Serum Thyrotropin Concentration in Children with Isolated Thyroid Nodules

Objective To investigate the correlation between serum thyroid-stimulating hormone (TSH) concentration and
nodule nature in pediatric patients with thyroid nodules, with the aim of identifying a marker able to differentiate
benign and malignant nodules.
Study design This was a retrospective analysis of serum TSH concentrations in a multicentric case series of 125
pediatric patients with benign and malignant thyroid nodules.
Results Of the 125 patients, 99 had benign thyroid nodules and 26 had differentiated thyroid cancer (24 papillary
and 2 follicular). Final diagnosis was based on surgery in 57 cases and on a benign cytology plus clinical follow-up in
68 cases. SerumTSHconcentration was significantly higher in patients with thyroid cancer compared with those with
benign nodules (3.23 1.59 mU/L vs 1.64 0.99 mU/L; P < .001). Binary logistic regression analysis revealed that
serum TSH was the sole predictor of malignancy (P < .001). Dividing the patient cohort into 5 groups based on serum
TSH quintiles (TSH cutoffs 0.40, 1.00, 1.50, 1.80, and 2.80 mU/L), we observed that cancer prevalence increased in
parallel with serum TSH (P < .001), with respective rates of 0%, 4%, 16%, 32%, and 52% in the 5 quintile groups.
Conclusion Because caseswithmalignant nodules aremost likely seen in the upper normal serum TSHrange (ie,>2.8
mU/L), serum TSHconcentration can serve as a predictor of thyroid cancer in pediatric patients with thyroid nodules and
can inform the decision of when to submit patients to further investigation by cytology