Abstract
Introduction: The widespread prevalence of thyroid diseases has been observed in routine clinical practice. The incidence of thyroid carcinoma is also rising, following the use of modern diagnostic imaging methods. Currently, the laboratory markers commonly used for determining the type and functionality of thyroid disorders are extensively studied, especially in order to justify their prognostic value for thyroid cancer manifestation.Aim: The objective of the current prospective clinical laboratory study was to explore the possible validity of specific laboratory markers in differentiating benign from malignant thyroid diseases.Materials and Methods: The study included a cohort of 228 patients (182 female and 46 male) with a median age of 49.60 ± 14.65 years. All patients underwent total thyroidectomy between 01.01.2005 and 01.03.2010 for a variety of thyroid disorders. None of them had a preoperative cytological diagnosis of thyroid cancer. Preoperative diagnoses were based on morpho ...
Introduction: The widespread prevalence of thyroid diseases has been observed in routine clinical practice. The incidence of thyroid carcinoma is also rising, following the use of modern diagnostic imaging methods. Currently, the laboratory markers commonly used for determining the type and functionality of thyroid disorders are extensively studied, especially in order to justify their prognostic value for thyroid cancer manifestation.Aim: The objective of the current prospective clinical laboratory study was to explore the possible validity of specific laboratory markers in differentiating benign from malignant thyroid diseases.Materials and Methods: The study included a cohort of 228 patients (182 female and 46 male) with a median age of 49.60 ± 14.65 years. All patients underwent total thyroidectomy between 01.01.2005 and 01.03.2010 for a variety of thyroid disorders. None of them had a preoperative cytological diagnosis of thyroid cancer. Preoperative diagnoses were based on morphological and functional criteria: goiter with a solitary non-functioning nodule (n=34; 14.9%), nontoxic multinodular goiter (n=152; 66.7%), toxic multinodular goiter (n=26; 11.4%), toxic adenoma (n=6; 2.6%), and Graves’ disease (n=10; 4.4%). Preoperative evaluations included the assessment of thyroid autoantibodies (thyroid peroxidase antibody [TPOAbs] and thyroglobulin antibody [TgAbs]) and thyroglobulin (Tg). The final diagnosis was based on the histopathological analysis of surgical specimens at the University Pathology Department. The histological diagnoses were compared with the primary diagnoses, and the patients were reclassified according to the final diagnoses. The median values of the laboratory markers were calculated for the different groups and were compared to determine the presence of statistically significant differences.Results: The incidence of thyroid cancer in this study cohort was significant (14.5%) and was statistically different between the preoperative groups. Thyroid carcinomas were diagnosed in patients with non-toxic thyroid disorders in almost all cases. Median values of the evaluated laboratory markers did not differ significantly between the groups with histologically established benign disease and malignancy. Tg was found to be significantly elevated in patients with hyperthyroidism as well as in those without chronic lymphocytic thyroiditis (CLT). Patients with histologically determined CLT had elevated titers of thyroid autoantibodies. A statistical significance was not established for the co-existence of Hashimoto thyroiditis and thyroid malignancy.Conclusions:1. The thyroid autoantibodies TgAbs and TPOAbs are valid laboratory parameters for the diagnosis of chronic lymphocytic thyroiditis.
2. Preoperative Τg is not a valid marker for the differential diagnosis of benign and malignant thyroid diseases.3. Tg may be a useful marker in screening for thyroid autonomy.4. Tg may be a marker for the diagnosis and follow-up of chronic lymphocytic thyroiditis, with the possibility of existence of CLT and its grade of activity being lower at higher Tg levels.5. The manifestation of thyroid cancer did not differ significantly between patients with or without chronic lymphocytic thyroiditis.6. The incidence of thyroid cancer appears to be minimal in cases of autonomous thyroid disorders compared to that in euthyroid cases
7. The final decision in performing surgery for thyroid diseases should be based primarily on combined data on patient history, clinical findings, and suspected malignancy on imaging findings, especially in the presence of a solitary non-toxic nodule. The currently available laboratory markers cannot play a substantial role in differentiating benign from malignant thyroid disease.
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