| Objective:To explore the values of preoperative serum thyroid stimulating hormone,thyroglobulin and antithyroglobulin antibody in predicting the risk of differentiated thyroid carcinoma.Methods:One hundred and twenty-two patients with thyroid nodules who got operations were studied, among which 55 patients with differentiated thyroid carcinoma(54 papillary and 1follicular),67 cases with benign thyroid nodules(40 nodular goiter and 27 adenoma). Serum thyroid-stimulating hormone(TSH) and thyroglobulin(Tg) were measured by chemiluminescence method,and antithyroglobulin antibody(Tg Ab) by radioimmunoassay.Thyroid tissues and cervical lymph nodes were checked using color doppler ultrasonic diagnostic instrument and the postoperative pathological results was regard as the gold standard of diagnosing thyroid cancer.Results:1. Preoperative serum Tg levels in thyroid cancer group(24.09±64.59) and benign thyroid nodules group(23.37±112.14)had no statistical differences(Z=1.092, P>0.05).TSH levels in thyroid carcinoma group(2.32±2.28) were higher than that in benign thyroid nodules group(1.75±1.22),(Z = 2.107, P < 0.05).TSH: Tg values of thyroid cancer group of(0.09±0.04) and that of benign thyroid nodule group(0.05±0.20) had statisticallysignificant difference(Z = 2.297, P < 0.05);2. Positive rate of Tg between benign thyroid nodules group and thyroid carcinoma group had no statistical difference.Positive rate of Tg Ab between the two groups had a statistically significant difference.As a result of the existence of serum Tg Ab and abnormally elevated can result in negative Tg tes,so we did a Tg and Tg Ab conjoint analysis, it is concluded that the positive rate of Tg and(or) Tg Ab in thyroid cancer group(72.7%) was higher than that in benign thyroid nodules group(55.2%)(χ2= 3.975, P< 0.05).3. Logistic regression analysis showed that Tg Ab negative, TSH value is 0.34~2.50 m IU/L is the protective factor of thyroid carcinoma;4. Receiver operating characteristic(ROC) curves showing sensitivity as a function of specificity were calculated for TSH,Tg levels and TSH:Tg values to evaluate the potential accuracy of the three index as predicting differentiated thyroid carcinoma.Under the curve(AUC) of The TSH model was 0.611, 95% confidence interval(95% CI) for(0.509~0.713),P<0.05. The optimum threshold was 2.31 m IU/L. The sensitivity and specificity were71.6% and 50.9% respectively. TSH: Tg model AUC=0.617, 95% CI=0.518~0.716), P<0.05.The best critical value was 0.11 IU/mg. The sensitivity and specificity were 61.2%and 50.9% respectively. AUC of Tg model was less than 0.5.Among the 122 cases of the research,47 cases had visible nodule calcification under ultrasound, including 37 cases of thyroid carcinoma,17 cases(45.9%) with TSH: Tg>0.11 IU/mg, 10 cases of benign nodules,only 2 cases(20%) of which the TSH: Tg>0.11, indicating that when ultrasonic tip nodule with calcification, TSH:Tg value>0.11 IU/mg will significantly increase the risk of thyroid cancer.Conclusions:1. The relative higher TSH and positive Tg Ab is a risk factor for thyroid cancer; 2.Serum thyroglobulin should not be an independent predicting factor of differentiated thyroid cancer; 3. TSH:Tg>0.11IU/mg will increase risk of differentiated thyroid cancer obviously, and can be used as effective supplementary means of ultrasound examination inpredicting differentiated thyroid carcinoma. |
PDF Full Text Request