ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Thyroid Endocrinology
This article is part of the Research TopicThyroid Hormone Actions in Cancer - Volume IIIView all articles
The Predictive Value of Preoperative TSH Levels for Lymph Node Metastasis in Papillary Thyroid Carcinoma
Provisionally accepted
- 1The Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, China
- 2Traditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, China
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Background: To investigate the predictive value of preoperative thyroid-stimulating hormone (TSH) levels for lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) and to develop a clinically applicable preoperative prediction model. Methods: This retrospective study included 645 patients with PTC, who were divided into two groups: LNM and non-LNM, based on postoperative pathological results. Clinical and pathological characteristics between the two groups were compared. Statistical analyses were performed using t-tests, χ² tests, Spearman correlation, univariate and multivariate logistic regression, and Lasso regression for variable selection. A predictive nomogram was constructed based on independent risk factors, and model performance was comprehensively evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: LNM was significantly associated with elevated preoperative TSH, younger age, male sex, higher BMI, and tumor characteristics (size, multifocality, location). TSH levels showed a clear dose-response relationship with LNM risk, with TSH > 4.5 µIU/mL increasing the risk of LNM by 31.36 times (OR = 31.36, 95%CI: 7.61 – 129.14, p < 0.001). The Lasso-regularized prediction model demonstrated optimal discriminative ability (AUC = 0.854), superior to the unregularized multivariate model (AUC = 0.835) and the single TSH model (AUC = 0.707). The nomogram showed excellent calibration and clinical applicability, providing positive net benefits within clinically relevant risk thresholds. Conclusion: This study successfully developed and validated a robust and clinically feasible preoperative nomogram for predicting LNM in PTC, clearly demonstrating a strong independent dose-response relationship between preoperative TSH levels and LNM risk. Combining statistical optimization through Lasso regression with clinical variables provides a valuable tool for improving preoperative risk stratification and personalized surgical decision-making in PTC patients.
Keywords: LASSO regression, lymph node metastasis, nomogram, Papillary thyroid carcinoma, preoperative assessment, Preoperative TSH, Risk factors, Risk prediction model
Received: 07 Jan 2026; Accepted: 09 Feb 2026.
Copyright: © 2026 Wang, Cao and Geng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhongli Geng
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