TSH Düzeyi Preoperatif Tiroid Nodüllerinde Malignite Açısından Öngörücüdür; Tek Merkez Deneyimimiz

Öz

Amaç: Tiroid nodülü nedeniyle tiroidektomi uygulanan hastalarda preoperatif tiroid uyarıcı hormon (TSH) düzeyinin postoperatif patolojik malignite ile ilişkisini değerlendirmek ve TSH'nin ayırt edici gücünü TI-RADS ile karşılaştırmaktır. Gereç ve Yöntem: Üçüncü basamak bir merkezde 1 Ocak 2023–1 Ocak 2025 tarihleri arasında tiroid nodülü nedeniyle opere edilen 366 hasta retrospektif olarak incelendi. Preoperatif TSH, sT3, sT4 ve rutin biyokimyasal parametreler, TI-RADS skoru, ince iğne aspirasyon biyopsisi (İİAB) sitolojisi ve cerrahi tip kaydedildi. Hastalar nihai patolojiye göre benign ve malign olarak iki gruba ayrıldı. TSH ve TI-RADS için ROC analizi yapıldı; kesim değeri Youden indeksi ile belirlendi. Malignite ile ilişkili değişkenler tek ve çok değişkenli lojistik regresyon ile değerlendirildi. Bulgular: Hastaların 223'ü (%60,9) benign, 143'ü (%39,1) malign patoloji aldı. Yaş ve cinsiyet açısından gruplar benzerdi (sırasıyla p=0,737; p=0,477). TSH malign grupta anlamlı olarak daha yüksekti (medyan 1,250 vs 1,115 µIU/mL; p=0,029); sT3 de malign grupta yüksekti (p=0,010). TSH için AUC 0,572 (%95 GA: 0,508–0,636) ile düşük bulunurken, TI-RADS için AUC 0,802 (%95 GA: 0,752–0,853) olarak hesaplandı. Youden indeksine göre TSH kesim değeri 0,687 µIU/mL idi (duyarlılık %85,8; özgüllük %32,8). Çok değişkenli modelde TSH ≥0,687 µIU/mL (OR=6,10; %95 GA: 2,28–16,33), TI-RADS skoru (OR=3,58; 2,25–5,69) ve non-benign İİAB sitolojisi (OR=16,04; 6,63–38,79) malignite ile bağımsız ilişkili bulundu (tümü p<0,001; Nagelkerke R²=0,613). Sonuç: TSH tek başına zayıf bir ayırt edici testtir; ancak referans aralığı içindeki düzeylerde bile TI-RADS ve İİAB'ye ek bağımsız risk bilgisi sağlayabilir.

Anahtar Kelimeler

• İnce iğne aspirasyon biyopsisi
• Tiroid neoplazileri
• Tiroid nodülü
• Tirotropin
• TI-RADS

TSH Levels Are Predictive of Malignancy in Preoperative Thyroid Nodules: Our Single-Center Experience

Öz

Objective: To evaluate the association between preoperative thyroid-stimulating hormone (TSH) levels and postoperative histopathological malignancy in patients undergoing thyroidectomy for thyroid nodules, and to compare the discriminative performance of TSH with that of TI-RADS. Material and Methods: A total of 366 patients operated for thyroid nodules between January 1, 2023 and January 1, 2025 at a tertiary center were retrospectively reviewed. Preoperative TSH, fT3, fT4 and routine biochemical parameters, TI-RADS score, fine-needle aspiration biopsy (FNAB) cytology and type of surgery were recorded. Patients were dichotomized as benign or malignant according to final pathology. ROC analysis was performed for TSH and TI-RADS, with the optimal cut-off determined by the Youden index. Variables associated with malignancy were assessed by univariate and multivariate logistic regression. Results: Final pathology was benign in 223 patients (60.9%) and malignant in 143 (39.1%). Groups were comparable for age and sex (p=0.737 and p=0.477, respectively). TSH was significantly higher in the malignant group (median 1.250 vs 1.115 µIU/mL; p=0.029), as was fT3 (p=0.010). The AUC was low for TSH (0.572; 95% CI: 0.508–0.636) but substantially higher for TI-RADS (0.802; 95% CI: 0.752–0.853). The Youden-derived TSH cut-off was 0.687 µIU/mL (sensitivity 85.8%, specificity 32.8%). In multivariate analysis, TSH ≥0.687 µIU/mL (OR=6.10; 95% CI: 2.28–16.33), TI-RADS score (OR=3.58; 2.25–5.69) and non-benign FNAB cytology (OR=16.04; 6.63–38.79) were independently associated with malignancy (all p<0.001; Nagelkerke R²=0.613). Conclusion: TSH alone is a weak discriminative test; however, even within the reference range, it may provide independent risk information complementary to TI-RADS and FNAB.

Anahtar Kelimeler

• Fine-needle aspiration biopsy
• Thyroid neoplasms
• Thyroid nodule
• Thyrotropin
• TI-RADS

Kaynakça

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