Is serum TSH a biomarker of thyroid carcinoma in patients residing in a mildly iodine-deficient area?

Abstract Optimal use of laboratory tests to diagnose and monitor patients with goiter, thyroid nodules, or thyroid cancer requires an appreciation of the pathophysiologic factors implicated in thyroid hyperplasia and neoplasia: growth factors (especially thyrotropin, TSH), growth-stimulating immunoglobulins, activating mutations of the TSH receptor, and other oncogenic transformations. In patients with diffuse goiter and thyroid nodules, serum TSH measurement in a highly sensitive assay excludes both primary hypothyroidism and common causes of thyrotoxicosis. In selected patients, screening for anti-thyroid peroxidase with or without anti-thyroglobulin antibodies can confirm the diagnosis of autoimmune thyroiditis. Serum calcitonin measurement is appropriate only when medullary thyroid carcinoma (MTC) is clinically suspected. Laboratory testing is essential in management of thyroid carcinoma patients after primary surgical therapy. Serum TSH measurement is vital to ensure that thyroxine replacement and TSH suppression are adequate in treatment of epithelial cancers. Serial monitoring of serum thyroglobulin (Tg) can detect tumor recurrence and quantify tumor burden. Interpretation of serum Tg results requires an appreciation of certain technical considerations (e.g., anti-Tg antibody interference) and the patient's concurrent TSH status. Periodic serum Tg measurements and 131I scans are complementary monitoring techniques. Serum calcitonin measurement and screening for ret protooncogene mutations are both valuable for identifying individuals with MTC.

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Free thyroxine, free triiodothyronine, and thyrotropin concentrations in hypothyroid and thyroid carcinoma patients receiving thyroxine therapy

Acta Endocrinologica ◽

10.1530/acta.0.1160418 ◽

1987 ◽

Vol 116 (3) ◽

pp. 418-424 ◽

Cited By ~ 16

Author(s):

K. Liewendahl ◽

T. Helenius ◽

B.-A. Lamberg ◽

H. Mähönen ◽

G. Wägar

Keyword(s):

Thyroid Carcinoma ◽

Equilibrium Dialysis ◽

Primary Hypothyroidism ◽

Free Thyroxine ◽

Suppressive Therapy ◽

Free Triiodothyronine ◽

Thyroxine Therapy ◽

Thyroxine Replacement ◽

Hypothyroid Patients ◽

Serum Tsh

Abstract. Free thyroxine (FT4) and free triiodothyronine (FT3) concentrations in serum were measured by direct equilibrium dialysis methods in patients receiving thyroxine replacement or suppression therapy. Four of 50 hypothyroid patients euthyroid on replacement therapy (mean thyroxine dose 120 μg/day) had supra-normal FT4 concentrations, whereas the FT3 concentrations were normal in all. Forty-one of 56 operated thyroid carcinoma patients on suppressive therapy (mean thyroxine dose 214 μg/day) had raised FT4 concentrations, whereas the FT3 concentration was elevated in only one patient. There was a large difference in mean FT4 values for hypothyroid and thyroid carcinoma patients (17.2 vs 29.5 pmol/l), whereas the difference in mean FT3 values was small (5.0 vs 6.1 pmol/l), suggesting a decreased peripheral conversion of T4 to T3 with increasing concentrations of FT4. Serum TSH concentrations, as determined by an immunoradiometric assay, varied from < 0.02 to 11.9 mU/l in treated hypothyroid patients; 21 patients (42%) had values outside the reference limits. As a single test, serum TSH is therefore not very useful for the assessment of adequate thyroxine dosage in patients with primary hypothyroidism. In thyroid carcinoma patients, the TSH concentrations were < 0.18 mU/l; 45 patients had values < 0.02 mU/l indicating sufficient suppression of TSH secretion in the majority of cases. On the basis of these results we recommend the combination of FT3 and TSH tests for monitoring thyroxine replacement and suppression therapy. FT4 appears less useful than FT3 for this purpose even if special reference values values were adopted for each patient group.

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Measurement of serum TSH and thyroid hormones in the management of treatment of thyroid carcinoma with radioiodine

British Journal of Radiology ◽

10.1259/0007-1285-50-599-799 ◽

1977 ◽

Vol 50 (599) ◽

pp. 799-807 ◽

Cited By ~ 111

Author(s):

C. J. Edmonds ◽

Susan Hayes ◽

J. C. Kermode ◽

B. D. Thompson

Keyword(s):

Thyroid Carcinoma ◽

Thyroid Hormones ◽

Serum Tsh

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Hashimoto's thyroiditis is associated with papillary thyroid carcinoma: role of TSH and of treatment with l-thyroxine

Endocrine Related Cancer ◽

10.1530/erc-11-0028 ◽

2011 ◽

Vol 18 (4) ◽

pp. 429-437 ◽

Cited By ~ 88

Author(s):

E Fiore ◽

T Rago ◽

F Latrofa ◽

M A Provenzale ◽

P Piaggi ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Hashimoto’S Thyroiditis ◽

