RELAÇÃO DOS NÍVEIS DO HORMÔNIO ESTIMULANTE DA TIREÓIDE (TSH) COM A MALIGINIDADE DOS NÓDULOS DE TIREÓIDE
Keywords:
nódulo de tireóide, câncer de tireóide, hôrmonio estimulante da Tireoide (TSH)Abstract
Introdução: associação entre os níveis elevados de TSH como fator trófico á célula tireoidiana e a maior prevalência de cânce tireoidiano tem sido discutida.
Objetivos: Relacionar os Níveis de TSH em Valores de Corte, conforme a literatura, com a malignidade em nódulos de tireóide (NT).
Material e métodos: Estudo tranversal de 159 prontuários ( 171NT) no HU/UFSC de agosto de 2010-2012. Realizadas avaliações cito-patológicas e do TSH em ensaio de quimiluminescência( terceira geração) á época da punção aspirativa e categorizando os pontos de corte. Pacientes com disfunçaõ estabelecida foram excluídos. Análises estatistícas com teste do X2 e Fischer e significância em p< 0,05.
Resultados: A média de idade dos pacientes foi de 48 anos com 92,4% de mulheres; 2,9% , 64,3% , 5,3%, 10,5%, 8,8% e 8,2% dos NT com Bethesda 1a VI respectivamente. O TSH variou de 0,08 a 10,5 ( média: 1,965 ± 1,69; mediana: 1,48) uUI/mL. Trinta e cindo NT foram operados, sendo 74,3% malignos e, deses, 80,8% carcinomas papilíferos. Análises dos grupamentos Bethesda e citopatológicos ( casos operados + não operados com citopatologias II, V, VI = 150 NT) em valores de corte de TSH< 1 e ? 1, TSH < 1,8 e ? 1,8 uUI/mL .Evidenciaram significância apenas em 1,8, com 32,7% dos NT Bethesda II e 71,4 % dos Bethesda VI ? 1,8 . Confirmando-se a Histopatologia onde 33,9%de 115 NT Benignos versus 60% de 35 NT Malignos apresentavam TSH? 1,8 uUI/mL(p<0,006).
Conclusão: Malignidade em NT relacionou-se com valro de corte de TSH? 1,8 uUI/mL.
References
Guyton & Hall. Fisiologia Médica .11 ed.São Paulo. Elsevier; 2006.931-43
Vilar, L. Endocrinologia Clínica. 4 ed. Rio de Janeiro:MEDSI;2009.
Ridgway, E.Chester and Wartofsky. Thyroid Nodules. J Clin Endocrinol Metab. 2006; 91:0
Maia AL, Ward LS,Carvalho GA,Graf H, Maciel Rui MB, Maciel LMZ,Rosário PW, Vaisman M.Nódulos de tireoide e câncer diferenciado de tireoide: consenso brasileiro . Arq Bras Endocrinol Metab 2007; 51(5):867-93
Ward, LS, Morari EC,Leite JL, Bufalo NE, Guilhen ACT, Araujo PPC , Tincani AJ, Assumpção LVM,Matos PS. Identifying a Risk Profile for Thyroid Cancer. Arq Bras Endocrinol Metab. 2007;51(5):713-22.
Guignard R, Truong T, Rougier Y, Baron Dubourdieu D, Guénel P. Pascal Acohol Drinking, Tobacco Smoking, and Anthropometric Characteristics as Risk Factors for Thyroid Cancer: A Countrywide Case-Control Study in New Caledonial na população multiétnica. Am J Epidemiol. 2007;166(10):1140–49.
Effraimidis G, Tijssen JGP, Wiersinga WM. Discontinuation Of smoking increases the risk for developing thyroid Peroxidase antibodies and / or Thyroglobulin antibodies: a prospective study J Clin Endocrinol Metab. 2009; 94(4):1324–28.
Li Y, Teng D, Shan Z, Teng X, Guan H, Yu X, Fan C, Chong W, Yang F, Dai H,Gu X, Yu Y, Mao J, Zhao D, Li J, Chen Y, Yang R, Chenyang L, Teng W. Antithyroperoxidase and Antithyroglobulin antibodies in a five-year follow-up survey of populations with different iodine intakes .J Clin Endocrinol Metab. 2008; 93(5):1751-1757.
