Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer

McGriff, Nayahmka J; Csákó, György; Gourgiotis, Loukas; Guthrie, Lori C.; Pucino, Frank; Sarlis, Nicholas J.

doi:10.1080/078538902321117760

Cited by 224 publications

(132 citation statements)

References 45 publications

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“…Suppression of TSH, using supraphysiologic doses of LT 4 , is used commonly to treat patients with thyroid cancer in an effort to decrease the risk of recurrence (73,168 …”

Section: What Is the Role Of Tsh Suppression Therapy?mentioning

confidence: 99%

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

Cooper

Doherty

Haugen

et al. 2006

Thyroid

1,915

938

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“…Suppression of TSH, using supraphysiologic doses of LT 4 , is used commonly to treat patients with thyroid cancer in an effort to decrease the risk of recurrence (73,168 …”

Section: What Is the Role Of Tsh Suppression Therapy?mentioning

confidence: 99%

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

Cooper

Doherty

Haugen

et al. 2006

Thyroid

1,915

938

View full text Add to dashboard Cite

“…There is a report stating that postoperative TSH suppression therapy can reduce the recurrence rate [13], but there is no substantial evidence to support this. Once the administration of L-thyroxine is started, for the purpose of suppressing TSH, the medication must, theoretically, be continued for the remainder of the patient's life.…”

Section: Treatment Modalities For Large Papillary Thyroid Carcinomas mentioning

confidence: 99%

Unique Treatment Policy for Well-differentiated Thyroid Cancer in Japan: Results of a Questionnaire Distributed to Members of the Japanese Society of Thyroid Surgery and the International Association of Endocrine Surgeons

2006

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Abstract. Although surgery has been the mainstay of treatment for patients with well-differentiated thyroid cancer, the extents of thyroid resection and lymph node dissection adopted in Japan differ from those in other countries. Furthermore, regarding the indications for postoperative radiation therapy and hormonal therapy, and treatment modalities for cancer recurrence, there are marked discrepancies between Japan and other countries. A questionnaire survey was thus conducted among domestic and overseas thyroid surgeons to ascertain the actual treatment policy for well-differentiated thyroid cancer in Japan and various foreign countries. For small papillary carcinomas of 2.0 cm or less (T1), thyroid resection was more extensive in foreign countries than in Japan, although the extent of lymph node dissection was limited in the former. For large papillary carcinomas exceeding 3.0 cm (T2), on the other hand, total thyroidectomy was the treatment of first choice for all overseas respondents, but of only 20% in Japan, despite lymph node dissection being more extensive in Japan than in other countries. Overseas surgeons were much more likely to favor postoperative TSH suppression therapy and high-dose 131 I therapy. For recurrence following surgery for papillary thyroid cancer, both domestic and overseas respondents indicated surgical resection to be the most common treatment option, and favored high-dose 131 I therapy as well. In Japan, however, high-dose 131 I therapy is available only in a few institutions. Such limited indications for highdose 131 I therapy in Japan may reflect a discrepancy in the frequency of total thyroidectomy, a prerequisite for postoperative high-dose 131 I therapy, between Japan and other countries. This is the first questionnaire study conducted in both Japan and other countries in relation to treatment modalities for thyroid cancer. The results reveal that there is a clear disparity in treatment policies between Japan and foreign countries.

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“…A tendency for a greater degree of TSH suppression to be associated with less disease progression was seen in a cohort of high-risk patients (10), although the difference did not reach significance. A meta-analysis that quantified adverse clinical outcomes from ten studies of patients on TSH suppression also suggested a benefit of this approach (11). However, some authors conclude that the benefit of TSH suppression is limited to patients with persistent or recurrent disease (12).…”

Section: Introductionmentioning

confidence: 99%

Endogenous Thyrotropin and Triiodothyronine Concentrations in Individuals with Thyroid Cancer

Jonklaas

Nsouli-Maktabi

Soldin

2008

Thyroid

111

102

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Background: Thyroid hormone suppression therapy is associated with decreased recurrence rates and improved survival in patients with differentiated thyroid cancer. Recently higher baseline thyrotropin (TSH) levels have been found to be associated with a postoperative diagnosis of differentiated thyroid cancer. Our objective was to confirm whether preoperative TSH levels were higher in patients who were diagnosed with differentiated thyroid cancer after undergoing thyroidectomy, compared with patients who were found to have benign disease. We also sought to determine whether thyroid hormone levels were lower in the patients with malignancy. Methods: The study was a retrospective analysis of a prospective study. The study setting was the General Clinical Research Center of an Academic Medical Center. Participants were 50 euthyroid patients undergoing thyroidectomy. Thyroxine, triiodothyronine (T 3 ), and TSH levels were documented in patients prior to their scheduled thyroidectomy. Following thyroidectomy, patients were divided into those with a histologic diagnosis of either differentiated thyroid cancer or benign disease. Preoperative thyroid profiles were correlated with patients' postoperative diagnoses. Results: All patients had a normal serum TSH concentration preoperatively. One-third of the group was diagnosed with thyroid cancer as a result of their thyroidectomy. These patients had a higher serum TSH level (mean ¼ 1.50 mIU=L, CI 1.22-1.78 mIU=L) than patients with benign disease (mean ¼ 1.01 mIU=mL, CI 0.84-1.18 mIU=L). There was a greater risk of having thyroid cancer in patients with TSH levels in the upper three quartiles of TSH values, compared with patients with TSH concentrations in the lowest quartile of TSH values (odd ratio ¼ 8.7, CI 2.2-33.7). Patients with a thyroid cancer diagnosis also had lower T 3 concentrations measured by liquid chromatography tandem mass spectrometry (mean ¼ 112.6 ng=dL, CI 103.8-121.4 ng=dL) than did patients with a benign diagnosis (mean 129.9 ng=dL, CI 121.4-138.4 ng=dL). Conclusion: These data confirm that higher TSH concentrations, even within the normal range, are associated with a subsequent diagnosis of thyroid cancer in individuals with thyroid abnormalities. This further supports the hypothesis that TSH stimulates the growth or development of thyroid malignancy during its early or preclinical phase. We also show for the first time that patients with thyroid cancer also have lower T 3 levels than patients with benign disease.

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Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer

Abstract: THST appears justified in ThyrCa patients following initial therapy. As most primary studies were imperfect, future research will better define the effect of THST upon ThyrCa clinical outcomes.

Cited by 224 publications

References 45 publications

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

Unique Treatment Policy for Well-differentiated Thyroid Cancer in Japan: Results of a Questionnaire Distributed to Members of the Japanese Society of Thyroid Surgery and the International Association of Endocrine Surgeons

Endogenous Thyrotropin and Triiodothyronine Concentrations in Individuals with Thyroid Cancer

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