Evaluating the Role of DPP-4, NIS, and TSH-R Expression in Predicting Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

Objective: This study aims to compare the expression levels of dipeptidyl peptidase-4 (DPP-4), sodium-iodide symporter (NIS), and thyroid-stimulating hormone receptor (TSH-R) in papillary thy- roid microcarcinoma (PTMC) patients with and without lymph node (LN) metastasis and to evaluate the impact of these parameters on disease prognosis.

Methods: A retrospective analysis was performed on 122 patients with PTMC. Immunohistochemical staining was used to analyze DPP-4, NIS, and TSH-R expression levels and assess their relationship with LN metastasis.

Results: Lymph node metastasis was present in 18.0% of the patients, while 82.0% had no metastasis. Lymph node metastasis was significantly more frequent in males (P = .031), patients with elevated TSH levels (P = .022), those with multiple tumor foci (P = .036), and in patients with larger tumor size (P= .013). Patients with high TSH-R expression intensity showed a significantly increased rate of LN metastasis (P = .042). No significant relationship was observed between LN metastasis and staining scores for NIS in surrounding or tumor tissue, nor for DPP-4.

Conclusion: Male gender, elevated TSH levels, multiple tumor foci, increased tumor size, and high TSH-R expression are significantly associated with LN metastasis in PTMC patients. These findings suggest that TSH-R expression may serve as a potential indicator for PTMC prognosis, although further studies with larger patient cohorts are required to confirm these findings.

Cite this article as: Kirman D, Coskun M, Cerit ET, İnan MA, Poyraz A, Karakoc MA. Evaluating the role of DPP-4, NIS, and TSH-R expression in predicting lymph node metastasis in papillary thyroid microcarcinoma. Endocrinol Res Pract. 2025;29(3):229-234.