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Zhang L, Zou G. Role of thyroid ultrasound combined with thyroglobulin in the diagnosis of postoperative recurrence of thyroid cancer. MINERVA ENDOCRINOL 2018; 44:192-198. [PMID: 29442477 DOI: 10.23736/s0391-1977.18.02740-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To study the application value of thyroid ultrasound combined with thyroglobulin (Tg) in the diagnosis of postoperative recurrence of thyroid cancer, so as to provide a reference for clinical practice. METHODS Eighty patients with thyroid cancer who underwent operative treatment for more than 2 times in our hospital from January 2014 to December 2016 were selected as the objects of study. After operation, residual thyroid tissues were removed via131Iodine (131I) treatment, the serum Tg and thyroid globulin antibody (TgAb) were detected, and the cervical ultrasound was performed. At 1 week after 131I treatment, the systemic single photon emission computed tomography (SPECT) was performed. Finally, the application values of serum Tg, TgAb and ultrasound in the diagnosis of postoperative recurrence of thyroid cancer were analyzed. RESULTS The sensitivity, specificity and accuracy of Tg level in detecting of recurrence and metastasis of differentiated thyroid cancer were 78.5%, 73.3% and 77.5%, respectively, and it was difficult to show whether the postoperative recurrence and metastasis of thyroid cancer occurred through the expression level of serum TgAb. Moreover, TgAb in different concentrations had an effect on the diagnosis of metastasis of differentiated thyroid cancer via Tg. When the TgAb level ≥100 IU/mL, the sensitivity, specificity and accuracy of Tg diagnosis were 51.9%, 50.0% and 51.7%, respectively. When the TgAb level <100 IU/mL, the sensitivity, specificity and accuracy of Tg diagnosis were 94.6%, 71.4% and 88.2%, respectively. Besides, the sensitivity, specificity and accuracy of ultrasonic diagnosis of lymphatic metastasis after the treatment of differentiated thyroid cancer were 78.5%, 60.0% and 75.0%, respectively. The sensitivity, specificity and accuracy of ultrasound combined with Tg in the diagnosis of thyroid cancer were 97.4%, 75.0% and 93.6%, respectively. The difference in the metastasis rate of thyroid cancer was not statistically significant between patients with papillary carcinoma and patients with follicular carcinoma after treatment (P>0.05). CONCLUSIONS Thyroid ultrasound combined with Tg is of high clinical value in the diagnosis of postoperative recurrence of thyroid cancer, which can significantly improve the sensitivity, specificity and accuracy of clinical diagnosis. The TgAb level can be detected when Tg is used to monitor the postoperative recurrence and metastasis of thyroid cancer, providing a reference for the clinical prevention and treatment.
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Affiliation(s)
- Li Zhang
- Department of Ultrasonography, Ningbo Fenghua People's Hospital, Ningbo, China
| | - Guilan Zou
- Department of Ultrasonography, Ningbo Medical Center, Lihuili East Hospital, Taipei Medical University, Ningbo Medical Center, Ningbo, China -
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Liu T, Men Q, Su X, Chen W, Zou L, Li Q, Song M, Ouyang D, Chen Y, Li Z, Fu X, Yang A. Downregulated expression of TSHR is associated with distant metastasis in thyroid cancer. Oncol Lett 2017; 14:7506-7512. [PMID: 29344196 DOI: 10.3892/ol.2017.7122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 02/13/2017] [Indexed: 12/16/2022] Open
Abstract
In differentiated thyroid cancer (DTC), the association between thyroid-stimulating hormone receptor (TSHR) and metastasis, and the underlying molecular mechanisms remain unclear. The role of TSHR in the epithelial-mesenchymal transition (EMT) has not yet been reported, to the best of our knowledge. In the present study, the role of TSHR in the distant metastasis of DTC was investigated. TSHR was significantly downregulated in well-differentiated thyroid cancer cells and tissues, and a lack of TSHR promoted thyroid cancer cell invasion and metastasis by inhibiting the EMT of thyroid cancer cells. In addition, the prognostic value of TSHR in thyroid cancer was analyzed. Immunohistochemical analysis of 172 DTC tissues revealed that a lack of expression of TSHR was associated with distant metastasis and a poor survival rate. Multivariate analyses demonstrated that TSHR expression was a significant prognostic factor for distant metastasis and survival time. The results from the present study demonstrated that TSHR inhibits metastasis through regulating EMT in vitro, and that a lack of expression of TSHR is a significant independent factor affecting distant metastasis and poor prognosis in DTC.
