




































    

 American Journal of Medical and Physical Education 

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THYROID FUNCTION TEST EVALUATION IN PROSTATE CANCER 

PATIENTS IN KHARTOUM STATE  

  

  

Abdallah E. Ali1, Sejood E. M. Abdalla1, Ibrahim A. A. Karti 2 and Haidar E. Saleh3  
1University of Alzaeim Al Azhari Faculty of Medical Laboratory Sciences, Department of Clinical Chemistry  
2Alofoug College of Science & Technology, Program of Medicine, Khartoum, Sudan.  
3Miami University, Sylvester Comprehensive Cancer Center (SCCC) Clinical Research Laboratory Services  

Miami Fl33136 USA  

 

Abstract: Introduction: Thyroid hormones (TH) are key regulators of essential cellular processes, including 

proliferation, differentiation, apoptosis, and metabolism. Thyroid hormones have an important role in the 

development of prostate cancer. So this study aims to assess thyroid function tests among prostatic cancer 

patients.  

methods: Total group study100, fifty Prostatic cancer patients as a case study and 50 healthy men as the 

control group, blood samples were collected for measurement for thyroid function test and Prostate Antigen 

by Tosoh  TM device (China) and enzyme-linked immune sorbent assay (ELISA) Fortress TM.              

Results: Statistical analysis of test results of the case study: the mean and SD±   PSA= (31.8 ± 12.5 ) , T3 = 

(3.3 ± 1.3) , T4 = (119.58 ± 46.21 ) and TSH =(4.6 ± 3.4) . For each P-value 0.0001 when compared to the 

control group, the frequency of thyroid disorders among case study participants is hyperthyroidism (33 = 

66%), normal (14 = 28%), and hypothyroidism (3 = 6%).  

 Conclusion: Hyperthyroidism is the most common thyroid disorder among patients with prostatic cancer.   

 

Keywords:   Prostate cancer, Thyroid hormones, T3, T4, TSH, and Prostate Antigen.  

  

Introduction  

Prostate cancer develops when the rates of cell division exceed those of cell death, leading to uncontrolled 

tumor growth. Following the initial transformation event, further mutations of a multitude of genes, including 

the genes for retinoblastoma, can lead to tumor progression and metastasis. Most prostate cancers are 

adenocarcinomas [1,2,3]. Triiodothyronine (T3) and its prohormone thyroxine (T4) are hypothesized to 

promote carcinogenesis through their important roles in cell differentiation, growth, and metabolism [4]. The 

hormones also promote tumor-induced angiogenesis [5], and have been shown to increase prostate cancer cell 

proliferation in vitro [6,7]. Thyroid-stimulating hormone (TSH) is produced by the anterior pituitary gland to 

regulate T4 secretion from the thyroid and is an important laboratory measure for determining thyroid status 

[8]. In individuals with normal thyroid function, T4 and TSH act in a negative feedback loop [5]; thus, a 

hypothyroid state is defined as having low T4 but high TSH, and hyperthyroid status is defined as having high 

T4 but low TSH [9]. It is hypothesized that hypothyroid men may be at a decreased risk of prostate cancer, 

whereas hyperthyroid men may have an increased risk.  Serum prostate-specific antigen (PSA) measurement 

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has been widely used in screening (early detection), diagnosis, and monitoring treatment response in various 

stages of prostate cancer (PCa) [4]. A major disadvantage of PSA-based PCa detection is the considerable 

number of false positive results that occur; many patients undergo unnecessary prostate biopsy procedures 

due to the false positive elevation in the serum PSA level. Various diagnostic and therapeutic procedures, as 

well as benign and physiologic conditions, have been shown to increase serum PSA concentrations (2-7) [10]. 

The close relationship between the prostate and thyroid gland Although it is very well known that thyroid 

hormone regulates thyrotropin-releasing hormone levels in the male reproductive system, including the 

prostate, the direct effect of thyroid hormones on the prostate is still unclear.  evaluated the relationship 

between serum T3 levels and risk of recurrence in patients treated for localized prostate cancer[11].  

