Nuclear localization of thyroid transcription factor-1 correlates with serum thyrotropin activity and may be increased in differentiated thyroid carcinomas with aggressive clinical course

Thyroid transcription factor 1 (TTF-1) is essential for thyroid differentia tion and regulates expression of thyroglobulin, thyroid peroxidase, sodium/ iodide symporter, and. thyrotropin receptor (TSH-R) genes. Because thyrotro pin (TSH) upregulates these same genes, we hypothesized TSH-R activation mi ght increase TTF-1 and that TTF-1 might be differentially expressed in beni gn and malignant thyroid disease. TTF-1 expression and sub-cellular localiz ation were determined by immunohistochemistry in 62 thyroid carcinomas, 15 benign lesions, and 2 normal thyroids. Nuclear TTF-1 was detected in benign (77%) and malignant lesions (69%), with similar intensity in both (1.1 +/- 0.19 versus 1.0 +/-0.10). Nuclear TTF-1 staining correlated with the effect ive serum TSH level (p = 0.02) and patient age (p < 0.05). Nuclear TTF-1 wa s detected in 35 papillary thyroid carcinomas (PTC), of which 23% developed recurrent or persistent disease, and was absent from 18 PTC, of which only 6% recurred (p = 0.06). We conclude that nuclear TTF-1 correlates with ser um TSH activity, increases with age, and may be increased in persistent or recurrent PTC.