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Affiliation(s)
- Tianrun Liu
- Department of Otorhinolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Qianqian Men
- Graceland Medical Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Xuan Su
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Weichao Chen
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Lan Zou
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Qiuli Li
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Ming Song
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Dian Ouyang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Yanfeng Chen
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Zhaoqu Li
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Xiaoyan Fu
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Ankui Yang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
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Fussey JM, Khan H, Ahsan F, Prashant R, Pettit L. Thyroid-stimulating hormone suppression therapy for differentiated thyroid cancer: The role for a combined T3/T4 approach. Head Neck 2017; 39:2567-2572. [PMID: 28960722 DOI: 10.1002/hed.24926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 04/24/2017] [Accepted: 07/17/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In the management of differentiated thyroid carcinoma, surgery with or without postoperative radioiodine, and thyroid-stimulating hormone (TSH) suppression is the standard of care in most patients. Levothyroxine is recommended for long-term TSH suppression. For some patients, this may be difficult to tolerate due to adverse effects, such as impaired cognitive function. METHODS This article reviews the evidence for the role of combination treatment with triiodothyronine (T3) and levothyroxine (T4) in these patients. RESULTS The evidence for combination T3 and T4 treatment comes mainly from studies on hypothyroidism, and research into its use for TSH suppression is limited. CONCLUSION Although the evidence base is not strong, there is a small group of patients who may benefit from combination T3 and T4 treatment due to difficulty tolerating thyroxine. Until further evidence is available, a case-by-case approach is recommended.
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Affiliation(s)
| | - Habib Khan
- Department of Clinical Oncology, The Deansley Centre, Royal Wolverhampton Hospital, Wolverhampton, UK
| | - Farhan Ahsan
- Department of Otolaryngology, The Shrewsbury and Telford NHS Trust, Telford, UK
| | - Ravi Prashant
- Department of Clinical Oncology, The Shrewsbury and Telford NHS Trust, Telford, UK
| | - Laura Pettit
- Department of Clinical Oncology, The Shrewsbury and Telford NHS Trust, Telford, UK
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Park S, Kim WG, Han M, Jeon MJ, Kwon H, Kim M, Sung TY, Kim TY, Kim WB, Hong SJ, Shong YK. Thyrotropin Suppressive Therapy for Low-Risk Small Thyroid Cancer: A Propensity Score-Matched Cohort Study. Thyroid 2017; 27:1164-1170. [PMID: 28699428 DOI: 10.1089/thy.2017.0177] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Thyrotropin (TSH) suppression has improved the clinical outcomes of patients with differentiated thyroid cancer (DTC). However, the efficacy of TSH suppressive therapy (TST) is unclear in patients with low-risk DTC. This study aimed to evaluate the efficacy of TST and optimal TSH levels of patients with low-risk DTC. METHODS This retrospective propensity score-matched cohort study included DTC patients (n = 446) who underwent lobectomy from 2002 to 2008 with or without TST (TST group and No-TST group). Disease-free survival (DFS) and dynamic risk stratification were compared between both groups using serum TSH levels. RESULTS Approximately 74% of TST patients and 11% of No-TST patients had suppressed serum TSH levels (<2 mIU/L). The median follow-up period was 8.6 years. During follow-up, the disease recurred in 10 (2.7%) patients, with no significant difference in DFS between the groups (p = 0.63). The proportion of patients with excellent treatment response was similar between the TST (65.2%) and No-TST (64.4%) groups. Incomplete biochemical response was noted in 17.2% of the TST group patients and 9.4% of the No-TST group patients. No significant difference was observed in the DFS between both groups by comparing serum TSH level (p = 0.57). CONCLUSIONS TST did not improve clinical outcomes, and serum TSH levels were not associated with recurrence in patients with low-risk small DTC. No clinical benefits were shown for TSH suppression in low-risk patients who underwent lobectomy. Thus, levothyroxine is not necessary for patients without evidence of hypothyroidism.