Materials and methods:  Study 

Group  

A cross-sectional study was conducted at Khartoum oncology and isotopic treatment hospital during the 

period from September to November 2021 .fifty patients were diagnosed with prostatic cancer aged from 26-

66 years as case and fifty healthy men as control.   

Inclusion criteria and Exclusion criteria: Men with prostatic cancer were involved in the study and other 

types of cancer patients did not be part of this study.  

Ethical consideration: The study was revised and ethically approved by the ethical and scientific committee 

of the Faculty of Medical Laboratory Sciences, University of Alzaiem Alazhari. Samples were taken with 

verbal consent from patients or their relatives. Data collection   

Data collected through a direct interview questionnaire was used to collect data. well-constructed 

questionnaires such as age, gender, and duration of the disease.    

Collection of specimens:  

Venous blood samples were collected by using sterile, dry, plastic syringes and a tourniquet to make the veins 

more prominent. The puncture sites are cleaned with 70% ethanol and 5 mL of blood is collected in lithium 

heparin containers. The lithium heparin blood sample was centrifuged at 4000 rpm to obtain the plasma and 

then stored at (-4 c) until the analysis.  

Measurement of biochemical parameters:  

Whole blood samples were collected in heparinized blood containers, and plasma was used for measurement 

of thyroid Function Test T3, T4, TSH, and Prostate Antigen by Tosoh TM device (China) and enzyme-linked 

immune sorbent assay (ELISA) Fortress TM, thyroid function tests are designed to distinguish hyperthyroidism 

and hypothyroidism from the euthyroid state. To accomplish direct measurements of the plasma level of 

hormones,  the TSH  ELISA test on the principle of solid phase enzyme-linked immunosorbent assay, the 

assay system utilizes a unique monoclonal antibody directed against a distinct antigen determinant on the 

intact TSH molecule.                          

Normal Rang: T3 (1.3_3.1 nmol/l)  T4(63_141 nmol/l) TSH (0.5_5 nmol/l)   PSA 

: Normal ( 0_4) Border(4_10) Susicious >10 .  

  

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Data analysis  

The statistical analysis of the results was performed by using the Statistical Package for Social  

Sciences (SPSS) version 15.0 for Windows version 10 using a T-test for testing difference significance and a 

Pearson correlation test ( r-value as the coefficient ). A P. value of  0.05 was considered statistically significant. 

Results  

This case-control study involved 50 professionally diagnosed patients with prostatic cancer set as the case 

group. Measuring PSA as well as TFT among case and control groups, showed an elevation of each parameter 

(T3, T4, TSH, and PSA) among case than the control group, giving significant differences when both groups; 

data compared as the p-value for each <0.000 as in table 1.                                    

In this case their age mean+ SD was 66.5+6.52 years, parallel with a healthy group of men set as the control 

group, their age’s mean SD was, patients were recruited from Khartoum oncology hospital, the majority of 

them from west origin 56%, then middle 22%, then northern origin 18% and lesser from south4%.              

Pearson's correlation showed a negative correlation between all measured parameters  (T3, T4, TSH, and PSA) 

with the age of patients and duration of the disease, only significant difference was obtained with TSH with 

duration p value <0.05 as in table 2.   

The correlation of  PSA  and TFT positive correlation with T3 and TSH, giving a significant difference, while 

a negative correlation was obtained with T4 with no significant difference as in table 3-3 and figures 2, 3 

respectively, and 4.  

Most of  the  patients  are  secondary  hyperthyroidism 66%  This may be  due  to decreased  production of  

TSH  from  the  pituitary  gland  or TSH-secreting tumor, or  more  rarely  from the overproduction  of  TRH  

from  the hypothalamus  or thyrotropin-releasing hormone  and  other  patients  are 28% Normal  and 3%  are  

hypothyroidisms as in figure 1  and in table 4 the  comparison of mean levels of TFTs and PSA and P value 

in hyperthyroidism patients  

Table 1: Comparison of mean levels of TFTs and PSA among study groups  

  Case group    N=50  Control group   

N=50  

p-value  

T3 nmol/l  3.3 ± 1.3  1.6 ± 0.67  0.000  

T4nmol/l  119.58 ± 46.21  101.6 ± 17.95  0.045  

TSH nmol/l  4.6 ± 3.4  1.7 ± 0.7  0.000  

PSA nmol/l  31.8 ± 12.5  1.85 ± 2.1  0.000  

Table 2: correlation of age and duration of disease with TFTs and PSA   

Parameters   Values  Age  Duration  

T3  R  -0.033  -0.117  

P  0.819  0.418  

T4  R  -0.092  -0.024  

P  0.526  0.870  

TSH  R  -0.051  -0.317*  

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  P  0.725  0.025  

PSA  R  -0.109  -0.259  

P  0.452  0.070  

r=Pearson’s correlation between 1 and -1.  