Yamazaki CA,Mamone MCC, Ikejiri ES,Hidal JT, Matsumura LK, Hojaij FC, Cervantes O, Abrahão M, Furlanetto RP,Maciel RMB. Incidência de Malignidade na Doença Nodular da Tiróide Com Baixa Suspeita Clínica:Estudo Observacional Prospectivo por Dois Anos Numa Coorte de 50 Pacientes. Arq Bras Endocrinol Metab.2004; 48(2):282-93
Coeli CM, Brito AS, Barbosa FS., Ribeiro MG, Sieiro APAV, Vaisman M. Incidência e mortalidade por câncer de tireoide no Brasil. Arq Bras Endocrinol Metab.2005; 45( 4):503-09
Cordioli MCV, Canalli MHBS, Coral MHC. Increase incidence of thyroid cancer in Florianopolis, Brazil: comparative study of diagnosed cases in 2000 and 2005. Arq Bras Endocrinol Metab.2009; 53(4): 453-60.
Vieira JGH, Kasamatsu TS, Hauache OM, Maciel RMB. Anticorpos Anti-Tiróide: Aspectos Metodológicos e Importância Diagnosticada Medida dos diferentes anticorpos em várias condições clínicas.Arq Bras Endocrinol Metab; 47(5):612-21
Rosario PW, Xavier CAM, Calsolari MR. 2010. TSH reference values for adult Brazilian Population. Arq Bras Endocrinol Metab. 2003;54(7):603-6
Aldighieri FC, Duarte PS, Alonso G. Padronização de Valores de Captação Tiroidiana Com Iodo 123 Arq Bras Endocrinol Metab .2005; 49(3):425-32
Vieira JGH, Maciel RM.B , Hauache OM, Nishida SK, Boelter DMG,Pinheiro M FMC. Valores Inesperadamente Elevados de TSH: A Presença de Formas de Alto Peso Molecular (“Macro TSH”) Deve Ser Investigada. Arq Bras Endocrinol Metab.2006;50(3):445-49.
Boelaert K, Horacek J, Holder R L, Watkinson J C, Sheppard M C, Franklyn J A. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab. 2006;91(11):4295–4301
Snozek CLH, Chambers EP, Reading CC, SeboT, Sistrunk JW, Singh, Ravinder JS, Grebe SKG.Serum thyroglobulin, high-resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin Endocrinol Metab. 2007; 92(11):4278–81.
Biscolla RPM, Ikejiri ES, Mamone MC, Nakabashi CCD, Andrade VP, Kasamatsu TS, Crispim F, Chiamolera MI, Andreoni DM, Camacho CP, Hojaij FC, Vieira JGH, Furlanetto RP, Maciel RMB. Diagnóstico de Metástases de Carcinoma Papilífero de Tiróide Através da Dosagem de Tiroglobulina no Líquido Obtido da Lavagem da Agulha Utilizada na Punção Aspirativa . Arq Bras Endocrinol Metab. 2007 ;51(3):419-25
Rosário PWS, Maia FCP, Barroso AL, Purisch S. Abordagem dos Pacientes Com Carcinoma Diferenciado de Tireóide Com Tireoglobulina Sérica Elevada e Pesquisa de Corpo Inteiro Negativa . Arq Bras Endocrinol Metab. 2005; 49( 2): 246-52
Kim ES, Lim DJ, Baek KH, Lee JM, Kim MK, Kwon HS, Song KH, Kang MI, Cha BY, Lee KW, Son HY. Thyroglobulin antibody is associated with increased cancer risk in thyroid nodules. Thyroid . 201020:885–91
Martins AD, Cunha MP, Vilagelin DG, Santos RB, Romaldini JH, Camara RC, As MB. Presença de malignidade nos nódulos de tireoide não se associa a anticorpos ou ao valor do TSH. Serviço de Endocrinologia,Pontifícia Universidade Católica de Campinas (PUC Campinas), SP . Brasil. Disciplina De Endocrinologia, PUC-Campinas,Campinas , SP, Brasil.No prelo 2012.
Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS,Jaume JC, ChenH. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab.2008; 93:809–14.
Hovens Guido C,Stokkel Marcel P,Kievit Job, Corssmit Eleonora P, Pereira Alberto M Romijn Johannes A,Smit Johannes W A. Associations of serum thyrotropin concentrations with recurrence and death in differentiated thyroid cancer. J Clin Endocrinol Metab. 2007;92(7):2610–15 .
Brown Aaron P,Chen Jergin,Hitchcock Ying J,Szabo Aniko, Shrieve Dennis CTward, Jonathan D. The risk of second primary malignancies up to three decades after the treatment of differentiated thyroid cancer. J Clin Endocrinol Metab. 2008; 93(2):504–15
Peeters RP, Geyten SVD, Wouters PJ, Darras VM, Kaptein E, Visser TJ, Greet VDB. Tissue thyroid hormone levels in critical illness .J Clin Endocrinol Metab. 2005; 90(12): 6498–507.
