Thyrotropin/Thyroglobulin ratio in combination with thyroid u/s to assess malignancy risk stratification of thyroid nodules

Ahmed Ahmed Abotaha; Ismail Mohamed  El mancy; Sayed Mohamed Tealeb; Gamal khedr; Ibrahim Ghoneim Ramadan; Gamal Ali Badr

doi:10.53730/ijhs.v6nS1.6007

Authors

Ahmed Ahmed Abotaha
Ahmedabotaha1990@gmail.com
Faculty of Medicine, Internal Medicine Department, Al-Azhar University, Cairo, Egypt
Ismail Mohamed El mancy Faculty of Medicine, Internal Medicine Department, Al-Azhar University, Cairo, Egypt
Sayed Mohamed Tealeb Faculty of Medicine, Pathology Department, Al-Azhar University, Cairo, Egypt
Gamal khedr Cancer institute of Tanta, Tanta, Egypt
Ibrahim Ghoneim Ramadan Faculty of Medicine, Internal Medicine Department, Al-Azhar University, Cairo, Egypt
Gamal Ali Badr Faculty of Medicine, Internal Medicine Department, Al-Azhar University, Cairo, Egypt

Keywords:

Thyrotropin/Thyroglobulin, thyroid, stratification, thyroid nodules

Abstract

Objective: we aimed to asses if thyrotropin/thyroglobulin ratio has a significant value in detection of malignant thyroid nodules. Design: Retrospective analysis. Material and Methods: This study included finally 100 subject collected as outpatient’s endocrinology clinic of ALHuessine university hospital or admitted at oncology institute of Tanta. Patients who had history of thyroid diseases or surgery, those with abnormal levels of anti- thyroglobulin antibodies, cases without simultaneous measurement of serum anti Tg., with history of current use of thyroid hormone replacement therapy were excluded from this study. Clinico pathological features, as well as serumTSH, Tg, and TSH/Tg were compared between histopathologically benign and malignant groups. Results: Data related to 100 subjects (40%) normal and 60(60%) patients with thyroid nodules were analyzed, 30 patients (50%) were malignant thyroid nodules and 30 patients (50%) were benign.The malignant patients exhibited significantly higher TSH, TSH/Tg, , and a lower Tg compared to the benign patients (p<0.05 for each). Conclusion: Preoperative TSH/Tg could be used as a predictive marker for differ-entiating between benign and malignant thyroid nodules.

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References

Cooper DS. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer Thyroid. 2009;19(11):1167–214. DOI: https://doi.org/10.1089/thy.2009.0110

Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993;328(8):553–9. DOI: https://doi.org/10.1056/NEJM199302253280807

Ezzat S, Sarti DA, Cain DR, et al. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med. 1994;154(16):1838–40. DOI: https://doi.org/10.1001/archinte.154.16.1838

Tan GH, Gharib H. Thyroid incidentalomas: management approaches to non-palpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997;126(3):226–31. DOI: https://doi.org/10.7326/0003-4819-126-3-199702010-00009

Gu th S, Theune U, Aberle J, et al. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest. 2009;39(8):699–706. DOI: https://doi.org/10.1111/j.1365-2362.2009.02162.x

Mortensen JD, Woolner LB, Bennett WA. Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab. 1955;15(10):1270–80. DOI: https://doi.org/10.1210/jcem-15-10-1270

Ali SZ. Thyroid cytopathology: Bethesda and be-yond. Acta Cytol. 2011;55:4-12. DOI: https://doi.org/10.1159/000322365

Jung KW, Park S, Kong HJ, Won YJ, Boo YK, Shin HR, Park EC, Lee JS. Cancer statistics in Korea: incidence, mortality and survival in 2006- 2007. J Korean Med Sci 2010; 25: 1113-21. DOI: https://doi.org/10.3346/jkms.2010.25.8.1113

Jung KW, Won YJ, Park S, Kong HJ, Sung J, Shin HR, Park EC, Lee JS. Lee EK, et al. • Usefulness of Serum Thyroglobulin in IndeterminateNodules 1018 http://jkms.org http://dx.doi.org/10.3346/jkms.2012.27.9.1014 Cancer statistics in Korea: incidence, mortality and survival in 2005. J Korean Med Sci 2009; 24: 995-1003. DOI: https://doi.org/10.3346/jkms.2009.24.6.995

Rosen JE, Stone MD. Contemporary diagnostic approach to the thyroid nodule. J Surg Oncol 2006; 94: 649-61. DOI: https://doi.org/10.1002/jso.20701

Cibas ES, Ali SZ. The Bethesda System for reporting thyroid cytopathology. Thyroid 2009; 19: 1159-65. DOI: https://doi.org/10.1089/thy.2009.0274

Oltmann SC, Leverson G, Lin SH, Schneider DF,Chen H, Sippel RS. Markedly elevated thyroglobulin levels in the preoperative thyroidectomy patient correlates with metastatic burden. J Surg Res.2014;187:1-5. DOI: https://doi.org/10.1016/j.jss.2013.12.017

Zubair Hussain S, Zaman MU, Malik S, Ram N, As-ghar A, Rabbani U, Aftab N, Islam N. Preablation stimulated thyroglobulin/TSH ratio as a predictor successful I (131)remnant ablation in patients withdifferentiated thyroid cancer following total thy-roidectomy. J Thyroid Res. 2014;2014:610273.. DOI: https://doi.org/10.1155/2014/610273

Petric R, Besic H, Besic N. Preoperative serum thy-roglobulin concentration as a predictive factor of malignancy in small follicular and Hürthle cell neo-plasms of the thyroid gland. World J Surg Oncol.2014;12:282. DOI: https://doi.org/10.1186/1477-7819-12-282

