Association of pre-op TSH levels with Thyroid Carcinoma in a Tertiary Care Setup in Karachi, Pakistan
DOI:
https://doi.org/10.51985/JBUMDC2024366Keywords:
Thyroid carcinoma, TSH, Pakistan, South Asia.Abstract
Objectives: This study aimed to explore the relationship between pre-operative TSH levels and the presence of thyroid cancer in patients with nodular thyroid disease in the Pakistani population, using data gathered from patients treated at Dr. Ruth K. M. Pfau Civil Hospital Karachi.
Study Design & Setting: A cross-sectional study was conducted at the Dow University of Health Sciences and Dr. Ruth K. M. Pfau Civil Hospital Karachi from January 2022 to December 2022.
Methodology: Patients with thyroid swellings (presenting with either solitary nodules or with multinodular goiter), both benign as well as suspected/confirmed malignancy based on FNAC results were recruited in the study. Preoperative TSH levels, along with other clinical data, were collected. Thyroidectomy was carried out in patients fulfilling the criteria for surgery, with specimens sent for histopathology. An independent t-test was used to compare TSH levels between malignant and benign nodules.
Results: A total of 82 patients were enrolled. Malignancy was confirmed in 41.5% (25 papillary carcinoma, 9 follicular carcinoma). Significantly higher mean TSH levels were observed in patients with malignant nodules (4.76 IU/mL) compared to those with benign nodules (2.48 IU/mL) (p < 0.001).
Conclusion: This study suggests a potential association between elevated pre-operative TSH levels and thyroid cancer in the Pakistani population. These findings warrant further investigation to explore causality and potential underlying mechanisms. The study highlights the value of TSH monitoring, particularly in resource-constrained settings.
References
- Zhang X, Tian L, Teng D, Teng W. The relationship between
thyrotropin serum concentrations and thyroid carcinoma.
Cancers. 2023 Oct 17;15(20):5017.
- Xiang Y, Xu Y, Bhandari A, Sindan N, Hirachan S, Yang Q,
Guo G, Shen Y. Serum TSH levels are associated with
postoperative recurrence and lymph node metastasis of
papillary thyroid carcinoma. American journal of translational
research. 2021;13(6):6108.
- Kim HI, Jang HW, Ahn HS, Ahn S, Park SY, Oh YL, Hahn
SY, Shin JH, Kim JH, Kim JS, Chung JH. High serum TSH
level is associated with progression of papillary thyroid
microcarcinoma during active surveillance. The Journal of
Clinical Endocrinology & Metabolism. 2018 Feb;103(2):446-
- Koshkina A, Fazelzad R, Sugitani I, Miyauchi A, Thabane L,
Goldstein DP, Ghai S, Sawka AM. Association of patient age
with progression of low-risk papillary thyroid carcinoma
under active surveillance: a systematic review and metaanalysis. JAMA Otolaryngology–Head & Neck Surgery. 2020
Jun 1;146(6):552-60.
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics,
CA: a cancer journal for clinicians. 2022 Jan 1;72(1).
- LeClair K, Bell KJ, Furuya-Kanamori L, Doi SA, Francis
DO, Davies L. Evaluation of gender inequity in thyroid cancer
diagnosis: differences by sex in US thyroid cancer incidence
compared with a meta-analysis of subclinical thyroid cancer
rates at autopsy. JAMA internal medicine. 2021 Oct
;181(10):1351-8.
- Zafon C, Obiols G, Baena JA, Castellví J, Dalama B, Mesa
J. Preoperative thyrotropin serum concentrations gradually
increase from benign thyroid nodules to papillary thyroid
microcarcinomas then to papillary thyroid cancers of larger
size. Journal of thyroid research. 2012;2012(1):530721.
- Ali SZ, VanderLaan PA, editors. The Bethesda system for
reporting thyroid cytopathology: definitions, criteria, and
explanatory notes. Springer Nature; 2023 Jun 29.
- Shahrokh M, Alsultan M, Kabalan Y. The relationship between
papillary thyroid carcinoma and preoperative TSH level: A
cross-sectional study from Syria. Medicine. 2023 Jul
;102(28):e34283.
