The association between thyroid-stimulating hormone and thyroid nodules, goiter and thyroid antibody positivity

Shaohan Li; Wenxing Guo; Qi Meng; Mei Zhu; Hongyan Wei; Fengying Ji; Long Tan; Wanqi Zhang

doi:10.3389/fendo.2023.1204552

The association between thyroid-stimulating hormone and thyroid nodules, goiter and thyroid antibody positivity

Front Endocrinol (Lausanne). 2023 Oct 2:14:1204552. doi: 10.3389/fendo.2023.1204552. eCollection 2023.

Authors

Shaohan Li¹, Wenxing Guo¹, Qi Meng¹, Mei Zhu², Hongyan Wei², Fengying Ji^{3

4}, Long Tan¹, Wanqi Zhang^{1

5

6}

Affiliations

¹ Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China.
² Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.
³ Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China.
⁴ Qingdao Institute of Preventive Medicine, Qingdao, China.
⁵ Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.
⁶ Tianjin Key Laboratory of Hormones and Development (Ministry of Health), Tianjin, China.

Abstract

Background: The relationship between normal thyroid-stimulating hormone (TSH) levels and thyroid disease in adults remains controversial. This study aimed to investigate the correlation between serum TSH levels, particularly those falling within the normal range, and thyroid diseases in Chinese adults, including thyroid nodules (TN), goiter (GR), and thyroid antibody positivity.

Materials and methods: This research was a cross-sectional study conducted in an adult population in Tianjin, China. Thyroid volume (Tvol) and TN were assessed using thyroid ultrasonography. Fasting venous blood and spot urine samples were collected to evaluate thyroid function and iodine status.

Results: A total of 2460 subjects participated in the survey. The prevalence of thyroid dysfunction was 9.76%, and abnormal TSH levels were found to potentially increase the risk of GR and thyroid antibody positivity in adults. A total of 2220 subjects with TSH within the normal reference range were included in the further study. In these patients, Tvol decreased as TSH levels increased, in both men and women (P < 0.0001). Low TSH levels (0.27-1.41 IU/mL) were identified as a risk factor for TN (odds ratio [OR], 1.46; 95% CI: 1.14-1.87) and GR (OR 5.90, 95% CI 2.27-15.3). Upon stratification by sex and age, the risk of TN was found to be higher in women and elderly individuals (≥60 years old), while the risk of GR was found to be higher in men and younger individuals (<60 years old). High TSH levels (2.55-4.2 IU/mL) were identified as a risk factor for thyroid antibody positivity (OR, 1.53; 95% CI: 1.11-2.10). Men and younger individuals with high TSH levels exhibited a higher risk of thyroid antibody positivity.

Conclusion: In adults with normal TSH levels, low TSH levels were associated with an increased risk of TN and GR, whereas high TSH levels were associated with thyroid antibody positivity. The research also suggests that adults whose TSH levels at upper or lower limits of the normal range should be reviewed regularly.

Keywords: goiter; thyroid antibody positivity; thyroid dysfunction; thyroid nodules; thyroid volume; thyroid-stimulating hormone.

MeSH terms

Adult
Aged
Cross-Sectional Studies
Female
Goiter*
Humans
Male
Middle Aged
Thyroid Nodule* / epidemiology
Thyrotropin

Substances

Thyrotropin

Grants and funding

This study was supported by the Tianjin Education Committee Social Science Major Project (Grant no. 2017JWZD35), Tianjin Natural Science Foundation (Grant no. 20JCZDJC00080) and Danone Nutrition Research and Education Fund (Grant no. DIC2020-05).