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Affiliation(s)
- Suyeon Park
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Won Gu Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Minkyu Han
- 2 Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Min Ji Jeon
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Hyemi Kwon
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Mijin Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Tae-Yon Sung
- 3 Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Tae Yong Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Won Bae Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Suck Joon Hong
- 3 Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Young Kee Shong
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
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Freudenthal B, Williams G. Thyroid Stimulating Hormone Suppression in the Long-term Follow-up of Differentiated Thyroid Cancer. Clin Oncol (R Coll Radiol) 2017; 29:325-328. [DOI: 10.1016/j.clon.2016.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 01/08/2023]
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Gao M, Ge M, Ji Q, Cheng R, Lu H, Guan H, Gao L, Guo Z, Huang T, Huang X, Li X, Lin Y, Liu Q, Ni X, Pan Y, Qin J, Shan Z, Sun H, Wang X, Xu Z, Yu Y, Zhao D, Zhang N, Zhang S, Zheng Y, Zhu J, Li D, Zheng X, Chinese Association Of Thyroid Oncology Cato Chinese Anti-Cancer Association. 2016 Chinese expert consensus and guidelines for the diagnosis and treatment of papillary thyroid microcarcinoma. Cancer Biol Med 2017; 14:203-211. [PMID: 28948061 PMCID: PMC5570598 DOI: 10.20892/j.issn.2095-3941.2017.0051] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ming Gao
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Minghua Ge
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Qinghai Ji
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Ruochuan Cheng
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Hankui Lu
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Haixia Guan
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Li Gao
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhuming Guo
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Tao Huang
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xiaoming Huang
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xiaoming Li
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Yansong Lin
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Qinjiang Liu
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xin Ni
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Yi Pan
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jianwu Qin
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhongyan Shan
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Hui Sun
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xudong Wang
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhengang Xu
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Yang Yu
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Daiwei Zhao
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Naisong Zhang
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Sheng Zhang
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Ying Zheng
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jingqiang Zhu
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Dapeng Li
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xiangqian Zheng
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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Haugen BR. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: What is new and what has changed? Cancer 2016; 123:372-381. [PMID: 27741354 DOI: 10.1002/cncr.30360] [Citation(s) in RCA: 360] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 01/13/2023]
Abstract
Thyroid nodules are very common, and thyroid cancer is currently the fifth leading cancer diagnosis in women. The American Thyroid Association has led the development and revision of guidelines for the management of patients with thyroid nodules and differentiated thyroid cancer (DTC). The most current revision was published in the January 2016 issue of the journal Thyroid. The current guidelines have 101 recommendations, with 8 figures and 17 tables that are hopefully helpful to those treating patients with thyroid nodules and cancer. The primary goals of the American Thyroid Association Guidelines Task Force were to use the current evidence to guide recommendations and yet be as helpful and practical as possible within the scope and strength of the evidence. The current review focuses on new and significantly revised recommendations that may very well change clinical practice. The author notes 3 new basic principles that have emerged in this guidelines revision: 1) the management of thyroid nodules, including the decision to perform a fine-needle aspiration biopsy as well as follow-up decision making, will be heavily influenced by the newly developed sonographic risk pattern; 2) the long-term management of DTC along with thyroid-stimulating hormone target goals will be heavily influenced by the 4 categories of "response to therapy"; and 3) the management of patients with radioactive iodine-refractory DTC will be divided into 4 basic decision-making groups: patients who should undergo monitoring, patients who should undergo directed therapies, patients who should undergo systemic therapies, and patients who should be offered entry into clinical trials. Cancer 2017;123:372-381. © 2016 American Cancer Society.
