Skip to main content
SpringerLink
Log in

Searching for the most effective thyrotropin (TSH) threshold to rule-out autonomously functioning thyroid nodules in iodine deficient regions

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

The purpose of this study is to evaluate the distribution of thyrotropin (TSH) values in patients with autonomously functioning thyroid nodules and to set a TSH threshold above which thyroid scintigraphy would be obviated. Four hundred fifty one patients were included in the present study. Inclusion criteria were age > 18 years, TSH levels between 0.40 and 4.0 mIU/L, detection of a single solid or predominantly solid thyroid nodule >10 mm in the longest diameter. Thyroid ultrasound and thyroid scintigraphy with 99mTc-pertechnetate were performed concurrently in all patients. Among 451 enrolled patients, 173 (38 %) had an autonomously functioning thyroid nodules, of which 137 (79 %) with a normal TSH level. Demographic data and nodules’ volume were not significantly different in patients with autonomously functioning thyroid nodules and non-functioning nodules, respectively. However, TSH levels were nonetheless significantly lower in patients with autonomously functioning thyroid nodules compared to those with non-functioning nodules (p < 0.001). Adopting a TSH cutoff level at 2.38 mUI/L, all autonomously functioning thyroid nodules were correctly identified (i.e., 100 % sensitivity) with a 100 % negative predictive value. Our study showed a very high prevalence of autonomously functioning thyroid nodules in mildly iodine-deficient regions and confirmed that serum TSH is not an effective screening test to diagnose an autonomously functioning thyroid nodules. Our data add arguments in favor of the first-line use of thyroid scintigraphy to assess thyroid nodules, at least in iodine deficient areas. As all scintigraphically detected autonomously functioning thyroid nodules had a TSH level below 2.38 mUI/L, a thyroid scintigraphy should be omitted when higher TSH values are found in patients carrying a thyroid nodule.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. L. Giovanella, L. Ceriani, G. Treglia, Role of isotope scan, including positron emission tomography/computed tomography, in nodular goitre. Best. Pract. Res. Clin. Endocrinol. Metab. 28, 507–518 (2014)

    Article  PubMed  Google Scholar 

  2. H. Schicha, M. Hellmich, W. Lehmacher, W. Eschner, M. Schmidt, C. Kobe et al., Should all patients with thyroid nodules ≥ 1 cm undergo aspiration biopsy? Nuklearmedizin 48, 79–83 (2009)

    PubMed  Google Scholar 

  3. B.R. Haugen, E.K. Alexander, K.C. Bible, J.M. Doherty, S.J. Mandel, Y.E. Nikiforov et al., 2015 American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 26, 1–133 (2016)

    Article  PubMed  Google Scholar 

  4. G. Popoveniuc, J. Jonklaas, Thyroid nodules. Med. Clin. North. Am. 96, 329–349 (2012)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. R. Gorges, T. Kandror, S. Kuschnerus, M. Zimny, R. Pink, H. Palmedo et al., Scintigraphically “hot” thyroid nodules mainly go hand in hand with a normal TSH. Nuklearmedizin 50, 179–188 (2011)

    Article  CAS  PubMed  Google Scholar 

  6. D. Graf, B. Helmich-Kapp, S. Graf, F. Veit, N. Lehmann, K. Mann, Functional activity of autonomous adenoma in Germany. Dtsch. Med. Wochenschr. 137, 2089–2092 (2012)

    Article  CAS  PubMed  Google Scholar 

  7. D. Sandrock, T. Olbricht, D. Emrich, G. Benker, D. Reinwein, Longterm follow-up in patients with autonomous thyroid adenoma. Acta Endocrinol. 128, 51–55 (1993)

    CAS  PubMed  Google Scholar 

  8. R. Chami, R. Moreno-Reyes, B. Corvilain, TSH measurement is not an appropriate screening test for autonomous functioning thyroid nodules: a retrospective study of 368 patients. Eur. J. Endocrinol. 170, 593–599 (2014)

    Article  CAS  PubMed  Google Scholar 

  9. G. Treglia, P. Trimboli, F.A. Verburg, M. Luster, L. Giovanella, Prevalence of normal TSH among patients with autonomously functioning thyroid nodules. Eur. J. Clin. Invest. 45, 739–744 (2015)

    Article  CAS  PubMed  Google Scholar 

  10. M. Olivieri, P. Vitti, Attività di monitoraggio del programma nazionale per la prevenzione dei disordini da carenza iodica. http://www.iss.it/binary/osna/cont/Rapporto_Istisan_2014.pdf (2014). Accessed 6 August 2016

  11. M. Anderson, B. de Benoist, I. Darrnton-Hill, F. Delalonge, Iodine deficiency in Europe. A continuing public health problem. http://www.who.int/nutrition/publications/VMNIS_Iodine_deficiency_in_Europe.pdf (2007). Accessed 6 August 2016

  12. M. Heinisch, G. Kumnig, D. Asböck, P. Mikosch, H.J. Gallowitsch, E. Kresnik et al., Goiter prevalence and iodine urinary excretion in a formerly iodine deficient region after introduction of statutory iodization of common salt. Thyroid 12, 809–814 (2002)

    Article  CAS  PubMed  Google Scholar 

  13. A.C. van de Ven, R.T. Netea-Maier, H.A. Ross, T.A. van Herwaarden, S. Holewijn, J. de Graaf et al., Longitudinal trends in thyroid function in relation to iodine intake: ongoing changes of thyroid function despite adequate current iodine status. Eur. J. Endocrinol. 170, 49–54 (2013)