Suh I, Vriens MR, Guerrero MA, Griffin A, Shen WT,Duh QY, Clark OH, Kebebew E. Serum thyroglobulin is a poor diagnostic biomarker of malignancy in fol-licular and Hürthle-cell neoplasms of the thyroid.Am J Surg. 2010;200:41-46. DOI: https://doi.org/10.1016/j.amjsurg.2009.08.030

Haugen BR, Alexander EK, Bible KC, Doherty GM,Mandel SJ, Nikiforov YE, Pacini F, Randolph GW,Sawka AM, Schlumberger M, Schuff KG, ShermanSI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L.2015 American Thyroid Association

Geanina Popoveniuc, , and Jacqueline Jonklaas, Med Clin North Am.Med Clin North Am. 2012 Mar; 96(2):329–349.doi: 10.1016/j.mcna.2012.02.002. DOI: https://doi.org/10.1016/j.mcna.2012.02.002

Shi L, Li Y, Guan H, Li C, Shi L, Shan Z, Teng W. Usefulness of serum thyrotropin for risk prediction of differentiated thyroid cancers does not apply to microcarcinomas: results of 1,870 Chinese patientswith thyroid nodules. Endocr J. 2012;59:973-980. DOI: https://doi.org/10.1507/endocrj.EJ12-0154

Moon SS, Lee YS, Lee IK, Kim JG. Serum thyrotropin as a risk factor for thyroid malignancy in euthyroid subjects with thyroid micronodule. Head Neck. 2012;34:949-952. DOI: https://doi.org/10.1002/hed.21828

He H, Li W, Liyanarachchi S, Jendrzejewski J, Srinivas M, Davuluri RV, Nagy R, de la Chapelle A. Genetic predisposition to papillary thyroid carcinoma: involvement of FOXE1, TSHR, and a novel lincRNAvgene, PTCSC2. J Clin Endocrinol Metab. 2015;100: E164-172. DOI: https://doi.org/10.1210/jc.2014-2147

Jonklaas J, Nsouli-Maktabi H, Soldin SJ. Endogenous thyrotropin and triiodothyronine concentrations in individuals with thyroid cancer. Thyroid. 2008;18:943-952. DOI: https://doi.org/10.1089/thy.2008.0061

Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, Chen H. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab. 2008;93:809-814. DOI: https://doi.org/10.1210/jc.2007-2215

Abbas Ali Tam,Nuran Sungu, Mustafa Ömer Yazıcıoğlu; Didem Özdemir, Bekir Çakırir, Cevdet Aydın, Muhammet Cüneyt Bilginer; Reyhan Ersoy, Ratio of Thyrotropin to Thyroglobulin as aNovel Marker for Differentiating Between Benign and Malignant Thyroid Nodules within Different Bethesda Categories , 2018;22:21-31 TSH/Tg Ratio and Thyroid Nodules. DOI: https://doi.org/10.25179/tjem.2017-58803

Kim KW, Park YJ, Kim EH, Park SY, Park DJ, Ahn SH, Park DJ, Jang HC, Cho BY. Elevated risk of papillarythyroid cancer in Korean patients with Hashimoto’sthyroiditis. Head Neck. 2011;33:691-695. DOI: https://doi.org/10.1002/hed.21518

Negro R1,Valcavi R,Riganti F,Toulis KA,Colosimo E,Bongiovanni M,Grassi P,Giovanella L,Gardini GPiana S Thyrotropin values in patients with micropapillary thyroid cancer versus benign nodular disease 01 Jul 2013, 19(4):651-655. DOI: https://doi.org/10.4158/EP12385.OR

Lin YS, Li TJ, Liang J, Li X, Qiu L, Wang S, Chen Y, Kang Z, Li F. Predictive value of preablation stimulated thyroglobulin and thyroglobulin /thyroid-stimulating hormone ratio in differentiated thyroid cancer. Clin Nucl Med. 2011;36:1102-1105. DOI: https://doi.org/10.1097/RLU.0b013e3182291c65

Lee EK, Chung KW, Min HS, Kim TS, Kim TH, Ryu JS, Jung YS, Kim SK, Lee YJ. Preoperative serum thyroglobulin as a useful predictive marker to differentiate follicular thyroid cancer from benign nodules in indeterminate nodules. J Korean Med Sci. 2012;27:1014-1018. DOI: https://doi.org/10.3346/jkms.2012.27.9.1014

Youn I, Sung JM, Kim EK, Kwak JY. Serum thyroglobulin adds no additional value to ultrasonographic features in a thyroid malignancy. Ultrasound Q. 2014;30:287-290. DOI: https://doi.org/10.1097/RUQ.0000000000000056

Guarino E, Tarantini B, Pilli T, Checchi S, Brilli L,Ciuoli C, Di Cairano G, Mazzucato P, Pacini F. Presurgical serum thyroglobulin has no prognostic value in papillary thyroid cancer. Thyroid. 2005;15:1041-1045. DOI: https://doi.org/10.1089/thy.2005.15.1041

EvangelosKarvounis , IoannisKappas , Anna Angelousi , George-Marios Makris , Thomas D Siamatras , Eva Kassi : The diagnostic and predictive accuracy of thyroglobulin to TSH ratio and TSH to thyroglobulin ratio in detecting differentiated thyroid carcinoma in normothyroid patients with thyroid nodules: A retrospective cohort study and systematic reviewoftheliterature 10 .408 1/onc ol.20 20. 439.

Adriano Francisco De Marchi Junior,Gláucia Maria Ferreira da Silva Mazeto: Thyroglobulin /thyrotropin ratio for predicting long-term response in differentiated thyroid carcinoma: a retrospective studyEndocrinol. Metab. 65 (4) • 2021