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Affiliation(s)
- Bryan R Haugen
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, Colorado
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58
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Ito Y, Oda H, Miyauchi A. Insights and clinical questions about the active surveillance of low-risk papillary thyroid microcarcinomas [Review]. Endocr J 2016; 63:323-8. [PMID: 26632168 DOI: 10.1507/endocrj.ej15-0637] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Over 20 years ago, two Japanese institutions initiated an active surveillance policy for papillary microcarcinomas (PMCs) without high-risk features (such as clinical lymph node and distant metastases) and suspected trachea or recurrent laryngeal nerve invasion. Since the most recent American Thyroid Association (ATA) guidelines adopt active surveillance as a therapy option for low-risk PMCs, the number of institutions worldwide carrying out this policy can be expected to increase. However, before adopting an active surveillance strategy, some important clinical questions must be considered. In this review, conceivable clinical questions with our answers based on the present accumulation of low-risk PMC surveillance data are presented.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
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Colevas AD, Shah MH. Evaluation of patients with disseminated or locoregionally advanced thyroid cancer: a primer for medical oncologists. Am Soc Clin Oncol Educ Book 2016:384-8. [PMID: 24451768 DOI: 10.14694/edbook_am.2012.32.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Historically, patients with thyroid cancers are managed by endocrinologists, surgeons and radiation oncologists. Due to recent progress in this field with advances in treatment of thyroid cancer, medical oncologists are now commonly involved in care of patients with advanced thyroid cancers. In this manuscript, we describe general principles in management of patients with various types of thyroid cancers including differentiated, medullary and anaplastic thyroid cancers.
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Affiliation(s)
- A Dimitrios Colevas
- From the Stanford Cancer Institute, Stanford University, Palo Alto, CA; The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Manisha H Shah
- From the Stanford Cancer Institute, Stanford University, Palo Alto, CA; The Ohio State University Comprehensive Cancer Center, Columbus, OH
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60
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Fröhlich E, Wahl R. MECHANISMS IN ENDOCRINOLOGY: Impact of isolated TSH levels in and out of normal range on different tissues. Eur J Endocrinol 2016; 174:R29-41. [PMID: 26392471 DOI: 10.1530/eje-15-0713] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/18/2015] [Indexed: 12/20/2022]
Abstract
Routine treatment of thyroid cancer (TC) includes long-term suppression of TSH. The necessity of this treatment in low- and intermediate-risk patients as well as the extent of TSH suppression is currently under discussion. A literature search was performed to illustrate the role of TSH in extrathyroidal cells and to identify potential reasons for different effects of exogenously suppressed and endogenously low TSH levels. Although adverse effects of subnormal and supranormal TSH blood levels on heart and brain have not been consistently found, studies show a clear negative effect of suppressed TSH levels on bone mineral density. Experimental data also support an important role of TSH in the immune system. The ability of levothyroxine (l-T4) to regulate TSH levels and triiodothyronine levels in a physiological manner is limited. Reduction of circadian changes in TSH levels, decrease of thyroid hormone-binding proteins, prevention of potential compensatory increases of TSH levels (e.g., in old age), and unresponsiveness of TSH-producing cells to TRH on l-T4 treatment might cause adverse effects of suppressed TSH levels. In view of the adverse effects of aggressive TSH suppression, achieving the suggested levels of TSH between 0.9 and 1 mU/l in the treatment of low-to-intermediate risk TC patients appears justified.
