Comparative Study of the Level of Inflammatory Factors of Erythrocyte Sedimentation Rate and Reactive Protein C in Benign and Malignant Thyroid Nodules

Mohsen  Eshraghi; Seyed Jalal Eshagh  Hosseini; Fatemeh Sadat  Razavinia; Enayatollah  Noori

Authors

Mohsen Eshraghi
Seyed Jalal Eshagh Hosseini
Fatemeh Sadat Razavinia
Enayatollah Noori

Keywords:

Pathology, Oral, Thyroid Neoplasms, Thyroid Nodule

Abstract

Objective: To evaluate the level of inflammatory factors of erythrocyte sedimentation rate and reactive protein C in benign and malignant thyroid nodules. Material and Methods: In this case-control study, patients who were referred because of an enlarged thyroid gland were selected, patients who had undergone surgery for the thyroid nodule were included in the study. Erythrocyte sedimentation rate and reactive protein C were measured before surgery in patients who were candidates for thyroid surgery. The histopathological records of patients were retrospectively reviewed. Relevant cases had a cytological evaluation of thyroid nodules by fine-needle aspiration cytology (FNAC). The mean of ESR / CRP in both groups was compared using an independent t-test (p>0.05). Results: In malignant tumor type, in all patients, with Pill (PTC), analyzes in the malignant group showed a significant difference between the mean ESR / CRP in both groups with and without thyroid history. Sub-analyzes in the malignant group were significantly different between the mean ESR / CRP in both groups with and without thyroid histories (p=0.009) (40.16 ± 28.81). The association between ESR and CRP, ESR / CRP and tumor size, ESR / CRP and age in each group as well as in the whole patients were evaluated using Pearson correlation test, which showed a positive association between ESR age and ESR (p=0.024, r=0.375). In the malignant group, a negative correlation was found between the age and the CRP rate (p=0.027, r=-0.441), and in the total patients between the age and the rate (ES=0.043, r=-0.256). Conclusion: Factors such as ESR and CRP, which are considered acute phase reactors and their levels increase in acute inflammatory conditions, may not have a significant increase in chronic inflammatory conditions and malignancies.

References

Tamhane S, Gharib H. Thyroid nodule update on diagnosis and management. Clin Diabetes Endocrinol 2016; 2:17. https://doi.org/10.1186/s40842-016-0035-7

Siadati S, Moazezi Z, Bayani M, Mirzapour A, Nikbakhsh N, Ghaemian N, et al. The diagnostic value of fine needle aspiration as compared to ‎pathology results in diagnosis of thyroid nodules: a 22-year ‎follow-up study. J Babol Univ Med Sci 2015; 17(9):39-43.

Mathur A, Weng J, Moses W, Steinberg SM, Rahabari R, Kitano M, et al. A prospective study evaluating the accuracy of using combined clinical factors and candidate diagnostic markers to refine the accuracy of thyroid fine needle aspiration biopsy. Surgery 2010; 148(6):1170-77. https://doi.org/10.1016/j.surg.2010.09.025

Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. J Endocrinol Invest 2010; 33(5 Suppl):51-6.

Metintas M, Ak G, Dundar E, Yildirim H, Ozkan R, Kurt E, et al. Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. Chest 2010; 137(6):1362-8. https://doi.org/10.1378/chest.09-0884

Hales NW, Krempl GA, Medina JE. Is there a role for fluorodeoxyglucose positron emission tomography/computed tomography in cytologically indeterminate thyroid nodules? Am J Otolaryngol 2008; 29(2):113-8.

Qureshi NR, Rahman NM, Gleeson FV. Thoracic ultrasound in the diagnosis of malignant pleural effusion. Thorax 2009; 64(2):139-43. https://doi.org/10.1136/thx.2008.100545.

Light RW. Pleural Diseases. 5th. ed. : Lippincott Williams & Wilkins; 2007.

Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18(3):581-92. https://doi.org/10.1093/annonc/mdl498

Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, et al. Schwartz's Principles of Surgery. 10th. ed. New York: McGraw-Hill; 2014.

Gallo M, Pesenti M, Valcavi R. Ultrasound thyroid nodule measurements: the" gold standard" and its limitations in clinical decision making. Endocr Pract 2003; 9(3):194-9. https://doi.org/10.4158/EP.9.3.194

Katoh H, Yamashita K, Enomoto T, Watanabe M. Classification and general considerations of thyroid cancer. Ann Clin Pathol 2015; 3(1):1045.

Borrello MG, Alberti L, Fischer A, Degl'Innocenti D, Ferrario C, Gariboldi M, et al. Induction of a proinflammatory program in normal human thyrocytes by the RET/PTC1 oncogene. Proc Natl Acad Sci U S A 2005; 102(41):14825-30. https://doi.org/10.1073/pnas.0503039102

Russell JP, Shinohara S, Melillo RM, Castellone MD, Santoro M, Rothstein JL. Tyrosine kinase oncoprotein, RET/PTC3, induces the secretion of myeloid growth and chemotactic factors. Oncogene 2003; 22(29):4569-77. https://doi.org/10.1038/sj.onc.1206759

Allin KH, Nordestgaard BG. Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci 2011; 48(4):155-70.

Eshraghi M, Mousavi SM. Hashimoto’s thyroiditis is not a risk factor for thyroid cancer. Universa Medicina 2018; 37(3):216-21.

Hou X, Jiang L, Chen C, Zhu X, Ge M. Different expression of erythrocyte sedimentation rate and C-reactive protein in papillary thyroid carcinoma and nodular goiter. Clin Lab 2015; 61(7):793-9. https://doi.org/10.7754/clin.lab.2015.150127

Baruah MP, Bhattacharya B. Significant role of serum CRP in differentiating inflammatory from non-inflammatory causes of thyrotoxicosis. Indian J Endocrinol Metab 2012; 16(6):976-81. https://doi.org/10.4103/2230-8210.103002

Sengupta A, Pal R, Kar S, Zaman FA, Sengupta S, Pal S. Fine needle aspiration cytology as the primary diagnostic tool in thyroid enlargement. J Nat Sci Biol Med 2011; 2(1):113-8. https://doi.org/10.4103/0976-9668.82308

Lai X, Xia Y, Zhang B, Li J, Jiang Y. A meta-analysis of Hashimoto’s thyroiditis and papillary thyroid carcinoma risk. Oncotarget 2017; 8(37):62414-24. https://doi.org/10.18632/oncotarget.18620

Bradly DP, Reddy V, Prinz RA, Gattuso P. Incidental papillary carcinoma in patients treated surgically for benign thyroid diseases. Surgery 2009; 146(6):1099-104. https://doi.org/10.1016/j.surg.2009.09.025