High Serum TSH Level Is Associated With Progression of Papillary Thyroid Microcarcinoma During Active Surveillance

Kim, Hye In; Jang, Hye Won; Ahn, Hyeon Seon; Ahn, Soohyun; Park, So Young; Oh, Young Lyun; Hahn, Soo Yeon; Shin, Jung Hee; Kim, Jung-Han; Kim, Jee Soo; Kim, Tae Hyuk; Kim, Sun Wook

doi:10.1210/jc.2017-01775

Cited by 102 publications

(65 citation statements)

References 30 publications

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“…9 In a recent study of 127 microPTC patients, the adjusted hazard ratio for progression was higher in patients with the highest serum TSH levels (HR 3.55; 95% CI, 1.22-10.28). 26 However, a similar earlier study found no significant association between TSH and microPTC progression. 27…”

Section: Active Surveillance Protocolsmentioning

confidence: 80%

“…The need for thyroid‐stimulating hormone (TSH) suppression in patients undergoing active surveillance is currently debated and may be worth evaluating in future studies, especially among young patients 9 . In a recent study of 127 microPTC patients, the adjusted hazard ratio for progression was higher in patients with the highest serum TSH levels (HR 3.55; 95% CI, 1.22‐10.28) 26 . However, a similar earlier study found no significant association between TSH and microPTC progression 27 …”

Section: Management Of Papillary Thyroid Microcarcinomamentioning

confidence: 99%

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Low‐risk papillary thyroid microcarcinoma: Optimal management toward a more conservative approach

Ramundo

Sponziello

Falcone

et al. 2020

Journal of Surgical Oncology

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The incidence of papillary thyroid microcarcinoma (microPTC) has dramatically increased in the last decades. Most of these tumors remain small and clinically “silent”, only small number progress. Although thyroid surgery used to be the only therapeutic approach, recent guidelines now consider active surveillance for low‐risk microPTC. For this reason, more accurate risk stratification of microPTC is needed. The optimal management of low‐risk microPTC through accurate risk stratification represents a major clinical issue.

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Section: Active Surveillance Protocolsmentioning

confidence: 80%

Section: Management Of Papillary Thyroid Microcarcinomamentioning

confidence: 99%

Low‐risk papillary thyroid microcarcinoma: Optimal management toward a more conservative approach

Ramundo

Sponziello

Falcone

et al. 2020

Journal of Surgical Oncology

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“…To assess patients eligible for AS and medical team characteristics, initial and follow-up evaluations require serial neck US to evaluate the size and location of the thyroid cancer and the status of the cervical LNs 5,6. However, in 2%–15% of patients initially eligible for AS, imaging studies and fine-needle aspiration cytology can underestimate tumor characteristics or extent, resulting in treatment delay and potentially compromising cure for patients with aggressive disease 7–13…”

Section: Discussionmentioning

confidence: 99%

“…However, in 2%–15% of patients deemed eligible for AS, tumor characteristics or extent may be underestimated, resulting in treatment delay and potentially compromising cure for patients with aggressive disease 7–13. However, no definite biological or clinical parameters currently exist to distinguish low-risk indolent PTMC from potentially aggressive PTMC.…”

Section: Introductionmentioning

confidence: 99%

Long-term oncologic outcomes of papillary thyroid microcarcinoma according to the presence of clinically apparent lymph node metastasis: a large retrospective analysis of 5,348 patients

