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Anti-Thyroid Antibodies and TSH as Potential Markers of Thyroid Carcinoma and Aggressive Behavior in Patients with Indeterminate Fine-Needle Aspiration Cytology

World Journal of Surgery volume 44, pages 363–370 (2020)Cite this article

Abstract

Background

Indeterminate fine-needle aspiration cytology (FNAC) imposes challenges in the management of thyroid nodules. This study aimed to examine whether preoperative anti-thyroid antibodies (Abs) and TSH are indicators of thyroid malignancy and aggressive behavior in patients with indeterminate FNAC.

Methods

This was a retrospective study of thyroidectomy patients from 2008 to 2016. We analyzed Abs and TSH levels, FNAC, and histopathology. Serum antibody levels were categorized as ‘Undetectable’, ‘In-range’ if detectable but within normal range, and ‘Elevated’ if above upper limit of normal. ‘Detectable’ levels referred to ‘In-range’ and ‘Elevated’ combined.

Results

There were 531 patients included. Of 402 patients with preoperative FNAC, 104 (25.9%) had indeterminate cytology (Bethesda III–V). Of these, 39 (37.5%) were malignant and 65 (62.5%) benign on histopathology. In the setting of indeterminate FNAC, an increased risk of malignancy was associated with ‘Elevated’ thyroglobulin antibodies (TgAb) (OR 7.25, 95% CI 1.13–77.15, P = 0.01) and ‘Elevated’ thyroid peroxidase antibodies (TPOAb) (OR 6.79, 95% CI 1.23–45.88, P = 0.008). Similarly, while still ‘In-range’, TSH ≥ 1 mIU/L was associated with an increased risk of malignancy (OR 3.23, 95% CI 1.14–9.33, P = 0.01). In all patients with malignancy, the mean tumor size was 8 mm larger in those with TSH ≥ 1 mIU/L (P = 0.03); furthermore, in PTC patients, ‘Detectable’ TgAb conferred a 4 × risk of lymph node metastasis (95% CI 1.03–13.77, P = 0.02).

Conclusion

In this cohort, in indeterminate FNAC patients, Abs and TSH were associated with an increased risk of malignancy. Additionally, TgAb and TSH were potential markers of aggressive biology. As such, they may be diagnostic and prognostic adjuncts.

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Acknowledgements

We would like to acknowledge all the surgeons who have contributed cases to the Monash University Endocrine Surgery Unit (MUESU) database.

Funding

No grants or funding received for this project.

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Authors and Affiliations

  1. Department of General Surgery, Monash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia

    Mohammadmehdi Adhami, Peter Michail, Apoorva Rao, Chhavi R. Bhatt, Simon Grodski, Jonathan W. Serpell & James C. Lee

  2. Department of Surgery, Monash University, Melbourne, Australia

    Simon Grodski, Jonathan W. Serpell & James C. Lee

  3. Department of Surgery, Monash Health, Melbourne, Australia

    Simon Grodski & James C. Lee

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  1. Mohammadmehdi Adhami
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  2. Peter Michail
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Correspondence to James C. Lee.

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Study approved by Alfred Health Human Research Ethics Committee (Project No: 185/19).

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Adhami, M., Michail, P., Rao, A. et al. Anti-Thyroid Antibodies and TSH as Potential Markers of Thyroid Carcinoma and Aggressive Behavior in Patients with Indeterminate Fine-Needle Aspiration Cytology. World J Surg 44, 363–370 (2020). https://doi.org/10.1007/s00268-019-05153-1

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