Endogenous thyrotropin and triiodothyronine concentrations in individuals with thyroid cancer

BACKGROUND: Thyroid hormone suppression therapy is associated with decreased recurrence rates and improved survival in patients with differentiated thyroid cancer. Recently higher baseline thyrotropin (TSH) levels have been found to be associated with a postoperative diagnosis of differentiated thyroid cancer. Our objective was to confirm whether preoperative TSH levels were higher in patients who were diagnosed with differentiated thyroid cancer after undergoing thyroidectomy, compared with patients who were found to have benign disease. We also sought to determine whether thyroid hormone levels were lower in the patients with malignancy. METHODS: The study was a retrospective analysis of a prospective study. The study setting was the General Clinical Research Center of an Academic Medical Center. Participants were 50 euthyroid patients undergoing thyroidectomy. Thyroxine, triiodothyronine (T(3)), and TSH levels were documented in patients prior to their scheduled thyroidectomy. Following thyroidectomy, patients were divided into those with a histologic diagnosis of either differentiated thyroid cancer or benign disease. Preoperative thyroid profiles were correlated with patients' postoperative diagnoses. RESULTS: All patients had a normal serum TSH concentration preoperatively. One-third of the group was diagnosed with thyroid cancer as a result of their thyroidectomy. These patients had a higher serum TSH level (mean = 1.50 mIU/L, CI 1.22–1.78 mIU/L) than patients with benign disease (mean = 1.01 mIU/mL, CI 0.84–1.18 mIU/L). There was a greater risk of having thyroid cancer in patients with TSH levels in the upper three quartiles of TSH values, compared with patients with TSH concentrations in the lowest quartile of TSH values (odd ratio = 8.7, CI 2.2–33.7). Patients with a thyroid cancer diagnosis also had lower T(3) concentrations measured by liquid chromatography tandem mass spectrometry (mean = 112.6 ng/dL, CI 103.8–121.4 ng/dL) than did patients with a benign diagnosis (mean 129.9 ng/dL, CI 121.4–138.4 ng/dL). CONCLUSION: These data confirm that higher TSH concentrations, even within the normal range, are associated with a subsequent diagnosis of thyroid cancer in individuals with thyroid abnormalities. This further supports the hypothesis that TSH stimulates the growth or development of thyroid malignancy during its early or preclinical phase. We also show for the first time that patients with thyroid cancer also have lower T(3) levels than patients with benign disease

Using Veterans Affairs Medical Center (VAMC) data to identify missed opportunities for HPV vaccination

Despite high HPV prevalence and low vaccination rates in the military, HPV vaccination is not required upon military service initiation. Given that national HPV vaccination rates remain low among people age 19–26 years, military service may represent an opportune time for intervention. The purpose of this study was to quantify the rate of HPV vaccination among young patients entering primary care at a single Veterans Affairs Medical Center (VAMC). Vaccination rates among veterans age ≤ 26 years old at first primary care visit were identified from the institutional data warehouse. Among 1,258 eligible patients, most were male (n = 782). The HPV vaccine initiation rate was 21.2%. Overall, 10.4% of patients received at least 1 HPV vaccine prior to initiating care at the VA (25.2% females and 1.4% males). An additional 10.8% of patients received their first HPV vaccine upon initiating care at the VA. Median age of first HPV vaccination was 21.4 years among patients that initiated the vaccine in the military versus 24.8 years among those that initiated vaccination at the VA. In conclusion, this study demonstrated low HPV vaccination rates both prior to transitioning to VA primary care and once receiving care at the VA. Additionally, among veterans that had not received vaccination upon initiating care at the VA, older age at vaccination was observed. Older age at vaccination may reduce HPV vaccine effectiveness given higher risk of exposure. Addition of HPV to the list of mandated vaccines upon military service initiation should be considered