探讨甲状腺结节患者术前血清促甲状腺激素(TSH)水平与分化型甲状腺癌(DTC)的关系。

回顾性分析2004年1月至2010年12月我科收治的6170例符合条件的各类甲状腺手术治疗患者临床资料,检测患者术前血清TSH水平并与术后病理组织结果进行对照分析。

6170例手术患者中389例术后病理证实为DTC(6.3%)。5781例良性组甲状腺结节患者血清TSH浓度为(1.1 ± 0.5)mU/L,389例恶性组患者为(2.8 ± 0.3)mU/L,两组间比较差异有统计学意义(P < 0.01)。高于TSH参考值范围与低于此范围的患者中患DTC的比例分别为9.1%、4.9%,二者差异有统计学意义(P < 0.001)。并随血清中TSH水平的增高,患甲状腺癌的机会增加。DTC患者中颈淋巴结转移组患者平均TSH水平高于无转移组(P < 0.05)。

随着血清中TSH水平的增高,甲状腺结节患者患DTC的概率增加,血清TSH水平与DTC颈淋巴结转移相关。

To investigate the relationship between preoperative serum TSH and differentiated thyroid cancer(DTC) in thyroid nodule patients.

From January 2004 to December 2010, data of preoperative serum TSH concentration and pathologic results from 6170 qualified patients underwent thyroid surgery in our department were analyzed retrospectively.

6.3% of patients (389 of 6170) had DTC on final pathology. Mean TSH in the 389 patients with DTC was (2.8 ± 0.3) mU/L vs. (1.1 ± 0.5) mU/L in those 5781 patients with benign diagnoses (P < 0.001). The likelihood of malignancy was 4.9% when TSH was less than 0.34 mU/L vs. 9.1% when 5.50 mU/L or greater(P < 0.001). When the patients were subdivided into TSH ranges, as TSH increased, the likelihood of malignancy on final pathology rose. The mean TSH was (4.5 ± 1.1) mU/L in DTC patients with lateral lymph node metastasis vs. (2.2 ± 0.3) mU/L in DTC patients without lateral lymph node metastasis (P < 0.005).

The likelihood of thyroid cancer increases with higher serum TSH concentration. Higher TSH level is associated with lateral lymph node metastasis.