Searching for the most effective thyrotropin (TSH) threshold to rule-out autonomously functioning thyroid nodules in i
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ORIGINAL ARTICLE
Searching for the most effective thyrotropin (TSH) threshold to rule-out autonomously functioning thyroid nodules in iodine deficient regions Luca Giovanella1,2 Federica D’Aurizio3 Alfredo Campenni’4 Rosaria Maddalena Ruggeri5 Sergio Baldari4 Frederik Anton Verburg2,6 Pierpaolo Trimboli1 Luca Ceriani1 ●
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Received: 21 June 2016 / Accepted: 13 August 2016 © Springer Science+Business Media New York 2016
Abstract The purpose of this study is to evaluate the distribution of thyrotropin (TSH) values in patients with autonomously functioning thyroid nodules and to set a TSH threshold above which thyroid scintigraphy would be obviated. Four hundred fifty one patients were included in the present study. Inclusion criteria were age > 18 years, TSH levels between 0.40 and 4.0 mIU/L, detection of a single solid or predominantly solid thyroid nodule >10 mm in the longest diameter. Thyroid ultrasound and thyroid scintigraphy with 99mTc-pertechnetate were performed concurrently in all patients. Among 451 enrolled patients, 173 (38 %) had an autonomously functioning thyroid nodules, of which 137 (79 %) with a normal TSH level. Demographic data and nodules’ volume were not significantly different in patients with autonomously functioning thyroid nodules and non-functioning nodules, respectively. However, TSH levels were nonetheless significantly lower in patients with autonomously functioning thyroid nodules compared to those with
non-functioning nodules (p < 0.001). Adopting a TSH cutoff level at 2.38 mUI/L, all autonomously functioning thyroid nodules were correctly identified (i.e., 100 % sensitivity) with a 100 % negative predictive value. Our study showed a very high prevalence of autonomously functioning thyroid nodules in mildly iodine-deficient regions and confirmed that serum TSH is not an effective screening test to diagnose an autonomously functioning thyroid nodules. Our data add arguments in favor of the first-line use of thyroid scintigraphy to assess thyroid nodules, at least in iodine deficient areas. As all scintigraphically detected autonomously functioning thyroid nodules had a TSH level below 2.38 mUI/L, a thyroid scintigraphy should be omitted when higher TSH values are found in patients carrying a thyroid nodule. Keywords Thyrotropin Thyroid nodule Scintigraphy Fine-needle aspiration ●
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Introduction * Luca Giovanella [email protected] 1
Deparment of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Thyroid Committee - European Association of Nuclear Medicine, Vienna, Austria
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Clinical Pathology Laboratory, Department of Laboratory Medicine, General Hospital “Santa Maria degli Angeli”, Pordenone, Italy
4
Department of Nuclear Medicine, University Hospital Messina, Messina, Italy
5
Department of Endocrinology Units, University Hospital Messina, Messina, Italy
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Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
Thyroid scintigraphy (ThyS) with either 99mTc-pertechnetate or 123I
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