Cibas ES & Ali SZ. The Bethesda system for Reporting Thyroid Cytopathology. Thyroid. 2009; 19 (11): 1159-65.
Bahn RS, Castro MR.Approach to the Patient with Nontoxic Multinodular Goiter.. J Clin Endocrinol Metab.2011; 96(5):1202–12.
Zubair W Baloch, Edmund S Cibas, Douglas P Clark, Lester J Layfield,Britt-Marie Ljung, Martha Bishop Pitman and Andrea Abati.The National Cancer Institute Thyroid fine needle aspiration stateof the science conference: a summation. CytoJournal.2008; 5:6.
Cibas ES & Ali SZ.. The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Patho l. 2009;132: 658-65.
Baloch ZW, Cibas ES, Clark DP, Layfield LJ, Ljung B, Pitman MB, Abati A. The National Cancer Institute Thyroid fine needle aspiration state of the science conference : A summation. CytoJournal [serial online] 2008 [cited 2012 Oct 15];5:6. Available from: http://www.cytojournal.com/text.asp?2008/5/1/6/41200
Cooper DS, Doherty GM , Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL , Tuttle RM, M.D. Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2009; 19 (11): 1167-214
Boelaert K. The association between serum TSH concentration and thyroid cancer. Endocr Relat Cancer .2009;16:1065–72
Fiore E, Rago T, Provenzale MA, Scutari M, Ugolini C, Basolo F, Coscio GD, Berti P; Grasso L, Elisei R, Pinchera A,Vitti P. Lower levels of TSH are associatede with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease:thyroid autonomy may play a protective role. Endocrine-Related Cancer.2009;16:1251-60.
Nixon IJ, Ganly I, Hann LE, Lin O, Yu C, Brandt S, Shah JP, Shaha A, Kattan MW, Patel SG. Nomogram for predicting malignancy in thyroid nodules using clinical, biochemical, ultrasonographic, and cytologic fetures. Surgery.2010 ;148:1120–1127; discussion 1127–28
Fiore E, Rago T, Provenzale MA, Scutari M, Ugolini C, Basolo F, Di Coscio G, Miccoli P, Grasso L, Pinchera A, Vitti P.L-Thyroxine-treated patients with nodular goiter have lower serum TSH and lower frequency of papillary thyroid cancer: results of a cross-sectional study on 27,914 patients. Endocr Relat Cancer.2010 ;17:231–39
Jin J, Machekano R, McHenry CR. The utility of preoperative serum thyroid-stimulating hormone level for predicting malignant nodular thyroid disease. Am J Surg. 2010 ;199:294–297; discussion 298
Moon SS, Lee YS, Lee IK , Kim JG. Serum thyrotropin as a risk factor for thyroid malignancy in euthyroid subjects with thyroid micronodule.Head & Neck,2011:949-52.
Rio AL, Biscolla RP, Andreoni DM, Camacho CP, Nakabashi CC,Mamone Mda C, Ikejiri ES, Matsumura LK, Hidal JT, Maciel RM,Furlanetto RP 2011 [ Evaluation of clinical, laboratorial and ultrasonographic predicting factors of malignancy in thyroid nodules.].Arq Bras Endocrinol Metab 55:29–37
Shi L, Li Y,Guan H, Li C, Shi L, Shan Z and Teng W.Usefulness of serum thyrotropin for risk prediction of differentiated thyroid cancers does not apply to microcarcinomas: results of 1870 Chinese patients with thyroid nodules.Endocrj.EJ12-0154:1-8.
Zafon C, Obiols G, Baena JA, Castellví J, Dalama B, Mesa J.Preoperative Thyrotropin SerumConcentrations Gradually Increase fromBenign Thyroid Nodules to Papillary ThyroidMicrocarcinomas Then to Papillary Thyroid Cancers of Larger Size. Journal of Thyroid Research,doi:10.1155/2012/530721.
Jonklaas J, Nsouli-Maktabi H, Soldin SJ. 2008 Endogenous thyrotropin and triiodothyronine concentrations in individuals with thyroid cancer. Thyroid 18:943–52.
Polyzos SA, Kita M, Efstathiadou Z, Poulakos P, Slavakis A, Sofianou D, Flaris N, Leontsini M, Kourtis A, Avramidis A. Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules. J Cancer Res Clin Oncol. 2008;134:953–60
Gul K, Ozdemir D, Dirikoc A, Oguz A, Tuzun D, Baser H, Ersoy R, CakirB. Are endogenously lower serum thyroid hormones new predictors for thyroid malignancy in addition to higher serum thyrotropin? Endocrine. 2010; 37:253–60.
