术前TSH水平与甲状腺结节良恶性关系

目的：探讨血清促甲状腺激素（TSH）浓度与甲状腺结节良恶性的关系。 方法：回顾性分析近3年间收治的421例甲状腺结节患者的临床资料，其中结节性甲状腺肿347例，甲状腺癌74例。比较良恶性甲状腺结节患者血清TSH浓度差异，并分析TSH浓度与甲状腺结节的恶性风险以及甲状腺癌不同病理类型与血清TSH浓度的关系。 结果：甲状腺癌患者血清TSH浓度明显高于结节性甲状腺肿患者（2.57±3.32）mIU/L vs. （1.67±2.90）mIU/L]（P<0.05）；甲状腺结节的恶性风险随血清TSH浓度的升高而逐渐升高，当TSH>5 mIU/L时，恶性率为50.0%；甲状腺癌不同病理类型间血清TSH浓度无统计学差异（P>0.05）。 结论：甲状腺结节恶性风险随血清TSH浓度的升高而增加，术前血清TSH测定可以作为甲状腺结节良恶性判断的一个辅助性指标。

Relationship between preoperative serum thyrotropin (TSH) level and the nature of thyroid nodule

Objective: To investigate the relationship between the serum thyroid stimulating hormone (TSH) level and the benign or malignant nature of the thyroid nodule(s). Methods: The clinical data of 421 patients with thyroid nodules admitted over the past three years were retrospectively analyzed. Of the patients, 347 cases were diagnosed as benign nodular goiter and another 74 cases were diagnosed as thyroid carcinoma. The difference in serum TSH concentration between the patients with benign and malignant thyroid nodule(s) was compared, and the relevance of the serum TSH concentration to the malignancy risk of thyroid nodule as well as the pathological types of thyroid cancer to serum TSH level were analyzed. Results: The average serum TSH concentration of the thyroid cancer patients was significantly higher than that of the patients with nodular goiter (2.57±3.32) mIU/L vs. (1.67±2.90) mIU/L] (P<0.05). The malignancy risk of thyroid nodule rose gradually with increasing serum TSH level, and the malignancy rate approached 50.0% as a TSH value exceeded 5 mIU/L. The serum TSH levels among the thyroid cancer patients of different pathological types showed no significant difference (P>0.05). Conclusion: The malignancy risk of thyroid nodule increases with increasing serum TSH level, thus the preoperative serum TSH determination can be exploited as a supplementary index for differentiating the nature of the thyroid nodule(s).