Prognosis of differentiated thyroid cancer in relation to serum thyrotropin and thyroglobulin antibody status at time of diagnosis

McLeod, Donald S. A., Cooper, David S., Ladenson, Paul W., Ain, Kenneth B., Brierley, James D., Fein, Henry G., Haugen, Bryan R., Jonklaas, Jacqueline, Magner, James, Ross, Douglas S., Skarulis, Monica C., Steward, David L., Maxon, Harry R. and Sherman, Steven I. (2014) Prognosis of differentiated thyroid cancer in relation to serum thyrotropin and thyroglobulin antibody status at time of diagnosis. Thyroid, 24 1: 35-42. doi:10.1089/thy.2013.0062

Author McLeod, Donald S. A.
Cooper, David S.
Ladenson, Paul W.
Ain, Kenneth B.
Brierley, James D.
Fein, Henry G.
Haugen, Bryan R.
Jonklaas, Jacqueline
Magner, James
Ross, Douglas S.
Skarulis, Monica C.
Steward, David L.
Maxon, Harry R.
Sherman, Steven I.
Title Prognosis of differentiated thyroid cancer in relation to serum thyrotropin and thyroglobulin antibody status at time of diagnosis
Journal name Thyroid   Check publisher's open access policy
ISSN 1050-7256
Publication date 2014-01-09
Year available 2014
Sub-type Article (original research)
DOI 10.1089/thy.2013.0062
Open Access Status
Volume 24
Issue 1
Start page 35
End page 42
Total pages 8
Place of publication New Rochelle, NY United States
Publisher Mary Ann Liebert, Inc. Publishers
Collection year 2015
Language eng
Formatted abstract
Background: Serum thyrotropin (TSH) concentration and thyroid autoimmunity may be of prognostic importance in differentiated thyroid cancer (DTC). Preoperative serum TSH level has been associated with higher DTC stage in cross-sectional studies; data are contradictory on the significance of thyroid autoimmunity at the time of diagnosis.

Objective: We sought to assess whether preoperative serum TSH and perioperative antithyroglobulin antibodies (TgAb) were associated with thyroid cancer stage and outcome in DTC patients followed by the National Thyroid Cancer Treatment Cooperative Study, a large multicenter thyroid cancer registry.

Methods: Patients registered after 1996 with available preoperative serum TSH (n=617; the TSH cohort) or perioperative TgAb status (n=1770; the TgAb cohort) were analyzed for tumor stage, persistent disease, recurrence, and overall survival (OS; median follow-up, 5.5 years). Parametric tests assessed log-transformed TSH, and categorical variables were tested with chi square. Disease-free survival (DFS) and OS was assessed with Cox models.

Results: Geometric mean serum TSH levels were higher in patients with higher-stage disease (Stage III/IV=1.48 vs. 1.02 mU/L for Stages I/II; p=0.006). The relationship persisted in those aged ≥45 years after adjusting for sex (p=0.01). Gross extrathyroidal extension (p=0.03) and presence of cervical lymph node metastases (p=0.003) were also significantly associated with higher serum TSH. Disease recurrence and all-cause mortality occurred in 37 and 38 TSH cohort patients respectively, which limited the power for survival analysis. Positive TgAb was associated with lower stage on univariate analysis (positive TgAb in 23.4% vs. 17.8% of Stage I/II vs. III/IV patients, respectively; p=0.01), although the relationship lost significance when adjusting for age and sex (p=0.34). Perioperative TgAb was not an independent predictor of DFS (hazard ratio=1.12 [95% confidence interval=0.74–1.69]) or OS (hazard ratio=0.98 [95% confidence interval=0.56–1.72]).

Conclusions: Preoperative serum TSH level is associated with higher DTC stage, gross extrathyroidal extension, and neck node metastases. Perioperative TgAb is not an independent predictor of DTC prognosis. A larger cohort is required to assess whether preoperative serum TSH level predicts recurrence or mortality.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
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