Serum cholesterol levels are inversely associated with the risk of malignancy in subjects with Bethesda category IV thyroid nodules.

INTRODUCTION: Some epidemiological data suggest that there may be an inverse relationship between cholesterol levels and the risk of thyroid cancer in the overall population. The present study was aimed to evaluate the lipid profile specifically in subjects with Bethesda category IV thyroid nodules, and compare whether there were any differences between those with benign and malignant nodules. METHODS: Single-centre, retrospective study on 204 subjects treated by partial or total thyroidectomy for excision of a Bethesda category IV thyroid nodule, who had undergone a blood lipid profile test in the 12 months prior to surgery. In addition to lipid measures, other demographic, clinical, biochemical and ultrasound data were collected. RESULTS: Seventy-five subjects (36.8%) were diagnosed with thyroid carcinoma in the definitive histopathological examination. Patients with thyroid cancer had lower levels of total cholesterol, LDL-cholesterol and non-HDL-cholesterol than subjects with benign thyroid diseases. There were no differences in HDL-cholesterol, triglycerides or total cholesterol/HDL-cholesterol ratio. There were no differences either between groups in other clinical, biochemical and ultrasound variables, including the use of lipid-lowering drugs. In multivariate analysis, only LDL-cholesterol was independently associated with malignancy. Subjects with follicular carcinoma showed the lowest cholesterol levels, while those with papillary carcinoma had intermediate values between the group with follicular carcinoma and the group with benign thyroid diseases. CONCLUSIONS: In subjects with cytologically indeterminate Bethesda category IV thyroid nodules, levels of total cholesterol, non-HDL-cholesterol and, particularly, LDL-cholesterol are lower among those with malignant nodules.

Correlation between TSH levels and quality of life among subjects with well-controlled primary hypothyroidism.

PURPOSE: It has been suggested that increasing levothyroxine dose to lower TSH levels within the normal laboratory range might be a therapeutic option for patients with apparently well-controlled primary hypothyroidism who are dissatisfied with their treatment and complain of physical or psychological symptoms. This study assessed whether there is a relationship between TSH levels and health-related quality of life (HRQoL) among subjects with adequately treated hypothyroidism. METHODS: HRQoL was measured with the specific thyroid disease ThyPRO-39 questionnaire in 218 consecutive patients with primary hypothyroidism of any cause attending an Endocrinology Department in a single center. Patients had TSH values within the normal laboratory range on a blood test performed not before than 6 weeks prior to study participation, but they were not aware of their lab results. The association between TSH values and the different ThyPRO-39 scales was analyzed by means of multiple regression models, both linear and additive, in which, in addition to TSH, a wide set of clinical and sociodemographic variables potentially related to HRQoL were also considered. RESULTS: TSH levels and the use of anxiolytic and antidepressant drugs were the only variables that showed a positive linear correlation with the ThyPRO-39 composite scale in the multivariate regression analysis, indicating greater impairment in HRQoL with increasing TSH values. TSH was also independently correlated to scores of scales dealing on tiredness and emotional susceptibility. CONCLUSIONS: In patients with primary hypothyroidism, higher TSH values, even within the normal reference range, are associated with greater deterioration of HRQoL.

TSH Level and Risk of Malignancy in Patients with Bethesda Category IV Thyroid Nodules.

Fine needle aspiration biopsy does not permit to distinguish between benign and malignant follicular thyroid lesions (category IV in the Bethesda Cytopathology System). Some reports have suggested an association between increased serum TSH levels and thyroid cancer, so the aim of this study was to investigate the association between TSH levels and malignancy in patients with follicular thyroid nodules. Therefore, we conducted a retrospective study of all subjects who underwent surgical treatment for Bethesda IV thyroid nodules in a single center (years 2012-2017). A total of 127 patients were analyzed, and malignancy was present in 38.6% of the patients. Using ROC analysis, the best TSH cut-off point to differentiate benign from malignant disease was 2.1 mU/l and the age cut-off with better sensitivity and specificity was 47 years. The proportion of subjects with TSH ≥ 2.1 mU/l was greater among subjects with cancer than in those with benign diseases (65.3 vs 44.9%, P = 0.029). The concurrence of both cut-off points (TSH ≥ 2.1 mU/l and age ≥ 47 years) showed a higher diagnostic accuracy than either of the two variables separately. Therefore, the present study supports an association between serum concentrations of TSH and risk of malignancy among subjects with Bethesda IV thyroid nodules. TSH levels could modify the diagnostic and therapeutic approach of patients with Bethesda IV nodules.

Adaptation and cross-cultural validation of the Spanish version of the Thyroid-Related Quality-of-Life Patient-Reported Outcome questionnaire.