Choi¹,

Lee²,

Lee³

et al. 2018

CMAR

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PurposeActive surveillance (AS) of low-risk papillary thyroid microcarcinoma (PTMC) may reduce the risk of overtreatment of clinically insignificant cancer. However, the absence of predictor for the progression of PTMC resulted in treatment delay and potentially compromising cure of aggressive disease. Therefore, to anticipate potential damage of delayed surgery, we investigated the oncologic outcomes of patients with low-risk PTMC initially eligible for AS except clinically apparent lymph node metastasis (LNM), imitating delayed surgery with neck dissection.Materials and methodsA total of 5,348 patients, enrolled between 1987 and 2016, with low-risk PTMC initially eligible for AS were included regardless of LNM. We classified our study patients into two groups: Group I, lobectomy with prophylactic central cervical node dissection; Group II, total thyroidectomy with modified radical neck dissection for LNM. In addition, we investigated the oncological outcomes of patients with second-wave surgery due to lateral lymph node recurrence (Group III, subgroup of Group I).ResultsGroup I showed more favorable clinicopathological characteristics compared with Group II. In Group I, only 29 (0.58%) of 4,927 patients underwent second-wave surgery with neck dissection for lateral lymph node recurrences, whereas in Group II, all 22 (5.23%) of 421 patients underwent second-wave selective node dissection because of nodal recurrence. Disease-free survival rates were significantly different between Groups I and II (P<0.05). Of note, the recurrence rate of Group II was still significantly higher than that of Group III (5.2% vs 0%, respectively; P=0.021). In addition, Kaplan–Mayer survival analysis indicated poor disease-free survival rates in Group II compared with Group III (P<0.05).ConclusionThe long-term treatment outcome of PTMC without LNM was favorable even if the recurrence occurs during follow-up period compared with that of PTMC with LNM. It should be noted that AS might be able to cause poor prognosis due to clinically apparent LNM.

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“…Regarding the characteristics at the time of diagnosis, patient age has been related to the risk of tumor growth, which is higher in young individuals (19)(20)(21)23). One study also associated serum TSH > 2.5 mIU/L with a higher risk of tumor growth (26). Importantly, low-risk mPTC is defined in the absence of known distant metastases, apparent extrathyroidal invasion or lymph node involvement, when the tumor is not adjacent to the trachea or recurrent laryngeal nerve, and when fine-needle aspiration (FNA) is not suggestive of an aggressive subtype.…”

Section: Papillary Thyroid Microcarcinomasmentioning

confidence: 99%

Thyroid nodules ≤ 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion

Rosário¹,

Ward²,

Graf³

et al. 2019

Archives of Endocrinology and Metabolism

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The indolent evolution of low-risk papillary thyroid microcarcinoma (mPTC) in adult patients and the consequences of thyroidectomy require a revision of the management traditionally recommended. Aiming to spare patients unnecessary procedures and therapies and to optimize the health system in Brazil, we suggest some measures. Fine-needle aspiration of nodules ≤ 1 cm without extrathyroidal extension on ultrasonography should be performed only in nodules classified as "very suspicious" (i.e., high suspicion according to ATA, high risk according to AACE, TI-RADS 5) and in selected cases [age < 40 years, nodule adjacent to the trachea or recurrent laryngeal nerve (RLN), multiple suspicious nodules, presence of hypercalcitoninemia or suspicious lymph nodes]. Active surveillance (AS) rather than immediate surgery should be considered in adult patients with low-risk mPTC. Lobectomy is the best option in patients with unifocal low-risk mPTC who are not candidates for AS because of age, proximity of the tumor to the trachea or RLN, or because they opted for surgery. The same applies to patients who started AS but had a subsequent surgical indication not due to a suspicion of tumor extension beyond the gland or multicentricity. Molecular tests are not necessary to choose between AS and surgery or, in the latter case, between lobectomy and total thyroidectomy. The presence of RAS or other RAS-like mutations or BRAFV600E or other BRAF V600E-like mutations should not modify the management cited above; however, the rare cases of mPTC exhibiting high-risk mutations, like in the TERT promoter or p53, are not candidates for AS.

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High Serum TSH Level Is Associated With Progression of Papillary Thyroid Microcarcinoma During Active Surveillance

Abstract: Sustained elevation of serum TSH levels during active surveillance is associated with PTMC progression. Maintaining a low-normal TSH range with levothyroxine treatment during active surveillance of PTMC might be considered in future studies.

Cited by 102 publications

References 30 publications

Low‐risk papillary thyroid microcarcinoma: Optimal management toward a more conservative approach

Low‐risk papillary thyroid microcarcinoma: Optimal management toward a more conservative approach

Long-term oncologic outcomes of papillary thyroid microcarcinoma according to the presence of clinically apparent lymph node metastasis: a large retrospective analysis of 5,348 patients

Thyroid nodules ≤ 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion

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