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Affiliation(s)
| | - Richard Wahl
- Center for Medical ResearchMedical University of Graz, Stiftingtalstraße 24, Graz, AustriaInternal Medicine (Department of EndocrinologyMetabolism, Nephrology and Clinical Chemistry), University of Tuebingen, Otfried-Muellerstrasse 10, Tuebingen, Germany
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61
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Ha TK, Kim DW, Park HK, Baek JW, Lee YJ, Park YM, Kim DH, Jung SJ, Ahn KJ. The Effect of Levothyroxine Discontinuation Timing on Postoperative Hypothyroidism after Hemithyroidectomy for Papillary Thyroid Microcarcinoma. Int J Endocrinol 2016; 2016:3240727. [PMID: 27293432 PMCID: PMC4879226 DOI: 10.1155/2016/3240727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/21/2016] [Accepted: 04/24/2016] [Indexed: 11/23/2022] Open
Abstract
Objective. No previous studies regarding the appropriate timing of thyroid hormone discontinuation after hemithyroidectomy have been published. This study aimed to identify the appropriate timing for levothyroxine discontinuation after hemithyroidectomy among patients with papillary thyroid microcarcinoma (PTMC). Methods. This study retrospectively evaluated 304 patients who underwent ≥1 attempt to discontinue levothyroxine after hemithyroidectomy for treating PTMC between January 2008 and December 2013. Fifty-three patients were excluded because of preoperative hypothyroidism or hyperthyroidism, a history of thyroid hormone or antithyroid therapy, no available serological data, or a postoperative follow-up of <24 months. We evaluated the associations of successful levothyroxine discontinuation with patient age, sex, preoperative serological data, underlying thyroid gland histopathology, anteroposterior diameter of the residual thyroid gland, number of discontinuation attempts, and initial discontinuation timing. Results. Among the 251 included patients, 125 patients (49.8%) achieved successful levothyroxine discontinuation during the follow-up period after hemithyroidectomy. There was a significant difference in the outcomes for patients who underwent an initial discontinuation attempt at ≤3 months and ≥4 months after hemithyroidectomy (p < 0.001). There were significant differences in the discontinuation outcomes according to underlying thyroid histopathology (p = 0.001), preoperative thyroid-stimulating hormone levels (p < 0.001), and number of discontinuation attempts (p < 0.001). Conclusions. Among patients with PTMC, the initial levothyroxine discontinuation attempt is recommended at ≥4 months after hemithyroidectomy.
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Affiliation(s)
- Tae Kwun Ha
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Republic of Korea
| | - Dong Wook Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Republic of Korea
- *Dong Wook Kim:
| | - Ha Kyoung Park
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Republic of Korea
| | - Jin Wook Baek
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Republic of Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Republic of Korea
| | - Young Mi Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Republic of Korea
| | - Do Hun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Republic of Korea
| | - Soo Jin Jung
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Republic of Korea
| | - Ki Jung Ahn
- Department of Radiation Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Republic of Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8384] [Impact Index Per Article: 1048.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Dralle H, Machens A, Basa J, Fatourechi V, Franceschi S, Hay ID, Nikiforov YE, Pacini F, Pasieka JL, Sherman SI. Follicular cell-derived thyroid cancer. Nat Rev Dis Primers 2015; 1:15077. [PMID: 27188261 DOI: 10.1038/nrdp.2015.77] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Follicular cell-derived thyroid cancers are derived from the follicular cells in the thyroid gland, which secrete the iodine-containing thyroid hormones. Follicular cell-derived thyroid cancers can be classified into papillary thyroid cancer (80-85%), follicular thyroid cancer (10-15%), poorly differentiated thyroid cancer (<2%) and undifferentiated (anaplastic) thyroid cancer (<2%), and these have an excellent prognosis with the exception of undifferentiated thyroid cancer. The advent and expansion of advanced diagnostic techniques has driven and continues to drive the epidemic of occult papillary thyroid cancer, owing to overdiagnosis of clinically irrelevant nodules. This transformation of the thyroid cancer landscape at molecular and clinical levels calls for the modification of management strategies towards personalized medicine based on individual risk assessment to deliver the most effective but least aggressive treatment. In thyroid cancer surgery, for instance, injuries to structures outside the thyroid gland, such as the recurrent laryngeal nerve in 2-5% of surgeries or the parathyroid glands in 5-10% of surgeries, negatively affect quality of life more than loss of the expendable thyroid gland. Furthermore, the risks associated with radioiodine ablation may outweigh the risks of persistent or recurrent disease and disease-specific mortality. Improvement in the health-related quality of life of survivors of follicular cell-derived thyroid cancer, which is decreased despite the generally favourable outcome, hinges on early tumour detection and minimization of treatment-related sequelae. Future opportunities include more widespread adoption of molecular and clinical risk stratification and identification of actionable targets for individualized therapies.
