Risk factors for hypothyroidism and thyroid hormone replacement after hemithyroidectomy in papillary thyroid carcinoma

Lee, Song Jae; Song, Chang Myeon; Ji, Yong Bae; Choi, Yun Young; Sohn, Young Seok; Park, Jung Hwan; Kim, Dong Sun; Tae, Kyung

doi:10.1007/s00423-021-02189-7

Cited by 19 publications

(11 citation statements)

References 53 publications

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“…yroid stimulating hormone (TSH) is the most important hormone regulating thyroid gland function. It activates the cAMP pathway and regulates hormone synthesis and proliferation of thyroid follicular cells by binding TSH receptor on the membrane of thyroid follicular cells, thus affecting the onset or progression of follicular cells-originated thyroid cancer [26,27].…”

Section: Discussionmentioning

confidence: 99%

Development of a Risk Predictive Model for Evaluating Immune Infiltration Status in Invasive Thyroid Carcinoma

Pang

Qin

2022

Evidence-Based Complementary and Alternative Medicine

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Aims. This study aimed to reveal the molecular characteristics and potential biomarker of immune-activated and immunosuppressive invasive thyroid carcinoma. Methods. Expression and clinical data for invasive thyroid carcinoma were obtained from the TCGA database. Tumor samples were divided into immune-activated or immunosuppressive groups based on the immune enrichment score calculated by ssGSEA. Differentially expressed genes (DEGs) between tumor vs. normal groups or between immune-activated vs. immunosuppressive groups were screened, followed by functional enrichment. Immune infiltration was evaluated using the ESTIMATE, CIBERSORTx, and EPIC algorithms, respectively. A random forest algorithm and Lasso cox analysis were used to identify gene signatures for risk model construction. Results. Totally 1171 DEGs were screened between tumor vs. normal groups, and multiple tumorigenesis-associated pathways were significantly activated in invasive thyroid carcinoma. Compared to immune-activated samples, immunosuppressive samples showed higher tumor purity, lower immune/stromal scores, and lower expression of immune markers, as well as lower infiltration abundance of CD4+ T cells and CD8+ T cells. A risk model based on a 12-immune signature (CCR7, CD1B, CD86, CSF2RB, HCK, HLA-DQA1, LTA, LTB, LYZ, NOD2, TNFRSF9, and TNFSF11) was developed to evaluate the immune infiltration status (AUC = 0.998; AUC of 0.958 and 0.979 in the two external validation datasets), which showed a higher clinical benefit and high accuracy. Immune-activated samples presented lower IC50 value for bortezomib, MG.132, staurosporine, and AZD8055, indicating sensitivity to these drugs. Conclusion. A 12-gene-based immune signature was developed to predict the immune infiltration status for invasive thyroid carcinoma patients and then to identify the subsets of invasive thyroid carcinoma patients who might benefit from immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Development of a Risk Predictive Model for Evaluating Immune Infiltration Status in Invasive Thyroid Carcinoma

Pang

Qin

2022

Evidence-Based Complementary and Alternative Medicine

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“…Although frequently shared by the supporters of TL, such an opinion has been called into question by European thyroidologists [8]. Numerous data demonstrated these doubts are reasonable [59][60][61][62]. TSH level above 2mIU/L was observed in 85% of patients 6 weeks after TL due to low-risk PTC.…”

Section: Controversies Related To "Less Is More" In Primary Thyroid S...mentioning

confidence: 99%

“…According to the Korean group, not only a high preoperative TSH was a risk factor for postoperative hypothyroidism. Also, a low free serum thyroxine level was significantly associated with the need for postoperative thyroid hormone supplementation [ 62 ]. The above-mentioned findings were confirmed in a prospective study, which demonstrated that the risk of hypothyroidism post TL depends on preoperative TSH level and the lower ratio of the weight of thyroid remnant to the patient’s weight [ 63 ].…”

