Relationship Between Serum Thyrotropin,Thyroglobulin Antibody Status And Prognosis In Patients With Differentiated Thyroid Cancer

Objective: Serum thyrotropin(TSH)concentration and Thyroglobulin antibody(Tg Ab)may be of prognostic importance in differentiated thyroid cancer(DTC).Preoperative serum TSH level was been associated with higher DTC stage in cross-sectional studies;data are contradictory on the significance of thyroid autoimmunity at the time of diagnosis.We sought to assess whether preoperative serum TSH and perioperative antithyroglobulin antibodies were associated with thyroid cancer stage and outcome in DTC patients.Methods: Retrieval and inspection hospitalized patients in our hospital in January 2004 to December 2011.Patients with available preope rative serum TSH(n = 617;the TSH cohort)or perioperative Tg Ab status(n = 1701;the Tg Ab 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 m U/L vs.1.02 m U/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 Tg Ab was associated with lower stage on univariate analysis(positive Tg Ab 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 Tg Ab 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 Tg Ab is not an independent predictor of DTC prognosis.A larger cohort is required to assess whether preoperative serum TSH level predicts recurrence or mortality.