Postoperative Thyroid-Stimulating Hormone Levels Did Not Affect Recurrence after Thyroid Lobectomy in Patients with Papillary Thyroid Cancer

Lee, Myung Chul; Kim, Min Joo; Choi, Hoon; Cho, Sun Wook; Lee, Guk Haeng; Park, Young Joo; Park, Do Joon

doi:10.3803/enm.2019.34.2.150

Cited by 36 publications

(26 citation statements)

References 25 publications

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“…Matsuzu et al reported a 6.5% rate of recurrence in the remaining thyroid and a 9.4% rate of recurrence in regional lymph nodes in 1088 patients followed for 25 years [38]. On the other hand, Lee et al reported a 0.9% recurrence rate in the contralateral lobe, but 87% of the tumors in this study were micropapillary cancers [61]. Many retrospective studies, with various inclusion criteria, have reported global recurrence rates ranging from 4.2-7.1% after lobectomy for low-risk cancers [19,[62][63][64][65].…”

Section: Oncologic Considerations: Recurrence In the Contralateral Locontrasting

confidence: 49%

Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

Hartl

Guerlain

Breuskin

et al. 2020

Cancers

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Many recent publications and guidelines have promoted a “more is less” approach in terms of treatment for low to intermediate risk differentiated thyroid cancer (DTC), which comprise the vast majority of thyroid cancers: less extensive surgery, less radioactive iodine, less or no thyroid hormone suppression, and less frequent or stringent follow-up. Following this approach, thyroid lobectomy has been proposed as a means of decreasing short- and long-term postoperative morbidity while maintaining an excellent prognosis for tumors meeting specific macroscopic and microscopic criteria. This article will examine the pros and cons of thyroid lobectomy for low to intermediate risk cancers and discuss, in detail, criteria for patient selection and oncological outcomes.

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Section: Oncologic Considerations: Recurrence In the Contralateral Locontrasting

confidence: 49%

Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

Hartl

Guerlain

Breuskin

et al. 2020

Cancers

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“…The mean TSH values did not affect recurrence-free survival. However, the mean TSH levels of patients in their study were within the recommended low-normal range (0.5–1.9 mIU/L) ( 16 ). Furthermore, a randomized controlled trial with low-risk PTC patients showed that disease-free survival (DFS) in patients without TSH suppression was not inferior by more than 10% to the DFS in patients with TSH suppression.…”

Section: Discussionmentioning

confidence: 83%

Thyroid Hormone Supplementation Therapy for Differentiated Thyroid Cancer After Lobectomy: 5 Years of Follow-Up

Kim

et al. 2020

Front. Endocrinol.

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Background: Lobectomy with preservation of the contralateral lobe has already become the most preferred surgical method for patients with low-risk thyroid cancer. The incidence of and risk factors for the development of hypothyroidism after lobectomy for thyroid cancer remains unclear. The previous practice of levothyroxine supplementation post-thyroidectomy, to bring about thyroid stimulating hormone (TSH) suppression, had some serious side effects. This study aimed to evaluate the incidence of hypothyroidism and to identify the factors associated with hypothyroidism requiring thyroid hormone replacement. Methods: We retrospectively reviewed the charts of 256 consecutive patients with differentiated thyroid cancer treated with lobectomy at the Gangnam Severance Hospital between April and December 2014 who were followed-up for more than 5 years. Patients were evaluated using a thyroid function test at the time of outpatient visit every 6 months for the 1st year, with an annual follow-up thereafter. Results: After 5 years, 66.0% (169) of the patients needed levothyroxine supplementation to maintain euthyroid status. The incidence of hypothyroidism requiring levothyroxine supplementation increased until 3 years but showed no significant change in the 4 and 5th year. Recurrence showed no difference between the group with and without levothyroxine supplementation. The presence of thyroiditis and preoperative TSH levels were correlated with postoperative levothyroxine supplementation to maintain euthyroid status, in univariate and multivariate analyses. Conclusion: High preoperative TSH levels and/or thyroiditis indicate a significantly increased likelihood of developing hypothyroidism requiring thyroid hormone supplementation after a thyroid lobectomy. Patients with an increased risk of postoperative hypothyroidism must be aware of their risk factors and should undergo more intensive follow-ups.

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“…The 2015 ATA guidelines suggest a TSH goal of 0.5-2 mU/L. However, a recent study demonstrated that postoperative serum TSH levels did not affect recurrence in low-risk PTC patients who underwent thyroid lobectomy (Lee et al 2019). If we consider that 73% of patients will have TSH >2 mU/L at 1 year after lobectomy (Cox et al 2018), many patients following the ATA recommendation will be unnecessarily treated with levothyroxine.…”

Section: Patients Treated With Total Thyroidectomy or Lobectomy Withomentioning

confidence: 99%

“…If we consider that 73% of patients will have TSH >2 mU/L at 1 year after lobectomy (Cox et al 2018), many patients following the ATA recommendation will be unnecessarily treated with levothyroxine. Therefore, the decision for TSH suppression in this group of patients should be made in terms of patient-specific considerations (Lee et al 2019). A review on the indications and follow-up of patients undergoing lobectomy for DTC was recently published (Park & Yoon 2019).…”

Section: Patients Treated With Total Thyroidectomy or Lobectomy Withomentioning

confidence: 99%

Dynamic risk assessment in patients with differentiated thyroid cancer

Pitoia

Jerkovich

2019

Endocrine-Related Cancer

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The stratification of patients with differentiated thyroid cancer based on their initial risk of recurrence, according to specific clinical, histopathological and perioperative data, is an important starting point for tailoring the follow-up during the first 1–2 years after initial therapy (surgery with or without radioiodine ablation). However, risk of recurrence re-stratification based on new clinical data that becomes available after considering the response to treatment (dynamic risk assessment) provides a more accurate prediction of the status at final follow-up and a more individualized approach. In this review, we summarized the available data regarding dynamic risk of recurrence and the suggested management of differentiated thyroid cancer patients according to the response to treatment. The use of this strategy is crucial to avoid overtreatment and intensive follow-up of the vast majority of patients who will have a very good prognosis and, on the other hand, focus therapeutic efforts on those patients who will have a worse prognosis. In the future, molecular biology analysis of the tumors and well-designed prospective studies will probably refine the risk of recurrence prediction.

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Postoperative Thyroid-Stimulating Hormone Levels Did Not Affect Recurrence after Thyroid Lobectomy in Patients with Papillary Thyroid Cancer

Cited by 36 publications

References 25 publications

Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

Thyroid Hormone Supplementation Therapy for Differentiated Thyroid Cancer After Lobectomy: 5 Years of Follow-Up

Dynamic risk assessment in patients with differentiated thyroid cancer

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