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Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06097 Halle, Germany
| | - Andreas Machens
- Department of General, Visceral and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06097 Halle, Germany
| | - Johanna Basa
- Division of Surgical Oncology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Vahab Fatourechi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Silvia Franceschi
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Ian D Hay
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Yuri E Nikiforov
- Department of Pathology and Laboratory Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Furio Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Janice L Pasieka
- Division of Surgical Oncology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Steven I Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Wang E, Karedan T, Perez CA. New insights in the treatment of radioiodine refractory differentiated thyroid carcinomas: to lenvatinib and beyond. Anticancer Drugs 2015; 26:689-97. [PMID: 25974026 DOI: 10.1097/cad.0000000000000247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
During the past two decades, several key somatic mutations associated with development and progression of differentiated thyroid cancer (DTC) have been revealed. Historically, the treatment for advanced DTC is challenging after patients become refractory to radioactive iodine. The response to doxorubicin, the only chemotherapy agent approved by the US Food and Drug Administration, is disappointing either as monotherapy or combination therapy. Because of the lack of effective systemic treatment coupled with increased understanding of molecular and cellular pathogenesis, multiple kinase inhibitors (MKIs) as an alternative therapy for the treatment of advanced DTC has generated much interest, enthusiasm, and, most excitingly, promising results. After the encouraging results of these agents in earlier trials, the Food and Drug Administration approved sorafenib for the treatment of locally recurrent, progressive, or metastatic DTC refractory to radioactive iodine treatment based on the results of a multicenter DECISION trial. Sorafenib therefore became the first MKI approved for this indication in more than 20 years. However, even more impressive responses and progression-free survival benefits were seen in the phase III SELECT trial with lenvatinib, giving even higher hopes for the future management of what was considered just a decade ago an orphan disease. Given the role of MKIs, a new era in the treatment of advanced DTC has begun. We review the key therapeutic targets, oncogenic pathways, and promising clinical results of these agents in refractory disease, as well as their roles after failure of first line kinase inhibitors.
