Naming difficulties after thyroid stimulating hormone suppression therapy in patients with differentiated thyroid carcinoma: a prospective cohort study

Abstract

Background Thyroid stimulating hormone (TSH) suppression therapy after differentiated thyroid carcinoma surgery causes cognitive impairment. However, data on naming difficulties (anomia)—related specific cognitive impairment are lacking. Methods A prospective cohort study was conducted, in which, patients with differentiated thyroid carcinoma and benign thyroid nodules were given oral L-T4 therapy after surgery, after meeting the criteria of TSH suppression therapy and thyroxine replacement therapy, respectively, the patients were continually given l -T4 therapy for 6 and 12 months, and then, the neuropsychological test was performed. Results Of the 255 subjects, 212 cases (83.13%) completed all the tests, including 33 cases in the normal control group (NC group), 110 cases in the TSH suppression therapy group (TS group), and 69 cases in the thyroxine replacement therapy group (TR group). There was no significant difference in background data among the three groups ( P > 0.05). The scores of mini-mental state examination, clock drawing test, digit symbol substitution test, personal history, temporal and spatial orientation, digit order relation, visual object recognition, associative learning, and color naming in the TS and TR groups were not significantly different from those in the NC group after 6 and 12 months of L-T4 therapy ( P > 0.05); the scores of picture recall, visual recall, comprehension memory, and digit span forward in the TS and TR groups were notably lower than those in the NC group ( P < 0.01); the scores of confrontation naming and listing the names in the TS group were significantly lower than those in the NC and TR groups, and the scores decreased with the prolongation of TSH suppression therapy ( P < 0.01). Conclusion TSH suppression therapy after differentiated thyroid carcinoma surgery could lead to short-term memory impairment, attention impairment, word selection anomia, and depression, of which, word selection anomia was aggravated with the prolongation of TSH suppression therapy. Therefore, we suggested that optimal TSH goals for individual patients must balance the potential benefit of TSH suppression therapy with the possible harm from subclinical hyperthyroidism especially in low risk differentiated thyroid carcinoma patients (ClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT0266532, Registered on 21 June 2016).

Factors influencing TSH suppression efficacy in postoperative papillary thyroid carcinoma patients: a retrospective cohort study

“…Several factors, including gender, age, weight, preoperative TSH concentration, and diseases affecting drug absorption, can influence the required dosage [8][9][10][11]. The goal of TSH suppression therapy is to achieve low or undetectable TSH levels, leading to subclinical hyperthyroidism [12]. However, prolonged low TSH levels can have negative effects on the cardiovascular and skeletal systems [13,14].…”

Seeking optimization of LT4 treatment in patients with differentiated thyroid cancer

“…However, TSH suppressive treatment can induce adverse effects on heart and bone (increased cardiovascular morbidity and mortality, and increased risk of osteoporosis and fractures) [ 5 ]. Moreover, Jin et al reported that TSH suppressive therapy is associated with neurological and psychiatric disorders (short-term memory impairment, attention impairment, word selection anomia, and depression) [ 6 ]. Therefore, accurate tailoring of treatment in any setting taking into account both patient characteristics (age and comorbidities) and risk of persistent/recurrent disease is highly recommended.…”

Development of a Rat Model for Evaluating Thyroid-Stimulating Hormone Suppression after Total Thyroidectomy

“…However, long-term TSH suppression therapy in DTC patients can lead to drug-induced subclinical hyperthyroidism. Subclinical hyperthyroidism significantly increases the incidence of cardiovascular events and mortality risk, and enhances the incidence of osteoporosis and fracture risk in postmenopausal women as well 6,7 , and even cause cognitive impairment in patients 8 . In order to further elucidate the effects of TSH suppression therapy on thyroid-cancer patients after thyroidectomy, it is very important to create animal models and study the relevant mechanisms.…”