Section: Introductionmentioning

confidence: 99%

Lobo-isthmectomy in the management of differentiated thyroid cancer

et al. 2023

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We have recently witnessed a rapid increase in the incidence of differentiated thyroid carcinoma (DTC), particularly low and very low-risk papillary thyroid carcinoma. Simultaneously, the number of cancer-related deaths has remained stable for more than 30 years. Such an indolent nature and long-term survival prompted researchers and experts to an ongoing discussion on the adequacy of DTC management to avoid, on the one hand, the overtreatment of low-risk cases and, on the other hand, the undertreatment of highly aggressive ones.The most recent guidelines of the American Thyroid Association (ATA GL) moved primary thyroid surgery in DTC towards a less aggressive approach by making lobectomy an option for patients with intrathyroidal low-risk DTC tumors up to 4 cm in diameter without evidence of extrathyroidal extension or lymph node metastases. It was one of the key changes in DTC management proposed by the ATA in 2015.Following the introduction of the 2015 ATA GL, the role of thyroid lobectomy in DTC management has slowly become increasingly important. The data coming from analyses of the large databases and retrospective studies prove that a less extensive surgical approach, even if in some reports it was related to a slight increase of the risk of recurrence, did not show a negative impact on disease-specific and overall survival in T1T2N0M0 low-risk DTC. There is no doubt that making thyroid lobectomy an option for low-risk papillary and follicular carcinomas was an essential step toward the de-escalation of treatment in thyroid carcinoma.This review summarizes the current recommendations and evidence-based data supporting the necessity of de-escalation of primary thyroid surgery in low-risk DTC. It also discusses the controversies raised by introducing new ATA guidelines and tries to resolve some open questions.

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“…The most common thyroid surgery‐related complications are hypocalcaemia, and recurrent laryngeal nerve injury. After TT there is always a need for thyroxine replacement therapy, however also in up to 40% after hemithyroidectomy (HT) 11 . Dysphagia, xerostomia, and increased cardiovascular disorders are attributed to RAI and/or TSH suppression therapy, leading to a lower quality of life (QOL) 12–15 …”

Section: Introductionmentioning

confidence: 99%

“…After TT there is always a need for thyroxine replacement therapy, however also in up to 40% after hemithyroidectomy (HT). 11 Dysphagia, xerostomia, and increased cardiovascular disorders are attributed to RAI and/or TSH suppression therapy, leading to a lower quality of life (QOL). [12][13][14][15] This de-escalating trend is also seen in the ATA-15, 6 considering lobectomy as the initial surgical approach for intrathyroidal DTC from 1 to 4 cm, no administration of RAI therapy for tumours <1 cm without any high-risk features, and considering RAI therapy (instead of routine administration) for well-differentiated T1-3 PTC ± < 5 microscopic nodal metastases (N0-N1aM0).…”

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confidence: 99%

The outcome of treatment in differentiated thyroid cancer according to recommendations in current Dutch and American guidelines

Dijk

Groen

Dijk

et al. 2022

Clinical Endocrinology

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Objective: Assessment of treatment outcome in current de-escalation for differentiated thyroid cancer (DTC) according to the 2015 Dutch thyroid cancer guidelines and American Thyroid Association guidelines (ATA-15).Design: Retrospectively, the recommendations of the NL-15 and ATA-15 guidelines were evaluated to estimate potentially adequate, under-and overtreatment of DTC in patients treated in the University Medical Center Groningen between 2007 and 2017.Patients: A total of 240 patients with a cT1-T3aN0-1aM0 DTC fulfilled the inclusion criteria.Measurements: After actual treatment was given, patients were again categorized according to both guidelines into low, intermediate, or high-risk based on tumour status. Next, they were categorized into a congruent low-risk (n = 60), congruent high-risk (n = 73), or incongruent risk group (n = 107). Follow-up data were used to estimate the proportion of potentially adequate, under-, and overtreatment according to both guidelines.Results: Comparing treatment recommended by NL-15 and ATA-15 showed significantly more over-and adequate treatment when following NL-15 recommendations, and more undertreatment following ATA-15 (all: p < .001). Subanalysis of the congruent low-risk group showed overtreatment in 64% when following NL-15 guidelines (p < .001). No treatment differences were found in the congruent high-risk group. Undertreatment was most often seen in the incongruent risk group when following ATA-15 (p < .001).Conclusions: Low-risk patients were treated too aggressively when following NL-15 recommendations, where the less aggressive ATA-15 approach seemed more adequate. Treatment of intermediate risk DTC patients varies greatly, with a relative

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Risk factors for hypothyroidism and thyroid hormone replacement after hemithyroidectomy in papillary thyroid carcinoma

Cited by 19 publications

References 53 publications

Development of a Risk Predictive Model for Evaluating Immune Infiltration Status in Invasive Thyroid Carcinoma

Development of a Risk Predictive Model for Evaluating Immune Infiltration Status in Invasive Thyroid Carcinoma

Lobo-isthmectomy in the management of differentiated thyroid cancer

The outcome of treatment in differentiated thyroid cancer according to recommendations in current Dutch and American guidelines

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