INTRODUCTION: The ThyPRO questionnaire is the most widely used tool for measuring quality of life in patients with benign thyroid diseases. The purpose of this study was to adapt and validate a Spanish translation of the ThyPRO and its abbreviated version (ThyPRO-39). MATERIAL AND METHODS: Adaptation to the Spanish language was performed using the forward-backward translation method, followed by a pretesting study on five representative patients. The final questionnaire (ThyPROes) was administered to 155 patients with thyroid disorders recruited in a tertiary Spanish hospital. Psychometric properties were evaluated by multitrait scaling and estimation of internal consistency reliability (Cronbach's alpha coefficient). Data from a previous sample of 902 Danish patients were used to analyze differential item functioning (DIF) between the Spanish and the original Danish versions of the questionnaire using ordinal logistic regression. RESULTS: Three of 85 items in ThyPROes and four of the 39 items in ThyPRO-39es lacked convergent validity, while lack of discriminant validity was found for in nine and 14 items of each version respectively. Cronbach's alpha was >0.7 for 12 of 13 scales in the ThyPRO and 10 of 12 scales in the ThyPRO-39es. Eight items in the ThyPROes were flagged with DIF (one with non-uniform DIF), as were two items in the ThyPRO-39es. DIF magnitude was small (explained variance in the item score <3%) in most cases, with a minor impact on scale scores. CONCLUSIONS: The Spanish versions of the ThyPRO and ThyPRO-39 show acceptable psychometric properties and good cross-lingual validity, and are suitable for use in clinical studies.

Adaptation and cross-cultural validation of the Spanish version of the Thyroid-Related Quality-of-Life Patient-Reported Outcome questionnaire / Adaptación y validación transcultural de la versión española del cuestionario Thyroid-Related Quality-of-Life Patient-Reported Outcome

Introduction: The ThyPRO questionnaire is the most widely used tool for measuring quality of life in patients with benign thyroid diseases. The purpose of this study was to adapt and validate a Spanish translation of the ThyPRO and its abbreviated version (ThyPRO-39). Material and methods: Adaptation to the Spanish language was performed using the forward-backward translation method, followed by a pretesting study on five representative patients. The final questionnaire (ThyPROes) was administered to 155 patients with thyroid disorders recruited in a tertiary Spanish hospital. Psychometric properties were evaluated by multitrait scaling and estimation of internal consistency reliability (Cronbach's alpha coefficient). Data from a previous sample of 902 Danish patients were used to analyze differential item functioning (DIF) between the Spanish and the original Danish versions of the questionnaire using ordinal logistic regression. Results: Three of 85 items in ThyPROes and four of the 39 items in ThyPRO-39es lacked convergent validity, while lack of discriminant validity was found for in nine and 14 items of each version respectively. Cronbach's alpha was >0.7 for 12 of 13 scales in the ThyPRO and 10 of 12 scales in the ThyPRO-39es. Eight items in the ThyPROes were flagged with DIF (one with non-uniform DIF), as were two items in the ThyPRO-39es. DIF magnitude was small (explained variance in the item score <3%) in most cases, with a minor impact on scale scores. Conclusions: The Spanish versions of the ThyPRO and ThyPRO-39 show acceptable psychometric properties and good cross-lingual validity, and are suitable for use in clinical studies

Introducción: El cuestionario Thyroid-Related Quality-of-Life Patient-Reported Outcome (ThyPRO) es el instrumento más utilizado para medir la calidad de vida en pacientes con enfermedades tiroideas benignas. Este estudio tiene como objetivo adaptar y validar una traducción al español del ThyPRO y su versión abreviada (ThyPRO-39). Material y métodos: La adaptación al español se realizó utilizando el método de traducción-retrotraducción, seguido de una prueba preliminar en 5 pacientes representativos. El cuestionario definitivo ThyPROes se administró a 155 pacientes con trastornos tiroideos en un hospital terciario en España. Las propiedades psicométricas se evaluaron mediante la matriz multirrasgo-multimétodo y la estimación de la fiabilidad de la consistencia interna (alfa de Cronbach). Se utilizaron datos previos de 902 pacientes daneses para analizar el funcionamiento diferencial de los ítems (FDI) entre la versión original danesa del cuestionario y la española, mediante regresión logística ordinal. Resultados: Tres de 85 ítems del ThyPROes y 4 de 39 del ThyPRO-39es carecían de validez convergente, mientras que 9 y 14, respectivamente, carecían de validez discriminante. El alfa de Cronbach fue >0,7 para 12 de 13 escalas del ThyPROes y 10 de 12 del ThyPRO-39es. Ocho ítems del ThyPROes mostraron FDI (uno con FDI no uniforme) y 2 lo hicieron en el ThyPro-39es. La magnitud del FDI fue pequeña (varianza explicada en la puntuación del ítem <3%) en la mayoría de casos, con un impacto menor en las puntuaciones de las escalas. Conclusiones: Las versiones españolas del ThyPRO y ThyPRO-39 muestran aceptables propiedades psicométricas y buena validez interlingüística, y son adecuadas para su uso en estudios clínicos