Table 3: Correlation of PSA with TFTs  

Variable    T3  T4  TSH  

PSA  person 

Correlation  

0.343  -0.033  0.280  

p-value  0.007  0.803  0.029  

Table 4: Comparison of mean levels of TFTs and PSA and P value in hyperthyroidism patients  

variable  Hyperthyroidism 

N=33   

Control 

 group  

N=50  

 p-value  

T3   3.1 ± 1.0  1.6 ± 0.67  0.000  

T4   39.8 ± 15.4  101.6 ± 17.95  0.000  

TSH   0.4 ± 0.1  1.7 ± 0.7  0.000  

PSA   12.3 ± 10.4  1.85 ± 2.1  0.000  

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Figure 2: Correlation between PSA and T3 among case studies (P. value=0.007, r=0.34)      Figure 3: 

Correlation between PSA and TSH among case studies (P. value=0.029, r=0.282)  

  

  

         
Figure  1 :  Frequency of thyroid disorders  among case  group   

                                                                                           

  

         

  

  

  

\   

  

  

  

66 % 

%  28  

%  6  

Sales  

Hyperthyroidism  

Normal  

Hyporthyrodism  

  

  

  

  

  

  

  

  

  

  

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Figure 4: Correlation between T4 and PSA among case studies (P. value=0.803, r=0.001) Discussion  

              Prostate cancer develops when the rates of cell division exceed those of cell death, leading to 

uncontrolled tumor growth.  Following the initial transformation event, a variety of genes, including those for 

retinoblastoma, can undergo further alterations that cause tumor growth and metastasis. Adenocarcinomas are 

the primary kind of prostate cancer. When PSA expression was thought to be unique to the prostate gland and 

was thought to be raised in benign situations, the blood PSA was the most significant biochemical tumor 

marker utilized in the screening, diagnosis, and monitoring of patients with prostate malignancies. Regardless 

of the fact that it is generally known that thyroid hormone modulates the levels of thyrotropin-releasing 

hormone throughout the male reproductive system, including the prostate, it is still unclear how thyroid 

hormones directly affect the prostate. In patients receiving treatment for locally advanced prostate cancer, 

they assessed the connection between serum T3 levels and the probability of recurrence[12]. Nearly every 

tissue in the body develops, differentiates, and grows in response to thyroid hormones [13]. According to 

Bilek et al. [14], the thyroid gland and the rat ventral prostate have a close association. The direct impact of 

thyroid hormones on the prostate is still unknown, despite the fact that it is widely known that thyroid hormone 

modulates thyrotropin-releasing hormone levels in the male reproductive system, including the prostate [15]. 

In patients receiving treatment for localized PCa, Lehrer et al. [16] examined the association between serum 

T3 levels and the likelihood of recurrence. They classified the 68 individuals in their study into three risks 

identified, moderate, and high risk. In the present study patients diagnosed with prostatic cancer were set as 

case group, measuring PSA as well as TFT among case and control groups, showed an elevation of each 

parameter among cases than a control group, giving significant difference, a suggests that Secondary 

hyperthyroidism increase the risk of prostatic cancer. A prospective cohort study of a community-dwelling 

population in Western Australia between the ages of 25 and 84 found some agreement. Tests including the 

TSH and FT4 were performed on the archived. Along with the 41 prostate malignancies, other cancer kinds 

were also included. A decreased risk of prostate cancer was linked to higher TSH (P = 0.005). Similar to this, 

greater FT4 was linked to a higher risk of prostate cancer (P = 0.009) [17] , middle-aged males with benign 

prostatic hyperplasia were given hormones. Levels of free thyroxin (FT4) and thyroid-stimulating hormone 

