Diagnostic value of tsh receptor antibody in terms of papillary thyroid cancers in hyperthyroidic patients

INTRODUCTION: "Graves" disease is the most common cause of hyperthyroidism among thyroid diseases. Graves is an autoimmune disease and its etiology mechanisms are not fully understood. Anti-Tg, Anti-TPO, TRAb can be shown among antibodies which occurs against thyroid antigens in this disease. TRAb autoantibody occurs against TSH-Receptors and plays an important role in appearance of the clinical and symptoms of Graves disease. At the same time, TRAb level is important in the regulation of medical treatment and follow-up of the postoperative period in Graves patients. When the pathology results of the patients operated on for benign diseases were examined, it was observed that incidental cancer results increased. 80% of these thyroid cancers appear as papillary thyroid cancer. Hyperthyroid patients constitute a large group of thyroid patients operated for benign reasons. The relationship mechanisms between high TRAb antibody levels and thyroid cancers in hyperthyroid patients have not been learned. Therefore, in our study, we aimed to investigate the value of positive TRAb level as a marker in the diagnosis of preoperative papillary thyroid cancer in hyperthyroid patients, which constitute a large group of thyroid patients. MATERIAL METHOD: In our study, patients who were operated in Ankara Yıldırım Beyazit University Faculty of Medicine General Surgery Department and Atatürk Training and Research Hospital between 2006 and 2019 due to thyroid gland pathologies were evaluated retrospectively. When examining the notes of 898 operated patients attention was paid to the following facts: preop hyperthyroid disease diagnosis, high TRAb autoantibody level in laboratory values and pathology results were compatible with Papillary Thyroid Cancer. 216 of 898 patients were operated with a pre-diagnosis of Toxic goiter and 76 patients were reported also papillary thyroid cancer as a result of pathology. In our study, using data such as gender, age, thyroid hormone -T3, T4, TSH levels, anti-TPO, anti-Tg, TRAb autoantibody values, tumor size, USG features of tumors and subtypes of papillary thyroid cancers, we investigated the relationship between TRAb autoantibody and Papillary Thyroid Cancers. RESULTS:The average age of 216 people participating in the study is 46.45 ± 13.22 (min: 19-max: 73). When other parameters released from TRAb and thyroid tissue were compared, it was seen that there was a weak relationship between TRAb and TSH, T3, T4 and anti-TPO. ROC curve analysis was performed between malignant and benign patients and TRAb. It was found that the area under the curve was not significant (p <0.724) and TRAb value could not be used for benign and malignant discrimination. In the binary logistic regression analysis, which was established by including the variables of age, gender and TRAb, it was observed that the pathology result increased 1.05 times as the age increased (p<0.001). It was observed that the coefficients of TRAb and gender variables were not significant. TRAB positivity was significantly higher in patients with diffuse and hyperechogenic USG results CONCLUSİON: In our study which was meant to determine the prognostic significance of TRAb values for Papillary Thyroid Ca in preoperative hyperthyroid patients , it was seen that TRAb was not a good diagnostic test in the benign / malignant differentiation of thyroid lesions. TRAb value cannot be used as a tumor marker for Papillary Thyroid Cancer in Hyperthyroid patients preoperatively.