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Affiliation(s)
- Emilie Wang
- aFlorida State University College of Medicine Tallahassee, Florida bJames Graham Brown Cancer Center, Department of Medicine, Division of Medical Oncology and Hematology, University of Louisville, Louisville, Kentucky, USA
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Carhill AA, Litofsky DR, Ross DS, Jonklaas J, Cooper DS, Brierley JD, Ladenson PW, Ain KB, Fein HG, Haugen BR, Magner J, Skarulis MC, Steward DL, Xing M, Maxon HR, Sherman SI. Long-Term Outcomes Following Therapy in Differentiated Thyroid Carcinoma: NTCTCS Registry Analysis 1987-2012. J Clin Endocrinol Metab 2015; 100:3270-9. [PMID: 26171797 PMCID: PMC5393522 DOI: 10.1210/jc.2015-1346] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Initial treatments for patients with differentiated thyroid cancer are supported primarily by single-institution, retrospective studies, with limited follow-up and low event rates. We report updated analyses of long-term outcomes after treatment in patients with differentiated thyroid cancer. OBJECTIVE The objective was to examine effects of initial therapies on outcomes. DESIGN/SETTING This was a prospective multi-institutional registry. PATIENTS A total of 4941 patients, median follow-up, 6 years, participated. INTERVENTION Interventions included total/near-total thyroidectomy (T/NTT), postoperative radioiodine (RAI), and thyroid hormone suppression therapy (THST). MAIN OUTCOME MEASURE Main outcome measures were overall survival (OS) and disease-free survival using product limit and proportional hazards analyses. RESULTS Improved OS was noted in NTCTCS stage III patients who received RAI (risk ratio [RR], 0.66; P = .04) and stage IV patients who received both T/NTT and RAI (RR, 0.66 and 0.70; combined P = .049). In all stages, moderate THST (TSH maintained subnormal-normal) was associated with significantly improved OS (RR stages I-IV: 0.13, 0.09, 0.13, 0.33) and disease-free survival (RR stages I-III: 0.52, 0.40, 0.18); no additional survival benefit was achieved with more aggressive THST (TSH maintained undetectable-subnormal). This remained true, even when distant metastatic disease was diagnosed during follow-up. Lower initial stage and moderate THST were independent predictors of improved OS during follow-up years 1-3. CONCLUSIONS We confirm previous findings that T/NTT followed by RAI is associated with benefit in high-risk patients, but not in low-risk patients. In contrast with earlier reports, moderate THST is associated with better outcomes across all stages, and aggressive THST may not be warranted even in patients diagnosed with distant metastatic disease during follow-up. Moderate THST continued at least 3 years after diagnosis may be indicated in high-risk patients.
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Affiliation(s)
- Aubrey A Carhill
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Danielle R Litofsky
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Douglas S Ross
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Jacqueline Jonklaas
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - David S Cooper
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - James D Brierley
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Paul W Ladenson
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Kenneth B Ain
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Henry G Fein
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Bryan R Haugen
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - James Magner
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Monica C Skarulis
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - David L Steward
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Mingxhao Xing
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Harry R Maxon
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Steven I Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
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Klein Hesselink E, Links T. Radioiodine Treatment and Thyroid Hormone Suppression Therapy for Differentiated Thyroid Carcinoma: Adverse Effects Support the Trend toward Less Aggressive Treatment for Low-Risk Patients. Eur Thyroid J 2015; 4:82-92. [PMID: 26279993 PMCID: PMC4521066 DOI: 10.1159/000432397] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/18/2015] [Indexed: 12/18/2022] Open
Abstract
Over the past decades, the incidence of differentiated thyroid carcinoma (DTC) has steadily increased, with especially a growing number of low-risk patients. Whereas DTC used to be treated rather aggressively, it is now acknowledged that aggressive treatment does not affect outcome for low-risk patients and that it can induce adverse effects. In this review an overview of the most clinically relevant adverse effects of radioiodine treatment and thyroid hormone suppression therapy (THST) is presented, and the trend toward less aggressive treatment for low-risk patients is outlined. Salivary gland dysfunction occurs in roughly 30% of patients, and is probably due to the concentration of radioiodine in the salivary glands by the sodium/iodide symporter. Beta radiation from radioiodine can result in sialoadenitis and eventually fibrosis and loss of salivary function. Furthermore, patients can experience bone marrow dysfunction following radioiodine treatment. Although this is in general subclinical and transient, patients that receive very high cumulative radioiodine doses may be at risk for more severe bone marrow dysfunction. THST can induce adverse cardiovascular effects in patients with DTC, such as diastolic and systolic dysfunction, and also adverse vascular and prothrombotic effects have been described. Finally, the effects of THST on bone formation and resorption are outlined; especially postmenopausal women with DTC on THST seem to be at risk of bone loss. In the past years, advances have been made in preventing low-risk patients from being overtreated. Improved biomarkers are still needed to further optimize risk stratification and personalize medicine.
