The utility of preoperative serum thyroid-stimulating hormone level for predicting malignant nodular thyroid disease

Am J Surg. 2010 Mar;199(3):294-7; discussion 298. doi: 10.1016/j.amjsurg.2009.08.028.


Introduction: The aim of this study was to assess whether serum thyroid-stimulating hormone (TSH) levels are of value in predicting malignancy in patients with nodular thyroid disease (NTD).

Methods: Patients with NTD and a preoperative TSH level who underwent thyroidectomy between 1990 and 2008 were identified from a prospective database. Age, sex, TSH concentration, nodule size, and pathology were evaluated. Logistic regression analysis was used to determine which factors were predictive of malignancy.

Results: Six hundred fifty-three patients were analyzed. The overall rate of malignancy was 20%; the rate was highest in patients<30 years (32%). The mean TSH level was higher in the malignant group (5.5 microIU/mL vs 1.4 microIU/mL, P<.0001). The rate of malignancy was 65% in patients with TSH levels>5.5 microIU/mL. Logistic regression analysis revealed that TSH level was the only significant risk factor for malignancy.

Conclusion: The serum TSH level may be useful in predicting the probability of cancer and optimizing the extent of thyroidectomy in patients with NTD.

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Diagnosis, Differential
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Preoperative Care
  • Retrospective Studies
  • Thyroid Neoplasms / blood*
  • Thyroid Neoplasms / diagnosis*
  • Thyroid Neoplasms / surgery
  • Thyroid Nodule / blood
  • Thyroid Nodule / diagnosis
  • Thyroid Nodule / surgery
  • Thyrotropin / blood*


  • Biomarkers
  • Thyrotropin