Thyroid hormone testing is routinely performed in clinical practice; however, its precise role in distinguishing malignant thyroid nodules preoperatively remains a subject of ongoing investigation. This study comprehensively evaluated preoperative serum levels of Thyroid-Stimulating Hormone (TSH), Total Thyroxine (TT4), and Free Triiodothyronine (FT3) in 100 patients (66 malignant, 34 benign) referred to the Misurata Oncology Center, Libya, for thyroidectomy. Serum TT4 levels were significantly elevated in malignant cases (median: 81.55 nmol/L) compared to benign cases (median: 18.53 nmol/L; P < 0.001), while TSH was significantly suppressed in malignant cases (median: 1.76 mIU/L vs. 5.90 mIU/L; P = 0.0179). FT3 showed no significant difference between groups. Multivariable ROC modeling combining age, TT4, and TSH achieved an area under the curve (AUC) of 0.94 (95% CI: 0.89–0.98), with 92.4% sensitivity and 88.2% specificity, demonstrating excellent diagnostic accuracy in discriminating malignant from benign thyroid lesions prior to surgery. Biological sex had no significant effect on hormone profiles. Integrating preoperative TT4, TSH, and patient age provides a robust, gender-neutral diagnostic framework for early detection and risk stratification of thyroid cancer, supporting a reduction in unnecessary diagnostic surgeries.
Keywords: Thyroid Cancer; Total Thyroxine (TT4); Thyroid-Stimulating Hormone (TSH); Preoperative Diagnostics; Misurata Oncology Center; ROC Analysis.
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