were more frequently male and younger compared to those with benign disease. Their median TSH levels were higher and adjusted odds-ratio (OR) for cancer in the highest-quartile of TSH (> 2.4 mUI/mL) was 2.36 (1.36-4.09). Although vitamin D deficiency/insufficiency was prevalent in our cohort (84%), no significant differences in 25OHD levels or quartile distribution were observed between benign and malignant cases. Among 187 patients with PTC, analyses of prognostic features revealed increased risk of lymph nodes metastases for subjects with highest-quartile TSH levels (OR = 3.7, p = 0.029). Decreased 25OHD levels were not overtly associated with poor prognosis in PTC.
  
  
  CONCLUSIONS
  In this cross-sectional cohort, higher TSH levels increased the risk of cancer in thyroid nodules and influenced its prognosis, particularly favoring lymph nodes metastases. On the other hand, no association was found between 25OHD levels and thyroid carcinoma risk or prognosis, suggesting that serum 25OHD determination may not contribute to risk assessment workup of thyroid nodules.
authors.affiliation: Endocrinology, Instituto do Câncer do Estado de São Paulo, Sao Paulo, Brazil.|Laboratório de Endocrinologia Celular e Molecular (LIM25), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Debora Lucia Seguro
authors.initials: DL
authors.lastname: Danilovic
authors.affiliation: Laboratório de Investigação Médica 18 (LIM-18), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Ferraz-de-Souza
authors.affiliation: Laboratório de Endocrinologia Celular e Molecular (LIM25), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Amanda Wictky
authors.initials: AW
authors.lastname: Fabri
authors.affiliation: Laboratório de Endocrinologia Celular e Molecular (LIM25), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Nathalie Oliveira
authors.initials: NO
authors.lastname: Santana
authors.affiliation: Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
authors.forename: Marco Aurelio
authors.initials: MA
authors.lastname: Kulcsar
authors.affiliation: Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.
authors.forename: Claudio Roberto
authors.initials: CR
authors.lastname: Cernea
authors.affiliation: Laboratório de Endocrinologia Celular e Molecular (LIM25), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Suemi
authors.initials: S
authors.lastname: Marui
authors.affiliation: Endocrinology, Instituto do Câncer do Estado de São Paulo, Sao Paulo, Brazil.
authors.forename: Ana Oliveira
authors.initials: AO
authors.lastname: Hoff
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000378:metabolism / Q000473:pathology*; D002291:Carcinoma, Papillary; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000378:metabolism / Q000473:pathology*; D013972:Thyrotropin / Q000378:metabolism*; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000453:epidemiology*
chemical_list: D014807:Vitamin D; D013972:Thyrotropin; C104450:25-hydroxyvitamin D