Expression Of TSHR In Papillary Thyroid Carcinoma With Hyperthyroidism

Objective: In recent years,the incidence o f papillary thyroid carcinoma(PTC)and papillary thyroid carcinoma with hyperthyroidism has increased year by year.PTC is the most common pathological type of thyroid carcinoma(TC),accounting for over 80%,and the prognosis is good.The most important treatment is surgical treatment,but the recurrence rate is as high as 35%.In order to reduce the rate of recurrence and metastasis,endocrine therapy,TSH inhibition therapy,is usually performed after surgery.The rationale for this treatment is that thyroid papillary carcinoma is dependent on thyrotropin,and studies have shown that TSH inhibition is associated with thyroid cancer thyroid stimulating hormone receptor(TSHR)expression and function.However,the expression and function of TSHR in cancer cells with PTC of hyperthyroidism are not clear,and endocrine therapy has many side effects,which seriously endangers the survival time and quality of life of patients.Therefore,the study of TSHR expression in PTC with hyperthyroidism is also urgent,in order to achieve postoperative individualized endocrine therapy and reduce related adverse reactions.The aim of this study was to investigate the expression of TSHR in PTC with hyperthyroidism by immunohistochemical staining,and to evaluate relevant clinical parameters such as gender,age,cervical lymph node metastasis and histological staging,PTC pathological subtype,and hyperthyroidism.The correlation with TSHR provides a theoretical basis for postoperative TSH inhibition therapy,and further explores the guiding significance of TSHR expression for clinical treatmentMethods: This study collected the clinical data of 104 patients with PTC who had hyperthyroidism who underwent surgical treatment of the thyroid mammary gland in the general surgery o f the General Hospital of Tianjin Medical University from September 2016 to September 2018,and obtained 104 cases from the pathology department.Archived wax blocks of patients’ tissues,31 cases of normal thyroid tissue other than 1cm adjacent to the ade noma of the same operation(ie,normal group),172 cases of PTC tissue with normal preoperative thyroid function and no history of hyperthyroidism or hypothyroidism(ie,simple PTC group)There were 23 cases of patients with hyperthyroidism(ie,the simple hyperthyroidism group)as a control group.All patients with thyroid cancer have been excluded from the treatment of preoperative thyroid disease,such as radiotherapy and chemotherapy.All tissue wax blocks were serially sliced in 5 μm thickness,one of which was used for routine HE staining,and the other two sections were used for immunohistochemical staining of TSHR and negative control.For each specimen,two or more pathologists were used.confirm.The immunohistochemical staining of the above sections was performed to observe the expression of TSHR,and the clinical data of the patients were analyzed.The SPSS 22.0 statistical software was used to analyze the data using chi-square test,non-parametric rank-sum test and rank correlation.The test criteria were statistically significant at P <0.05.Results: In 31 normal thyroid tissues,the positive rate of TSHR expression was 100.0%,and the positive and strong positive expression rate was 100.0%.In 172 cases of PTC tissue,the positive rate of TSHR expression was 92.0%,positive and strong positive.The expression rate was 77.3%.In 21 cases of hyperthyroid only tissue,the positive rate of TSHR expression was 95.2%,and the positive and strong positive expression rate was 90.5%.In the tissue of 104 PTC combined with hyperthyroidism,the positive rate of TSHR expression was 93.3.%,positive and strong positive expression rate accounted for 77.0%.The Kruskal-Wallis H test was statistically significant for the four groups of data.It can be considered that the expression of TSH receptors in the tissue of normal thyroid,PTC only,hyperthyroidism only,and PTC combined with hyperthyroidism is different.The Wilcoxon rank sum test was used to compare the two groups.The difference of TSH expression between the normal group and the hyperthyroid only group and the PTC group and the PTC with hyperthyroidism group was statistically significant,while the normal group and the hyperthyroidism group and the PTC group were compared.There was no statistically significant difference in the PTC group with hyperthyroidism.It can be considered that the expression of TSH receptor in normal thyroid tissue and hyperthyroid only tissue was higher than that of PTC alone and PTC combined with hyperthyroidism.By routinely staining and analyzing the PTC sections of 104 patients with hyperthyroidism in this experiment,the positive and strong positive expression rate of58 cases of conventional PTC combined with hyperthyroidism was 86.7%;for 14 cases of microcarcinoma of PTC combined with hyperthyroidism,the positive and strong positive expression rate accounted for 71.4%;the positive and strong positive expression rate of 14 cases of follicular variants of PTC combined with hyperthyroidism was 71.4%;the positive and strong positive rate of 12 cases of oncocytic variant of PTC combined with hyperthyroidism was 75.0%;the positive and strong positive rate of 6 cases of high invasive subtype of PTC was 16.7%.The Kruskal-Wallis H test was performed o n the five groups of data.The difference was statistically significant.It can be considered that the expression of TSHR in the five pathological types of hyperthyroidism combined with PTC is different.The Wilcoxon rank sum test was used to compare the five groups.The expression of TSHR in the hyperthyroidism combined with PTC high invasive subtype and the other four groups were statistically significant.It can be concluded that the expression of TSHR in hyperthyroidism combined with PTC high invasive subtype was lower than other pathologies.The type of TSHR was expressed,while there was no difference in TSHR expression between the remaining subtypes.In addition,the PTC group with hyperthyroidism was grouped based on patient gender,age,lymph node metastasis,tumor size,TNM stage,hyperthyroidism,TSH value,TSH receptor antibodies(TRAb)positive or not,thyroid hormone(T3)and T4 values and the corresponding statistical analysis was performed,and there was no statistical significance.It is not yet considered that TSH receptor expression in PTC tissues with hyperthyroidism is associated with these factors.Conclusion: 1.The expression intensity of TSHR in PTC tissues with hyperthyroidism is lower than that of normal thyroid tissue.There was no statistical difference between hyperthyroid only tissue and PTC only tissue.2.TSHR expression of PTC high invasive subtype tissue is lower than that of other low invasive subtypes of PTC combined with hyperthyroidism.There was no statistical difference between the subtypes,which indirectly proved the correlation between TSHR and tissue differentiation.3.The expression of TSHR was not correlated with gender,age,lymphatic metastasis,tumor size,TNM stage and hyperthyroidism related factors;4.Although the expression of TSHR was lower in PTC combined with hyperthyroidism,its expression rate still reached 77.0%,indicating that it still has a certain dependence on TSH,which is of great significance for guiding individualized TSH inhibition therapy.