- Golbert L, de Cristo AP, Faccin CS, Farenzena M, Folgierini
H, Graudenz MS, Maia AL. Serum TSH levels as a predictor
of malignancy in thyroid nodules: A prospective study. PloS
one. 2017 Nov 16;12(11):e0188123.
- Ospina NS, Iñiguez-Ariza NM, Castro MR. Thyroid nodules:
diagnostic evaluation based on thyroid cancer risk assessment.
bmj. 2020 Jan 7;368.
- Su A, Zhao W, Wu W, Wei T, Ruan M, Li Z, Zhu J. The
association of preoperative thyroid-stimulating hormone level
and the risk of differentiated thyroid cancer in patients with
thyroid nodules: A systematic review and meta-analysis. The
American Journal of Surgery. 2020 Sep 1;220(3):634-41.
- Tam AA, Ozdemir D, Aydýn C, Bestepe N, Ulusoy S, Sungu
N, Ersoy R, Cakir B. Association between preoperative
thyrotrophin and clinicopathological and aggressive features
of papillary thyroid cancer. Endocrine. 2018 Mar;59:565-72.
- Zafon C, Obiols G, Baena JA, Castellví J, Dalama B, Mesa
J. Preoperative thyrotropin serum concentrations gradually
increase from benign thyroid nodules to papillary thyroid
microcarcinomas then to papillary thyroid cancers of larger
size. Journal of thyroid research. 2012 Jan 1;2012.
- He LZ, Zeng TS, Pu L, Pan SX, Xia WF, Chen LL. Thyroid
hormones, autoantibodies, ultrasonography, and clinical
parameters for predicting thyroid cancer. International Journal
of Endocrinology. 2016 Jan 1;2016.
- Seib CD, Sosa JA. Evolving understanding of the epidemiology
of thyroid cancer. Endocrinology and Metabolism Clinics.
Mar 1;48(1):23-35
- Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper
DS. The diagnosis and management of thyroid nodules: a
review. Jama. 2018 Mar 6;319(9):914-24.
- Shimura H, Matsumoto Y, Murakami T, Fukunari N, Kitaoka
M, Suzuki S. Diagnostic strategies for thyroid nodules based
on ultrasonographic findings in Japan. Cancers. 2021 Sep
;13(18):4629.
- Shobab L, Burman KD, Wartofsky L. Sex differences in
differentiated thyroid cancer. Thyroid. 2022 Mar 1;32(3):224-
- Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends
in thyroid cancer incidence and mortality in the United States,
-2013. Jama. 2017 Apr 4;317(13):1338-48.
- Gómez-Izquierdo J, Filion KB, Boivin JF, Azoulay L, Pollak
M, Yu OH. Subclinical hypothyroidism and the risk of cancer
incidence and cancer mortality: a systematic review. BMC
Endocrine Disorders. 2020 Dec;20:1-0.
- Russo D, Arturi F, Schlumberger M, Caillou B, Monier R,
Filetti S, Suarez HG. Activating mutations of the TSH receptor
in differentiated thyroid carcinomas. Oncogene. 1995 Nov
;11(9):1907-11.
- Hu N, Li ZM, Liu JF, Zhang ZZ, Wang LS. An overall and
dose-response meta-analysis for thyrotropin and thyroid cancer
risk by histological type. Oncotarget. 2016 Jul 7;7(30):47750.
- Zhang X, Tian L, Teng D, Teng W. The relationship between
thyrotropin serum concentrations and thyroid carcinoma.
Cancers. 2023 Oct 17;15(20):5017.
- Fiore E, Rago T, Latrofa F, Provenzale MA, Piaggi P, Delitala
A, Scutari M, Basolo F, Di Coscio G, Grasso L, Pinchera A.
Hashimoto's thyroiditis is associated with papillary thyroid
carcinoma: role of TSH and of treatment with L-thyroxine.
Endocrine Related Cancer. 2011 Jul 1;18(4):429
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Tehmina Junaid, Areej Fatimah Iqrar Siddiqui, Tariq Zahid Khan, Zeba Ahmed, Basit Arif, Sana Kazmi, Muhammad Umair Tahseen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0 