Azizi G, Malchoff CD. Autoimmune thyroid disease: a risk factor for thyroid cancer. Endocr Pract .2011;17:201–9
Maia FF, Matos PS, Silva BP, Pallone AT, Pavin EJ, Vassallo J,Zantut-Wittmann DE . Role of ultrasound, clinical and scintigraphyc parameters to predict malignancy in thyroid nodule. Head NeckOnco.2011 ;l 3:17
Kim KW, Park YJ, Kim EH, Park SY, Park do J, Ahn SH, Park do J, Jang HC, Cho BY . Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto’s thyroiditis. Head Neck 2011;33: 691–95
Petric R, Perhavec A, Gazic B, Besic N. Preoperative serum thyroglobulin concentration is an independent predictive factor of malignancy in follicular neoplasms of the thyroid gland. J Surg Oncol. 2012; 105:351–56.
Fighera TM, Perez CLS, Faris NA, Cavalcanti TCS,Mesa JR CO, Miazaki FY,Graf H,Carvalho GA. Serviço de Endocrinologia e Metabolismo da Universidade Federal do Paraná (SEMPR,HC,Curitiba),PR . Brasil . Disciplina De Endocrinologia UFPR,Curitiba ,PR, Brasil.No prelo. 2012.
Faure E, Sala M, LOrcansky S, Corino M, Membros do Departamento de tireoide. Es El Bivel de TSH un Predicitor de citologia maligna em nódulos tireoideos.Serviço de Endocrinologia da Sociedade Argentina,Buenos Aires, Argentina.No prelo. 2012.
Araújo RB, Nogueira CR,Tagliarini JV, Castilho EC, Marques MEA, Kly Y, Carvalho LR, Mazeto G. Punção tireoidea suspeita: TSH como marcador para malignidade. Serviço de Emdocrinologia da Faculdade de Medicina de Botucatu (FMB-Unesp,Botucatu),SP.Brasil.No prelo. 2012.
Perez CLS, Inoue TH, Graf H, Carvalho GA. Níveis séricos de TSH e risco de Malignidade na investigação de nódulos de tireoide.Serviço de endocrinologia e metabologia (SEMPR), Hospittal das clinicas da Universidade Federal do Paraná(UFPR), Curitiba, Brasil. No prelo. 2012.
Canalli, MHBS. Nódulo de Tireóide: Punção com Agulha Fina. Florianópolis, Dissertação (Mestrado em Ciências Médicas) – Centro de Ciências da Saúde, Universidade Federal de Santa Catarina). 1998.
Fiore E, Rago T, Latrofa F, Provenzale MA, Piaggi P, Delitala A, Scurati M, Basolo F, Grasso L, inchera A, Vitti P.Hashimoto’s thyroiditis is associated with papillary thyroid carcinoma: role TSH and treatement with L-thyroxine. Endocr Relat Cancer. 2011; 18:429-37
Singh B, Shaha AR, Trivedi H, Carew JF, Poluri A, Shah JP.Coexistente Hashimoto’s thyroiditis with papillary thyroid carcinoma: impact on presentation, management, and outcome.Surgery.1999;126(6):1070-6
McLeod DAS, Waters KF, Carpenter PW,Ladenson PW, Cooper DS, Ding LE. Thyrotropin and Thyroid Cancer Diagnosis: A Systematic Review and Dose-Response Meta-Analysis. J Clin Endocrinol Metab.2012; 97: 2682-2712
Dorange A, Triau S, Mucci-Hennekinne S, Bizon A, Laboureau- Soares S, Illouz F, Rodien P, Rohmer V. An elevated level of TSH might be predictive of differentiated thyroid cancer. Ann Endocrinol (Paris) .2011;72:513–21
Chiu HK, Sanda S, Fechner PY, Pihoker C. TSH correlation with the risk of papillary thyroid carcinoma in pediatric patients. Thyroid . 2011; 21:A117 (Abstract)
Castro MR, Espiritu RP, Bahn RS, Henry MR, Gharib H, Caraballo PJ, Morris JC. Predictors of malignancy in patients with cytologically suspicious thyroid nodules. Thyroid 2011; 21:1191–98.
Alexande EK, Kennedy GC, Baloch ZW, Cibas ES, Chudova D, Diggans J, Friedman RL, Kloos RT, LiVolsi VA, Mandel SJ, Stephen S. R, Stewar DL, Walsh PS, Wilde J, Zeiger MA, Lanman RB, Haugen BR. Preoperative Diagnosis of Benign Thyroid Nodules with Indeterminate Cytology. N Engl J Med 2012; 367:705-15
Downloads
Published
Issue
Section
License
Copyright (c) 2016 Arquivos Catarinenses de Medicina
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
