Current controversies in the management of patients with indeterminate thyroid nodules.

10 Certain US features with TSH levels >4.5 mIU/L were associated with a higher ROM; however, this did not reach statistical significance. 24 This is supported by additional reports. 59 , 60 Low TSH levels, on the other hand, cause less thyroid epithelial cell differentiation and increase the risk of malignant cell transformation in 3 variants. 61 Another study showed a significantly lower PTC rate in patients with TSH levels <0.4 mU/L compared to patients with TSH levels >3.4 mU/L. 62 In conclusion, the clinical management of CITNs remains controversial and challenging.

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