Assessment of thyroid hormone profiles and derived ratios for predicting thyroid nodule malignancy using the Bethesda system: thyroid hormone ratios in malignancy risk stratification of thyroid nodules: a cross-sectional study
Keywords:
Thyroid Nodule, Biopsy, Thyroid Function Tests, Thyroid Cancer, Cytodiagnosis, Thyrotropin, Thyroid Neoplasms, Fine Needle Aspiration Biopsy, Hormonal Ratio Biomarkers, Preoperative Risk AssessmentAbstract
BACKGROUND: Thyroid nodules are common, and although most are benign, a proportion may be malignant. Fine-needle aspiration biopsy (FNAB), interpreted using the Bethesda System, is the standard diagnostic method. However, in euthyroid patients, the predictive value of thyroid function tests and their derived ratios in relation to Bethesda categories remains unclear.
OBJECTIVES: To evaluate thyroid function parameters and their association with Bethesda classification in euthyroid patients with thyroid nodules, and to identify potential predictors of malignancy.
DESIGN AND SETTING: This retrospective cross-sectional study was conducted at the University of Health Sciences Haydarpaşa Numune Training and Research Hospital and included a convenience sample of eligible euthyroid patients who underwent FNAB between January 2020 and December 2023.
METHODS: A total of 828 euthyroid patients were included. Demographic data, pre-biopsy TSH, fT3, fT4, and derived ratios (TSH/T4, TSH/T3, and T3/T4) were analyzed for correlations with Bethesda categories and compared between the benign and malignant groups.
RESULTS: The mean age was 52.85 ± 12.53 years, and 80.8% of participants were female. Benign cytology was found in 54.6% of cases, and malignant cytology was found in 2.8%. Cases with malignant cytology were younger (p = 0.003) and more frequently male (p = 0.021). No significant differences were observed in hormone levels or ratios between the benign and malignant groups. However, TSH and the TSH/T4 ratio showed positive correlations with Bethesda category (p = 0.034 and p = 0.033, respectively).
CONCLUSION: The TSH level and TSH/T4 ratio were correlated with Bethesda categories; however, thyroid function tests and derived ratios showed no diagnostic value for predicting malignancy in euthyroid nodules.
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Copyright (c) 2026 İrem Şenoymak, Mustafa Can Şenoymak, Memet Taşkın Egici, İrem Kahveci, İsra Oğuz, Adnan Gökçel
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