Ratio of thyrotropin to thyroglobulin as a novel marker for differentiating between benign and malignant thyroid nodules within different bethesda categories Benign ve malign tiroid nodüllerinin ayrımında ve farklı bethesda kategorilerinde yeni bir belirteç olarak tirotropin tiroglobulin oranı

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Tam A. A., Ozdemir D., Aydin C., Bilginer M. C., Yazicioglu M. O., Sungu N., ...More

Turkish Journal of Endocrinology and Metabolism, vol.22, no.1, pp.21-31, 2018 (Scopus) identifier identifier

  • Publication Type: Article / Article
  • Volume: 22 Issue: 1
  • Publication Date: 2018
  • Doi Number: 10.25179/tjem.2017-58803
  • Journal Name: Turkish Journal of Endocrinology and Metabolism
  • Journal Indexes: Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.21-31
  • Keywords: Bethesda, Thyroglobulin, Thyroid malignancy, Thyrotropin, TSH/Tg
  • Ankara Yıldırım Beyazıt University Affiliated: Yes


© 2018 by Turkish Journal of Endocrinology and Metabolism Association.Objective: We aimed to determine whether the ratio of thyrotropin (TSH) to thyroglobulin (Tg) (TSH/Tg) would be able to assist in predicting malignancy in thyroid nodules. Material and Methods: Euthyroid patients operated between the year 2007 and 2014 were retrospectively reviewed. Patients who previously had thyroid disease or surgery and those with increased levels of anti-thyroglobulin antibodies were excluded from this study. Clinicopathological features, as well as serum TSH, Tg, and TSH/Tg were compared between histopathologically benign and malignant groups. Results: Data related to 370 (60.3%) benign and 244 (39.7%) malignant patients were analyzed. The malignant patients exhibited significantly higher TSH, TSH/Tg, and total thyroid volume, and a lower Tg compared to the benign patients (p<0.001 for each). There were 924 (74.2%) benign and 321 (25.8%) malignant nodules. Cytological distribution of the nodules was observed to be as follows: 343 (27.6%) nondiagnostic, 637 (51.2%) benign, 121 (9.7%) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 39 (3.1%) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 64 (5.1%) suspicious for malignancy (SM), and 41 (3.3%) malignant. TSH, Tg, and TSH/Tg were significantly different in different Bethesda categories (p<0.001 for each). Median TSH/Tg was the lowest in benign (0.013), and highest in SM (0.054) and malignant (0.086) cytologies. TSH/Tg was significantly higher in the malignant nodules compared to benign nodules, in AUS/FLUS, FN/SFN, and SM categories (p=0.001, p<0.001, and p=0.003, respectively). In the regression analysis, TSH/Tg demonstrated higher diagnostic performance compared to TSH and Tg (p<0.001). Discussion: Preoperative TSH/Tg could be used as a novel marker for differentiating between benign and malignant thyroid nodules. It could also assist in the prediction of risk of malignancy and management decisions when the cytology is indeterminate.