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Serum Thyrotropin Concentration as a Predictor of Malignancy in Thyroid Follicular Neoplasm

SEYYED MORTEZA TAGHAVI

Objective: The clinical importance of thyroid nodules is the need to exclude thyroid malignancy, and fine-needle aspiration biopsy (FNAB) is the current gold standard for the evaluation of thyroid nodules. The main limitation of FNAB is follicular neoplasm. Follicular thyroid carcinoma differentiates less frequently with FNAB from microfollicular or cellular adenomas. Serum TSH is introduced recently as a useful marker for predicting malignancy in a thyroid nodule. The main aim of our study was the evaluation of this correlation in patients with thyroid nodule with cytology reports of follicular neoplasm, in them the final diagnosis of benign or malignant disease confirmed histologically after surgery.

Method: We prospectively collected data on 75 patients including 64 females and 11 males presenting with thyroid nodule with cytology report of follicular neoplasm. A primary evaluation was performed at presentation through measurement of T4, T3, and TSH concentrations and thyroid radioisotope scan. A final histological diagnosis was made in all patients after thyroid surgery. The influence of factors including age, gender, size and location of nodules, and serum TSH concentration on the final diagnostic outcome was investigated statistically.

Results: In 42 patients (56%), the nodule was on right lobe, in 30 patients (40%), the nodule was on left lobe and in 3 patients (4%), on isthmus. Mean age was 37.6 ± 11.36 (15-68) years. Mean size of nodules was 18.4 ± 17.48 mm. Mean TSH was 0.9 ± 1.29 mU/liter. After surgery, malignancy was confirmed in 19 (25.3%) patients. In 38 patients (50.7%), final pathology was follicular adenoma and in 18 (24%), it was multinodular goiter. There was no correlation between sex, age, size and location of nodule and malignancy. Mean TSH was significantly higher in cancer patients.

Conclusion: The serum TSH concentration at presentation is an independent predictor of the presence of thyroid malignancy in patients with follicular neoplasm.