HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Accepted manuscript (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Fiore, E. Articles by Vitti, P. PubMed PubMed Citation Articles by Fiore, E. Articles by Vitti, P.

E Fiore, Department of Endocrinology, University of Pisa, Pisa, 56100, Italy
T Rago, Department of Endocrinology, University of Pisa, Pisa, Italy
A Provenzale, Department of Endocrinology, University of Pisa, Pisa, Italy
M Scutari, Department of Endocrinology, University of Pisa, Pisa, Italy
C Ugolini, Department of Surgery - Section of Pathology, University of Pisa, Pisa, Italy
F Basolo, Department of Surgery - Section of Pathology, University of Pisa, Pisa, Italy
G Di Coscio, Department of Surgery - Section of Cytopathology, University of Pisa, Pisa, Italy
P Berti, Department of Surgery, University of Pisa, Pisa, Italy
L Grasso, Department of Endocrinology, University of Pisa, Pisa, Italy
R Elisei, Department of Endocrinology, University of Pisa, Pisa, Italy
A Pinchera, Department of Endocrinology, University of Pisa, Pisa, Italy
P Vitti, Department of Endocrinology, University of Pisa, Pisa, Italy

Correspondence: Emilio Fiore, Email: fiore.emilio{at}gmail.com

Abstract

Higher TSH values, even within normal ranges, have been associated with a greater risk of thyroid malignancy. In this study the relationship between TSH and papillary thyroid cancer (PTC) has been analyzed in 10178 patients submitted to fine needle aspiration of thyroid nodules with a cytology of PTC (n=497) or benign thyroid nodular disease (BTND, n=9681). In 942 patients submitted to surgery (521 from BTND and 421 from PTC) the histological diagnosis confirmed an elevated specificity (99.6%) and sensitivity (98.1%) of cytology.TSH levels were significantly higher in PTC than in BTND both in the cytological and histological series. TSH was significantly higher in PTC than in BTND both in patients with a clinical diagnosis of multinodular goiter (MNG) and single/isolate nodule (S/I). A significant age-dependent development of thyroid autonomy (TSH <0.4 µU/mL) was observed in patients with benign thyroid disease, but not in those with PTC, diagnosed both on cytology and histology. In patients with MNG, the frequency of thyroid autonomy was higher and the risk of PTC was lower compared to those with S/I. In all patients, the presence of thyroid auto-antibodies (TAb) was associated with a significant increase of TSH. However, both in TAb positive and TAb negative patients TSH levels were significantly higher in PTC than in BTND. Our data confirm a direct relationship between TSH levels and risk of PTC in patients with nodular thyroid diseases. Thyroid autonomy conceivably protects against the risk of PTC, while thyroid autoimmunity does not play a significant role.