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Aims: To study the diagnostic value of Turnout-Associated Trypsin Inhibitor (TATI) in thyroid cancer. Methods: Patients with thyroid cancer (n = 15) and benign thyroid disease (n = 21) were included in the present study. Serum TATI levels were measured preoperatively in all patients. Turnout was papillary in 10 cases, while in some seven patients evidence of extrathyroid invasion (involving thyroid capsule or a neck structure) was present. Results: Median (interquartile range) TATI levels were 15 µl/L (12 µl/L), 14·5 µl/L (9·8 µl/L) and 29 µl/L (14 µl/L), in patients with benign disease, thyroid cancer without local invasion and thyroid cancer with local invasion, respectively (P = 0·001, Kruskal-Wallis test). Post hoc analysis revealed statistically significantly increased levels in patients with local invasion in comparison with both, the remaining cancer cases and those with benign disease (p < 0·01 and p >< 0.05, Dunn test). Using the Receiver Operating Characteristic (ROC) curve method, TATI levels of 18·5 µl/L had sensitivity and specificity of 100% and 79%, respectively, in predicting local invasion, compared to patients with benign disease or absence of local invasion (area under the curve 0·94, 95% confidence interval: 0·81-0·99, p = 0·0003). No association between TATI levels and histology (papillary carcinoma versus nonpapillary cancer) was found (median levels of 20 in both groups, p = 0·81, Mann-Whitney test). Conclusion: Our findings indicate that preoperative measurement of TATI might be helpful in predicting locally advanced thyroid cancer and need to be confirmed in a bigger series. [ABSTRACT FROM AUTHOR]