Risk of incident circulatory disease in patients treated for differentiated thyroid carcinoma with no history of cardiovascular disease

Abstract

Context The incidence of differentiated thyroid cancer (DTC) is increasing, yet the prognosis is favourable and long‐term survival is expected. Exogenous TSH suppression has been used for many years to prevent DTC recurrence and may be associated with increased risks of circulatory diseases. Design Risks of circulatory disease in patients treated for DTC were compared to randomly matched patients without DTC (controls) up to a 1:5 ratio using age, sex, body mass index (BMI) and smoking as the matching parameters in a population‐based, open cohort study using The Health Improvement Network. Patients A total of 3009 patients treated for DTC with no pre‐existing cardiovascular disease were identified and matched to 11 303 controls, followed up to median of 5 years. Results A total of 1259 incident circulatory events were recorded during the observation period. No difference in the risk of ischaemic heart disease (IHD) (adjusted hazards ratio [aHR]: 1.04, 95% CI: 0.80‐1.36) or heart failure (HF) (aHR: 1.27, 95% CI: 0.89‐1.81) was detected. The risk of atrial fibrillation (AF) and stroke was significantly higher in patients with DTC (aHR: 1.71, 95% CI: 1.36‐2.15 and aHR: 1.34, 95% CI: 1.05‐1.72, respectively). In a sensitivity analysis limited to newly diagnosed patients with DTC, only the risk of AF was consistently elevated (aHR: 1.86, 95% CI: 1.33‐2.60). Conclusions The increased risk of AF in patients who have undergone treatment for DTC but without pre‐existing CVD may warrant periodic screening for this arrhythmia. Whereas no evidence of increased risk of IHD or HF was observed, the increased risk of stroke/TIA warrants further investigation.

The role of cardiovascular assessment in low risk thyroid neoplasm patients: results from a tertiary care center experience

“…A recent study conducted by Toulis et al, on the other hand, proved a higher mortality rate and an higher rate of cerebrovascular events even in those subjects. 15 This study, even without any data about the degree of TSH suppression, seems consistent with the correlation that we observed between TSH suppression class and the incidence of arrhythmic events, even more significant if restricted to those subjects with no previous events.…”

“…Patients in follow up after DTC show an increased risk of cardiovascular events compared to the population with same demographic characteristics with no history of such disease. 6,[15][16][17] In the extensive analysis performed by Pajamaki et al in 2017, a significant prevalence of cardiovascular disease was proven in cancer patients, both for the events in toto and for arrhythmic events. The different incidence between cases and controls was much more evident in the younger subgroups of population (<40, 40-60 yrs), that is those in which the "basal" cardiovascular risk was lower.…”

Pro-Arrhythmic Signaling of Thyroid Hormones and Its Relevance in Subclinical Hyperthyroidism

“…TCA is considered an independent predictor for AF along with well-known AF risk factors [140,154,155]. Notably, the increased risk of AF in patients treated for DTCA but without pre-existing cardiovascular disease may warrant periodic screening for this arrhythmia [156]. This is in line with a recent study indicating that patients with DTCA along with TSH suppression below 0.1 mIU/L have a higher risk of AF [151].…”

Incident atrial fibrillation in patients with differentiated thyroid cancer: a meta-analysis

“…Four studies reported that the risk of incident AF was significantly higher in DTC patients compared to cancer-free controls, adjusted for established risk factors, such as age, hypertension, diabetes and coronary artery disease ( Klein Hesselink et al 2015 , Pajamäki et al 2018 , Suh et al 2019 , Toulis et al 2019 ), whereas another study reported a higher AF prevalence when compared to the general population ( Abonowara et al 2012 ). The sixth study included a cohort of DTC patients with low- and intermediate-risk for recurrence, examining the benefits of TSH suppression and potential skeletal and cardiovascular adverse events ( Wang et al 2015 ).…”