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Prevalence of normal TSH value among patients with autonomously functioning thyroid nodule
Giorgio Treglia1, Pierpaolo Trimboli1,2, Frederik A Verburg3,4
1Department of Nuclear Medicine and Thyroid Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
European Journal of Clinical Investigation
|May 6, 2015
Summary
Thyroid scintigraphy (TS) is essential for detecting autonomously functioning thyroid nodules (AFTN). About half of AFTN patients have normal TSH levels, making TSH alone insufficient for diagnosis.
Area of Science:
- Endocrinology
- Nuclear Medicine
Background:
- International guidelines vary on thyroid scintigraphy (TS) effectiveness for thyroid nodules.
- The role of TS in identifying autonomously functioning thyroid nodules (AFTN) with normal TSH is debated.
Purpose of the Study:
- To review literature on normal TSH prevalence in AFTN patients.
- To meta-analyze data on normal TSH values in AFTN.
Main Methods:
- Literature search (Jan 2000-Dec 2014) for AFTN detected by TS.
- Selected studies reporting serum TSH values in AFTN.
- Calculated pooled prevalence of AFTN with normal TSH using per-patient analysis and 95% CIs.
Main Results:
- Eight records with 2761 AFTN were analyzed.
- Pooled prevalence of AFTN with normal TSH was 50% (95% CI: 32-68%).
- Potential limitations include selection bias and study heterogeneity.
Conclusions:
- Approximately 50% of AFTN patients identified by TS have normal TSH.
- TSH measurement alone is insufficient to detect or exclude AFTN.
- Thyroid scintigraphy remains mandatory for AFTN diagnosis.
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