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現在、甲状腺結節の悪性腫瘍の予測因子としてよく知られるものが次々と発見されており、これらには生理検査で検出される固形・固定腫瘍、成長が早い腫瘍、大きい腫瘍部位、気管切開、嚥下困難、リンパ節腫脹、乳幼児期に頭頸部に低線量放射線を照射した経験、20歳未満または70歳を超える年齢、男性、などが含まれる。良性の経過と良好な予後をたどる甲状腺腫瘍を検出することで、外科手術の回数を大幅に減らすことができる。しかし、中には腫瘍の悪性度を判断できない場合もある。そのような場合には、別の診断方法が必要となる。これらには、BRAF遺伝子およびRAS遺伝子の点突然変異の検出、PAX8/PPARγおよびRET/PTC転座の検出などが含まれる。しかし、遺伝子検査は費用が高く、感度が比較的低いため、これらの方法は必ずしも定期的な診断に適しているわけではない。血清中ホルモン濃度の測定は、より安価で、より迅速な検査結果を得られる。本総説は、分化型甲状腺癌、すなわち甲状腺乳頭癌の発生と進行における甲状腺刺激ホルモン（TSH）の役割を評価するものである。多くの研究により、甲状腺結節の悪性化、および急速な成長、侵襲性、転移を伴う疾患の進行における高TSH濃度の重要性が実証されている。多くの研究者は、TSHの濃度が甲状腺腫瘍の良性・悪性の鑑別に有用であることを見出し、診断の補助として利用できることを示唆している。しかし、TSH濃度と甲状腺癌との間に関連性を認めない研究者もいる。最近になりようやく、TSH濃度と甲状腺癌との間に逆相関を示す証拠が蓄積されつつある。一方で、遺伝学研究はTSH濃度と甲状腺癌発症との間に相互関係があることを支持している。
Currently, there is growing number of well-known predictors of malignancy of the thyroid nodules including a solid fixed formation that is detected by physiological examination, rapid growth and large size of the site, tracheostomy, dysphagia or lymphadenopathy, irradiation in the history of low doses of radiation of the head and neck in infancy, age less for 20 years and more than 70 years and male gender. Detection of thyroid tumors, characterized by benign course and favorable prognosis, can significantly reduce the number of surgical interventions. However, there are cases where the potential of malignancy of the tumor can not be determined. In this case, alternative diagnostic methods are required. These may include the detection of BRAF and RAS spot mutations, PAX8 / PPAR? and RET / PTC translocation, but given the high cost of research data and relatively low sensitivity, these methods are not always suitable for routine diagnostics. The determination of the level of serum hormones may be cheaper and faster. This review is devoted to the assessment of the current concept on thyroid stimulating hormone role in development and progression differentiated thyroid cancer, namely papillary thyroid carcinoma. Numerous studies demonstrated the significance of high (TSH) in thyroid nodes malignisation and progression associated with rapid growth, aggressiveness and metastasis development. Many authors find this test useful for distinguishing benign and malignant thyroid tumors and suggest that it may be used as an auxiliary in the diagnostics. However there some authors who did not find any relationship between TSH and thyroid cancer. Finally, there is a growing body of investigations demonstrating the opposite relations between TSH levels and thyroid malignancies. Genetic studies also are in favor of the reciprocal association between the level of TSH and the development of thyroid cancer.
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Currently, there are several well-known predictors of thyroid nodule malignancy; these include solid, fixed tumors that are detected on physiological examination, rapid growth, enlargement of the site, tracheostomy, dysphagia, lymphadenopathy, history of irradiation with low doses of radiation to the head and neck during infancy, age <20 years or >70 years, and male gender. Timely detection of thyroid tumors that are characterized by a benign course and favorable prognosis can significantly reduce the number of surgical interventions required. However, in some cases, the malignant potential of the tumor cannot be determined and alternative diagnostic methods such as those involving the detection of BRAF and RAS point mutations and PAX8/PPARγ and RET/PTC translocations are required. However, given the high cost of genetic testing and relatively low sensitivity, these methods are not always suitable for routine diagnostics. Determination of serum hormone levels may be more cost-effective and yield faster results. This review assesses the role of thyroid-stimulating hormone (TSH) in the development and progression of differentiated thyroid cancer, namely papillary thyroid carcinoma. Numerous studies have reported the significance of high TSH level in the malignization of thyroid nodules and disease progression associated with rapid growth, aggressiveness, and metastasis. Many authors have found TSH level to be useful for distinguishing between benign and malignant thyroid tumors and have suggested that it can be used as an auxiliary diagnostic biomarker for thyroid tumors. However, some authors have found no correlation between TSH level and thyroid cancer. Finally, there is growing evidence on opposing associations between TSH levels and thyroid cancers. Nevertheless, some genetic studies support the presence of a reciprocal association between TSH levels and thyroid cancer development.