(TSH) were assessed. The FT4 quartile had a large increase. No statistically significant difference was seen 

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in TSH [18]. In previous study, thyroid hormones were found related to the pathophysiology of several cancer 

forms, according to study results, results from case-control and population-based studies are inconclusive 

when it comes to the link between thyroid hormones and cancer. Numerous pieces of evidence point to an 

increased risk of various solid tumors in people with asymptomatic and clinical hyperthyroidism[19]. The 

results of a study agreed that there is a link between thyroid hormones and prostate cancer case-control 20]. 

The patients in this study were 56.7 years old on average. According to our research, elevated serum PSA 

levels were related to higher serum TSH, T3, and T4 levels. Previous research demonstrated lower serum TSH 

and greater serum T3 levels in men with benign prostatic hyperplasia and prostate cancer. Additionally, it is 

well-known that a number of factors can affect PSA, the most widely used biomarker for the diagnosis of 

prostate cancer [21]. Increased T3 levels have been linked to a number of markers of prostate cancer 

histopathological aggressiveness, according to a prior study [22]. According to new endocrinological 

guidelines [23], men with clinical or subclinical hypothyroid status had a lower chance of developing prostate 

cancer than men with normal thyroid function. This was found in a previous study. Similar to this, we found 

that males with the highest TSH levels (which indicate a hypothyroid state) had a decreased risk of developing 

prostate cancer. These results are in line with earlier laboratory and epidemiologic evidence that thyroid 

hormones affect the incidence of prostate cancer [24,25,26-29]. Another cross-sectional investigation 

similarly revealed that prostate cancer cases had more circulating T3 than controls did [27]. The association 

between thyroid hormones or status and the incidence of prostate cancer was only explored in two prospective 

studies [28,29]. One found that males who self-reported having thyroid disease had a higher chance of 

developing prostate cancer [28], but this study did not distinguish between hypothyroid and hyperthyroid 

conditions. TSH concentration and risk were found to be negatively correlated in the one study that looked at 

circulating thyroid hormone levels and prostate cancer (advanced cases were not looked at individually) [29] 

T4 and TSH interact negatively in individuals who have normal thyroid function [8]. Accordingly, a 

hypothyroid state is characterized by low T4 and high TSH, and a hyperthyroid state by high T4 and low TSH 

.   T4 and T3 binding to the plasma membrane receptor integrin avb3 stimulates several pro-carcinogenic 

pathways, including PI-3K and MAPK/ERK1/2, and boosts cell proliferation and angiogenesis, which is a 

well-known biological mechanism via which this may occur [5]. Importantly, integrin avb3 has been linked 

to the spread of prostate cancer [30]. Nearly every tissue in the body develops, differentiates, and grows in 

response to thyroid hormones [13]. According to Bilek et al. [14], the thyroid gland and the rat ventral prostate 

have a close association. The direct impact of thyroid hormones on the prostate is still unknown, despite the 

fact that it is widely known that thyroid hormone modulates thyrotropin-releasing hormone levels in the male 

reproductive system, including the prostate [15]. 2001 saw Lehrer et al. It is hypothesized that hypothyroid 

men may be at a decreased risk of prostate cancer, whereas hyperthyroid men may have an increased risk.in 

this study, most of the patients are secondary hyperthyroidism 66%  this increase the risk of diseases.   

Conclusion    

According to our findings, elevated serum PSA levels were linked to decreased serum TSH and 

elevated serum T3 and T4 levels. Although the mechanism of how thyroid hormones affect patients with 

prostate cancer is still unknown, further studies are needed to corroborate the results of our study.  

Hyperthyroidism is more common than hypothyroidism among patients with prostate cancer.  

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Ethics Committee Approval: The study had the approval of the Institutional Ethics Committee. Informed 

Consent: All participants provided informed consent.  

Peer-review: Internally peer-reviewed.  

Conflict of Interest: The authors declared no conflict of interest.  

Financial Disclosure: The authors declare that they have no relevant financial.  

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https://doi.org/10.21873/anticanres.14199


    

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