High serum TSH level is associated with progression of papillary thyroid microcarcinoma during active surveillance.

High serum TSH level is associated with progression of papillary thyroid microcarcinoma during active surveillance.

J Clin Endocrinol Metab. 2017 Dec 01;:

Authors: Kim HI, Jang HW, Ahn HS, Ahn S, Park SY, Oh YL, Hahn SY, Shin JH, Kim JH, Kim JS, Chung JH, Kim TH, Kim SW

Abstract
Objective: Thyroid-stimulating hormone (TSH) is a growth factor affecting initiation or progression of papillary thyroid cancer (PTC), which supports TSH suppressive therapy in PTC patients. In patients with papillary thyroid microcarcinoma (PTMC) during active surveillance, however, the association between serum TSH level and growth of PTMC has not been demonstrated.
Patients: We analyzed 127 PTMCs in 126 patients under active surveillance with serial serum TSH measurement and ultrasonography.
Design: The patients were categorized into highest, middle, and lowest time-weighted average of TSH (TW-TSH) group. PTMC progression was defined as volume increase by 50% or more compared to starting point. Kaplan-Meier survival analysis according to TW-TSH groups and Cox proportional hazard modeling was performed. We identified the cut-off point for TSH level using maximally selected log-rank statistics.
Results: During a median follow-up of 26 months, PTMC progression was detected in 28 (19.8%) patients. Compared to the lowest TW-TSH group, the adjusted HR (95% CI, P-value) for PTMC progression in the highest TW-TSH group was significantly higher [3.55 (1.22-10.28); P = 0.020] while that in middle TW-TSH group was not [1.52 (0.46-5.08); P = 0.489]. The cut-off point of serum TSH level for PTMC progression was 2.50 mU/L.
Conclusions: Sustained elevation of serum TSH level during active surveillance is associated with PTMC progression. Maintaining low-normal TSH range by levothyroxine (LT4) treatment during active surveillance of PTMC might be considered with future studies.

PMID: 29211863 [PubMed - as supplied by publisher]

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