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9434795 
Journal Article 
Review 
Thyrotropin and thyroid cancer diagnosis: a systematic review and dose-response meta-analysis 
Mcleod, DSA; Watters, KF; Carpenter, AD; Ladenson, PW; Cooper, DS; Ding, EL; , 
2012 
Yes 
Journal of Clinical Endocrinology and Metabolism
ISSN: 0021-972X
EISSN: 1945-7197 
ENDOCRINE SOC 
WASHINGTON 
2682-2692 
English 
22622023 
WOS:000307457400051 
TSH is the major growth factor for thyrocytes and may have a causative role in thyroid cancer.The objective of the study was to systematically assess the association between serum TSH and thyroid cancer.The MEDLINE and EMBASE databases were searched using synonyms for TSH and thyroid cancer, supplemented with reference list searches and author contact.Prospective cohort, case-control, and cross-sectional studies were identified with TSH the exposure and thyroid cancer the outcome.Three reviewers independently extracted data. Studies reporting odds ratio (OR) for TSH levels and thyroid cancer were analyzed via meta-analysis and generalized least-squares trend estimation for dose-response relationships.Data extracted from 28 studies included a total of 42,032 subjects and 5,786 thyroid cancer cases. Dose-response spline analysis revealed a nonlinear relationship (P < 0.001). For TSH levels less than 1 mU/liter, the OR for thyroid cancer was 1.72 (1.42, 2.07) per milliunits per liter. However, the relationship changed for TSH levels 1 mU/liter and greater, with the OR thereafter being 1.16 (1.12, 1.21) per milliunits per liter. Studies controlling for autoimmunity reported the lowest OR [TSH below 2.5 mU/liter, OR 1.23 (1.02-1.47) per milliunits per liter; TSH 2.5 mU/liter or greater, OR 0.98 (0.89-1.09) per milliunits per liter]. Six groups assessed serum TSH in relation to markers of poor thyroid cancer prognosis, with three showing significant positive relationships.Higher serum TSH concentration is associated with an increased risk of thyroid cancer. Thyroid autoimmunity may partially explain the association, but further epidemiological assessment is required. Future clinical research should investigate the validity of including serum TSH in diagnostic nomograms, its prognostic importance, and the potential for therapeutic TSH suppression in thyroid cancer prevention.