title: Preoperative serum thyroglobulin and changes in serum thyroglobulin during TSH suppression independently predict follicular thyroid carcinoma in thyroid nodules with a cytological diagnosis of follicular lesion.
abstract: BACKGROUND
  Fine-needle aspiration biopsy (FNAB) cannot distinguish a follicular thyroid carcinoma (FTC) from a follicular adenoma in follicular lesions. We designed this study to determine whether the preoperative thyroglobulin (Tg) and change in serum Tg during thyroid-stimulating hormone (TSH) suppression can predict FTC in thyroid nodules with a cytological diagnosis of follicular lesion.
  
  
  METHODS
  Among 854 patients who underwent thyroid surgery, the 198 patients who presented with thyroid nodules with a cytological diagnosis of follicular lesion were analyzed. Predictive factors for malignancy were evaluated using multivariate logistic regression models. Subgroup analyses of patients with TSH suppression therapy by levothyroxine were also conducted.
  
  
  RESULTS
  Thirty-two patients (16%) had FTC, and 166 patients had confirmed benign nodules. The median preoperative serum Tg levels were significantly higher in patients with FTC compared to those with benign pathology (449 vs. 34 ng/mL, p < 0.001). The serum Tg (odds ratios (OR) 10.311, p < 0.001) and tumor volume (OR 4.500, p = 0.035) were found to be independent predictors for FTC in all patients with a cytological diagnosis of follicular lesion. Forty-eight patients received TSH suppression therapy. When we performed subgroup analyses on the patients with TSH suppression therapy, decrease less than 15% in serum Tg during TSH suppression was found to be an independent predictor of FTC (OR 13.918, p = 0.018).
  
  
  CONCLUSIONS
  Preoperative serum Tg and changes in serum Tg during TSH suppression independently predict FTC in thyroid nodules with a cytological diagnosis of follicular lesion.
authors.affiliation: a Division of Endocrinology and Metabolism, Department of Internal Medicine , Soonchunhyang University Hospital, Soonchunhyang University College of Medicine , Seoul , Korea.
authors.forename: Hye Jeong
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: b Division of Endocrinology and Metabolism, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine , Bucheon , Korea.
authors.forename: Ji-Oh
authors.initials: JO
authors.lastname: Mok
authors.affiliation: b Division of Endocrinology and Metabolism, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine , Bucheon , Korea.
authors.forename: Chul Hee
authors.initials: CH
authors.lastname: Kim
authors.affiliation: c Division of Endocrinology and Metabolism, Department of Internal Medicine , Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine , Cheonan , Korea.
authors.forename: Yeo Joo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: c Division of Endocrinology and Metabolism, Department of Internal Medicine , Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine , Cheonan , Korea.
authors.forename: Sang Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: a Division of Endocrinology and Metabolism, Department of Internal Medicine , Soonchunhyang University Hospital, Soonchunhyang University College of Medicine , Seoul , Korea.
authors.forename: Hyeong Kyu
authors.initials: HK
authors.lastname: Park
authors.affiliation: a Division of Endocrinology and Metabolism, Department of Internal Medicine , Soonchunhyang University Hospital, Soonchunhyang University College of Medicine , Seoul , Korea.
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Byun
authors.affiliation: a Division of Endocrinology and Metabolism, Department of Internal Medicine , Soonchunhyang University Hospital, Soonchunhyang University College of Medicine , Seoul , Korea.
authors.forename: Kyoil
authors.initials: K
authors.lastname: Suh
authors.affiliation: a Division of Endocrinology and Metabolism, Department of Internal Medicine , Soonchunhyang University Hospital, Soonchunhyang University College of Medicine , Seoul , Korea.
authors.forename: Myung Hi
authors.initials: MH
authors.lastname: Yoo
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000097:blood* / Q000473:pathology*; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood* / Q000473:pathology*; D016606:Thyroid Nodule / Q000097:blood* / Q000473:pathology*; D013972:Thyrotropin / Q000187:drug effects*; D013974:Thyroxine / Q000008:administration & dosage*
chemical_list: D014408:Biomarkers, Tumor; D013972:Thyrotropin; D013954:Thyroglobulin; D013974:Thyroxine
keywords: Follicular neoplasm; malignancy; thyroglobulin