Research on the association between thyroid hormone levels and cancer mortality remains limited and inconclusive. We determined the relation of thyroid stimulating hormone (TSH), free T4 (FT4), and free T3 (FT3) levels with mortality in overall cancer and specific tumor types. Thyroid hormone levels 1-5 years prior to cancer diagnosis, as well as multiple clinical and demographic parameters, were retrospectively collected for 10,325 Israeli cancer patients, diagnosed between 2000 and 2016. Patients treated with thyroid altering medications were excluded. Cancer diagnosis was determined via the Israel National Cancer Registry. Multivariate-adjusted Cox proportional hazards model was used to assess the hazard ratios (HRs) based on thyroid hormone function for cancer mortality. A total of 5265 patients died during the follow-up period (median of 4.4 years). TSH, FT4, and FT3 levels in the hypothyroid range were associated with increase in overall mortality (adjusted HR 1.20, 1.74, 1.87, respectively). We further analyzed the association between TSH and mortality in 14 cancer subgroups. Specifically, TSH in both the hyperthyroid and hypothyroid range was associated with melanoma mortality (adjusted HR 2.20, 4.47, respectively). In conclusion, pre-diagnosis of thyroid dysfunction is associated with increased cancer mortality, a relation likely driven by specific cancer types. These findings suggest that thyroid hormones may potentially serve as prognostic markers in cancer.

中文翻译：

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诊断前甲状腺激素功能障碍与癌症死亡率有关。

关于甲状腺激素水平与癌症死亡率之间关系的研究仍然有限且无定论。我们确定了促甲状腺激素 (TSH)、游离 T4 (FT4) 和游离 T3 (FT3) 水平与总体癌症和特定肿瘤类型死亡率的关系。回顾性收集了 2000 年至 2016 年间诊断的 10,325 名以色列癌症患者在癌症诊断前 1-5 年的甲状腺激素水平以及多个临床和人口统计学参数。排除了接受甲状腺改变药物治疗的患者。癌症诊断是通过以色列国家癌症登记处确定的。多变量调整的 Cox 比例风险模型用于评估基于甲状腺激素功能的癌症死亡率风险比 (HR)。随访期间共有 5265 例患者死亡（中位数为 4. 4 年）。甲状腺功能减退范围内的 TSH、FT4 和 FT3 水平与总死亡率的增加相关（调整后的 HR 分别为 1.20、1.74、1.87）。我们进一步分析了 14 个癌症亚组中 TSH 与死亡率之间的关联。具体而言，甲状腺功能亢进和甲状腺功能减退范围内的 TSH 均与黑色素瘤死亡率相关（调整后的 HR 分别为 2.20、4.47）。总之，甲状腺功能障碍的预诊断与癌症死亡率增加有关，这种关系可能由特定的癌症类型驱动。这些发现表明甲状腺激素可能作为癌症的预后标志物。我们进一步分析了 14 个癌症亚组中 TSH 与死亡率之间的关联。具体而言，甲状腺功能亢进和甲状腺功能减退范围内的 TSH 均与黑色素瘤死亡率相关（调整后的 HR 分别为 2.20、4.47）。总之，甲状腺功能障碍的预诊断与癌症死亡率增加有关，这种关系可能由特定的癌症类型驱动。这些发现表明甲状腺激素可能作为癌症的预后标志物。我们进一步分析了 14 个癌症亚组中 TSH 与死亡率之间的关联。具体而言，甲状腺功能亢进和甲状腺功能减退范围内的 TSH 均与黑色素瘤死亡率相关（调整后的 HR 分别为 2.20、4.47）。总之，甲状腺功能障碍的预诊断与癌症死亡率增加有关，这种关系可能由特定的癌症类型驱动。这些发现表明甲状腺激素可能作为癌症的预后标志物。