    PubMed  Google Scholar 

  14. J.I. Hamburger, The autonomously functioning thyroid nodule: Goetsch’s disease. Endocrine Reviews 8, 439–447 (1998)

    Article  Google Scholar 

  15. L. Hegedus, S.J. Bonnema, F.N. Bennedbaek, Management of simple nodular goiter: current status and future perspectives. Endocr. Rev. 24, 102–132 (2003)

    Article  PubMed  Google Scholar 

  16. P. Andermann, S. Schlögl, U. Mäder, M. Luster, M. Lassmann, C. Reiners, Intra- and interobserver variability of thyroid volume measurements in healthy adults by 2D versus 3D ultrasound. Nuklearmedizin 46, 1–7 (2007)

    CAS  PubMed  Google Scholar 

  17. P. Laurberg, S. Andersen, A. Carlé, J. Karmisholt, N. Knudsen, I.B. Pedersen, The TSH upper reference limit: where are we at? Nat. Rev. Endocrinol. 7, 232–239 (2011)

    Article  CAS  PubMed  Google Scholar 

  18. M.I. Surks, J.G. Hollowell, Age-specific distribution of serum thyrotropin and antithyroid antibobides in the US population: implications for the prevalence of subclinical hypothyroidism. J. Clin. Endocrinol. Metab. 92, 4575–4582 (2007)

    Article  CAS  PubMed  Google Scholar 

  19. B. Biondi, Thyroid and obesity: an intriguing relationship. J. Clin. Endocrinol. Metab. 95, 3614–3617 (2010)

    Article  CAS  PubMed  Google Scholar 

  20. J.G. Hollowell, N.W. Stehling, W.E. Flanders, Serum TSH, T4, and anthyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J. Clin. Endocrinol. Metab. 87, 489–499 (2002)

    Article  CAS  PubMed  Google Scholar 

  21. L. DeGroot, M. Abalovich, E.K. Alexander, Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J. Clin Endocrinol. Metab. 97, 2543–2565 (2012)

    Article  CAS  Google Scholar 

  22. Kopp, P., Thyrotoxicosis of other ethiologies. In: De Groot L.J. (ed.) Endotext, http://www.thyroidmanager.org/chapter/thyrotoxicosis-of-other-etiologies/ (2000). Accessed 6 August 2016

  23. J. Ehrenkranz, P.R. Bach, G.L. Snow, A. Schneider, J.L. Lee, S. Ilstrup, S.T. Bennett, S. Benvenga, Circadian and circannual rhythms in thyroid hormones: determining the TSH and free T4 reference intervals based upon time of day, age, and sex. Thyroid 25, 954–961 (2015)

    Article  CAS  PubMed  Google Scholar 

  24. M. Plebani, Biochemical and imaging biomarkers: the search for the Holy Grail. Clin. Chem. Lab. Med. 48, 1055–1056 (2010)

    CAS  PubMed  Google Scholar 

  25. B.C. Ahn, Personalized medicine based on theranostic radioiodine molecular imaging for differentiated thyroid cancer. Biomed. Res. Int. 2016, 9(2016). doi: 10.1155/2016/1680464

  26. G. Ronga, M. Filesi, R. D’Apollo, M. Toteda, A.D. Di Nicola, M. Colandrea et al., Autonomous functioning thyroid nodules and 131I in diagnosis and therapy after 50 years of experience: what is still open to debate? Clin. Nucl. Med. 38, 349–353 (2013)

    Article  PubMed  Google Scholar 

  27. G. Beckett, F. MacKenzie, Thyroid guidelines – are thyroid-stimulating hormone assays fit for purpose? Ann. Clin. Biochem. 44, 203–208 (2007)

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Deparment of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    Luca Giovanella, Pierpaolo Trimboli & Luca Ceriani

  2. Thyroid Committee - European Association of Nuclear Medicine, Vienna, Austria

    Luca Giovanella & Frederik Anton Verburg

  3. Clinical Pathology Laboratory, Department of Laboratory Medicine, General Hospital “Santa Maria degli Angeli”, Pordenone, Italy

    Federica D’Aurizio

  4. Department of Nuclear Medicine, University Hospital Messina, Messina, Italy

    Alfredo Campenni’ & Sergio Baldari

  5. Department of Endocrinology Units, University Hospital Messina, Messina, Italy

    Rosaria Maddalena Ruggeri

  6. Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany

    Frederik Anton Verburg

Authors
  1. Luca Giovanella
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Federica D’Aurizio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alfredo Campenni’
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rosaria Maddalena Ruggeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sergio Baldari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frederik Anton Verburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pierpaolo Trimboli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luca Ceriani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Giovanella.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics board of Ente Ospedaliero Cantonale, Bellinzona (Switzerland) and Univerity Hospital of Messina (Italy). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals.

Informed consent

Informed consent was obtained from all individual participants included in the present study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giovanella, L., D’Aurizio, F., Campenni’, A. et al. Searching for the most effective thyrotropin (TSH) threshold to rule-out autonomously functioning thyroid nodules in iodine deficient regions. Endocrine 54, 757–761 (2016). https://doi.org/10.1007/s12020-016-1094-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-016-1094-3

Keywords

Search

Navigation