MEASUREMENT OF SERUM TSH IN THE INVESTIGATION OF PATIENTS PRESENTING WITH THYROID ENLARGEMENT

Citation
Akp. Lim et al., MEASUREMENT OF SERUM TSH IN THE INVESTIGATION OF PATIENTS PRESENTING WITH THYROID ENLARGEMENT, QJM-MONTHLY JOURNAL OF THE ASSOCIATION OF PHYSICIANS, 91(10), 1998, pp. 687-689
Citations number
12
Categorie Soggetti
Medicine, General & Internal
ISSN journal
14602725
Volume
91
Issue
10
Year of publication
1998
Pages
687 - 689
Database
ISI
SICI code
1460-2725(1998)91:10<687:MOSTIT>2.0.ZU;2-G
Abstract
In otherwise euthyroid patients presenting with thyroid enlargement, r eduction in serum thyrotrophin (TSH) concentrations measured in a sens itive assay may be a marker of thyroid autonomy and may therefore indi cate a benign underlying pathology. We investigated prospectively a co hort of 467 subjects presenting consecutively to our thyroid clinic wi th nodular or diffuse enlargement of the thyroid. Subjects were divide d into those cvi ih normal (0.4-5.5 mU/l), low but detectable (0.1-0.3 9 mU/l) or undetectable (<0.1 mU/l) serum TSH concentrations. The fina l pathological diagnosis was defined by fine-needle aspiration cytolog y;and clinical follow-up of at least 2 years or by fine-needle aspirat ion cytology and histology following surgical treatment. Serum TSH con centrations below normal were found in 75 patients (16.1%), those with low serum TSH results having higher mean free T4 concentrations, were older and were more likely to be female. In those with undetectable s erum TSH, no patient had a diagnosis of thyroid neoplasia and in those with low but detectable TSH, thyroid neoplasms were diagnosed in two patients (3.4%). In those with normal serum TSH, 12.0% had a final dia gnosis of thyroid neoplasm (p=0.013). Overall, thyroid malignancy was found in one patient (1.3%) of those with a serum TSH measurement belo w the normal range and 6.9% of those with normal serum TSH (p<0.06). R eduction in serum TSH at presentation may identify a group which requi res less intensive investigation and follow-up than those without bioc hemical evidence of thyroid autonomy.