Pre-operative serum TSH levels: A risk factor for advanced metastatic differentiated thyroid carcinoma

Advanced metastatic differentiated thyroid carcinoma

  • Sumera Batool aga khan university hospital, karachi
  • Muhammad Shakir Afridi aga khan university hospital, karachi
  • Adeel Akbar Khoja aga khan university hospital, karachi
  • Najmul Islam aga khan university hospital, karachi
Keywords: Thyroid cancer, Differentiated thyroid cancer (DTC), TSH levels, American Joint Committee on Cancer (AJCC), Fine needle aspiration cytology (FNAC)


Background and Objective: As the thyroid cancer incidence is increasing, the search for its risk factor is becoming more important. Serum thyroid stimulating hormone (TSH) levels being a growth factor for normal thyroid tissue, is also considered as growth promotor of cancer cells. In our study we aimed for pre-operative serum TSH levels of Differentiated thyroid cancers (DTC) done before their first surgery and determined its association with advanced disease in terms of stage, multifocal disease, lymph node involvement and distant metastasis.

Methods: We have conducted a retrospective review of thyroid cancers from 1st January 2008 to 31st December 2017. Out of 281, 142 cases were included according to inclusion criteria. We noted the demographic details of participants, their histopathological diagnosis and serum TSH levels done before first surgery from the medical records. We calculated the stage of tumor through modified American Joint Committee (AJCC) staging system.

Results: Out of 147 participants, 89.4% had papillary carcinoma or its variants whereas 10.6% reported follicular carcinoma. The mean pre-op TSH level of the patients included was 2.04 ± 1.79. In addition to the descriptive analysis, the univariate regression analysis revealed that the association of serum TSH levels was found to be statistically insignificant with advanced stage of thyroid cancer, multifocal disease, lymph node metastasis and distant metastasis respectively.

Conclusion: The serum TSH levels before surgery was not associated with poor prognosis of differentiated thyroid cancer with respect to higher staging, multifocal disease, lymphatic or distant metastasis.


How to cite this:
Batool S, Afridi MS, Khoja A, Islam N. Pre-operative serum TSH levels: A risk factor for advanced metastatic differentiated thyroid carcinoma. Pak J Med Sci. 2019;35(5):1312-1317. doi:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Muhammad Shakir Afridi, aga khan university hospital, karachi

Dr Muhammad Shakir Afridi did data collection and data analysis and also written the abstract of the manuscript 

Adeel Akbar Khoja, aga khan university hospital, karachi

Dr Adeel akbar khoja did the data analysis and results writting and editing the discussion part

Najmul Islam, aga khan university hospital, karachi

Dr Najmul Islam did the review and final approval of the menuscipt  

Original Articles