High Titer ◽

Nodular Goiter ◽

Hashimoto's Thyroiditis ◽

Papillary Thyroid ◽

Significant Difference ◽

Serum Tsh ◽

Tsh Levels

The possible association between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) is a still debated issue. We analyzed the frequency of PTC, TSH levels and thyroid autoantibodies (TAb) in 13 738 patients (9824 untreated and 3914 under l-thyroxine, l-T4). Patients with nodular-HT (n=1593) had high titer of TAb and/or hypothyroidism. Patients with nodular goiter (NG) were subdivided in TAb−NG (n=8812) with undetectable TAb and TAb+NG (n=3395) with positive TAb. Among untreated patients, those with nodular-HT showed higher frequency of PTC (9.4%) compared with both TAb−NG (6.4%; P=0.002) and TAb+NG (6.5%; P=0.009) and presented also higher serum TSH (median 1.30 vs 0.71 μU/ml, P<0.001 and 0.70 μU/ml, P<0.001 respectively). Independently of clinical diagnosis, patients with high titer of TAb showed a higher frequency of PTC (9.3%) compared to patients with low titer (6.8%, P<0.001) or negative TAb (6.3%, P<0.001) and presented also higher serum TSH (median 1.16 vs 0.75 μU/ml, P<0.001 and 0.72 μU/ml, P<0.001 respectively). PTC frequency was strongly related with serum TSH (odds ratio (OR)=1.111), slightly related with anti-thyroglobulin antibodies (OR=1.001), and unrelated with anti-thyroperoxidase antibodies. In the l-T4-treated group, when only patients with serum TSH levels below the median value (0.90 μU/ml) were considered, no significant difference in PTC frequency was found between nodular-HT, TAb−NG and TAb+NG. In conclusion, the frequency of PTC is significantly higher in nodular-HT than in NG and is associated with increased levels of serum TSH. Treatment with l-T4 reduces TSH levels and decreases the occurrence of clinically detectable PTC.

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Reference intervals of thyroid hormones in a previously iodine-deficient area in Darfur, Sudan

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018818781299 ◽

2018 ◽

Vol 9 (9) ◽

pp. 293-297 ◽

Cited By ~ 1

Author(s):

Nagi I. Ali ◽

Abdullah O. Alamoudi ◽

Ishag Adam

Keyword(s):

Age Groups ◽

Progressive Increase ◽

Reference Intervals ◽

Thyroid Stimulating Hormone ◽

Serum Samples ◽

Multi Stage ◽

Significant Difference ◽

Males And Females ◽

Deficient Area ◽

Serum Tsh

Background: Thyroid-stimulating hormone (TSH), thyroxin (T4) and T3 levels are varied in the different settings with disorders of thyroid homeostasis. It is recommended that every setting has to establish its own reference intervals (RIs) for these hormones. Methods: A multi-stage stratified sampling method was used to select a representative sample of a Sudanese adult (>20 years of age) in Nyala in western Sudan in the Darfur region during the period between January and June 2016 to establish RIs of thyroid-related hormones (TSH, T4 and T3). In this study, 1753 serum samples (male and female) with different age groups were investigated. A radioimmunoassay gamma counter was used to measure the level of these hormones. Results: The median (95% intervals) of serum TSH, T4 and T3 levels was 1.2 (0.50–3.0) mIU/l, 111.0 (72.0–161.0) nmol/l and 1.5 (0.8–2.8) nmol/l respectively. While the level of TSH was significantly higher in the age group between 31 and 40 years, both T4 and T3 levels have shown a progressive increase with age. There was no significant difference in the TSH, T4 and T3 level when the RIs were compared between males and females. Conclusion: The RIs for TSH, T4 and T3 in this setting were different from the levels provided by the manufacturers. The RIs were different in the different age groups.

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Individually-tailored thyroxine requirement in the same patients before and after thyroidectomy: a longitudinal study

Acta Endocrinologica ◽

10.1530/eje-15-0314 ◽

2015 ◽

Vol 173 (3) ◽

pp. 351-357 ◽

Cited By ~ 16

Author(s):

S C Del Duca ◽

M G Santaguida ◽

N Brusca ◽

I Gatto ◽

M Cellini ◽

...

Keyword(s):

Longitudinal Study ◽

Thyroid Carcinoma ◽

Total Thyroidectomy ◽

Treatment Regimen ◽

Older Patients ◽

Differentiated Thyroid Carcinoma ◽

Therapeutic Approaches ◽

Before And After ◽

Serum Tsh ◽

Treatment Settings

ObjectiveThyroxine (T4) requirement after total thyroidectomy for differentiated thyroid carcinoma (DTC) is a debated issue. As most of the studies in the area have been retrospective and/or performed with heterogeneous therapeutic approaches, we designed our study to determine T4 requirement in the same patients and treatment settings, before and after total thyroidectomy.Design, patients and methodsThis was a longitudinal study including 23 goitrous patients treated with T4 in an individually tailored fashion. All patients exhibited a stable TSH (median TSH=0.28 mU/l) at a stable T4 dose for at least 1 year before surgery (median T4 dose=1.50 μg/kg per day). The patients underwent total thyroidectomy based on cancer suspicion or compressive symptoms. Eventually diagnosed as having DTC (pT1b-pT2N0) and following surgical and radiometabolic treatment, they were treated with the same pre-surgical doses of T4.ResultsThree months after surgery,using the same pre-surgical dose, median TSH increased up to 5.38 mU/l (P<0.0001) and so the T4 dose had to be increased (median T4 dose=1.95 μg/kg per day; +30%; P<0.0001). Once divided by patients' age, we observed that, after thyroidectomy and maintaining the same pre-surgical dose, serum TSH significantly increased both in younger and in older patients (median TSH=4.57 and 6.11 mU/l respectively). Serum TSH was restored to the pre-surgical level by increasing the dose up to 1.95 and 1.77 μg/kg per day (+25 and +21%) respectively.ConclusionsFollowing the same treatment regimen, a thyroidectomized patient requires one-third higher therapeutic T4 dose than before surgery. Despite this increase, the dose of T4 needed in our patients remains significantly lower than that previously described in athyreotic patients.

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