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Affiliation(s)
| | - T.P. Links
- *Prof. Dr. T.P. Links, University of Groningen, University Medical Center Groningen, Department of Endocrinology, HPC AA31, PO Box 30.001, NL-9700 RB Groningen (The Netherlands), E-Mail
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Wang LY, Smith AW, Palmer FL, Tuttle RM, Mahrous A, Nixon IJ, Patel SG, Ganly I, Fagin JA, Boucai L. Thyrotropin suppression increases the risk of osteoporosis without decreasing recurrence in ATA low- and intermediate-risk patients with differentiated thyroid carcinoma. Thyroid 2015; 25:300-7. [PMID: 25386760 PMCID: PMC6916125 DOI: 10.1089/thy.2014.0287] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Levothyroxine suppression of thyrotropin (TSH) is broadly applied to patients with thyroid cancer despite lack of consensus on the optimal TSH concentration necessary to reduce cancer recurrence while minimizing toxicity from subclinical hyperthyroidism. The objectives of this study were to examine the beneficial effects and the cardiac and skeletal toxicity of TSH suppression in well-differentiated thyroid carcinoma (DTC). METHODS A total of 771 patients (569 women) at ATA low or intermediate risk of recurrence, with a mean age of 48±14 years, and undergoing total thyroidectomy at a tertiary care center between 2000 and 2006 were followed for a median of six and a half years. They were divided into a suppressed TSH group (median TSH ≤0.4 mIU/L) and a nonsuppressed group (median TSH >0.4 mIU/L). Structural recurrence of thyroid cancer, postoperative atrial fibrillation (AF), and osteoporosis were examined in the two groups. Osteoporosis was only examined in women. RESULTS A total of 43/771 (5.6%) patients recurred, 29/739 (3.9%) patients were diagnosed with postoperative osteoporosis, and 17/756 (2.3 %) were diagnosed with postoperative AF. Despite similar rates of recurrence (HR 1.02, p=0.956 [CI 0.54-1.91]), patients treated to a median TSH ≤0.4 mIU/L were at increased postoperative risk of a composite outcome of AF and osteoporosis (HR 2.1, p=0.05 [CI 1.001-4.3]) compared to those not suppressed. A differential risk of AF alone (HR 0.78, p=0.63 [CI 0.3-2.1]) was not detected, but postoperative osteoporosis was increased among women with a suppressed TSH compared to those not suppressed (HR 3.5, p=0.023 [CI 1.2-10.2]). The increased risk of postoperative osteoporosis disappeared when the patient's median TSH was maintained around 1 mIU/L. CONCLUSION TSH suppression significantly increases the risk of postoperative osteoporosis without changing tumor recurrence in ATA low- and intermediate-risk patients with DTC. Future interventions should focus on avoiding harm in indolent disease.
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Affiliation(s)
- Laura Y. Wang
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew W. Smith
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Frank L. Palmer
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - R. Michael Tuttle
- Department of Medicine, Division of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Azhar Mahrous
- Department of Medicine, Division of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Iain J. Nixon
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snehal G. Patel
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James A. Fagin
- Department of Medicine, Division of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Boucai
- Department of Medicine, Division of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York
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69
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Do Cao C, Wémeau JL. Risk-benefit ratio for TSH- suppressive Levothyroxine therapy in differentiated thyroid cancer. ANNALES D'ENDOCRINOLOGIE 2015; 76:1S47-52. [DOI: 10.1016/s0003-4266(16)30014-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ebina A, Sugitani I, Fujimoto Y, Yamada K. Risk-adapted management of papillary thyroid carcinoma according to our own risk group classification system: Is thyroid lobectomy the treatment of choice for low-risk patients? Surgery 2014; 156:1579-88; discussion 1588-9. [DOI: 10.1016/j.surg.2014.08.060] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 08/20/2014] [Indexed: 11/25/2022]
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Sugitani I, Fujimoto Y, Yamada K. Association between serum thyrotropin concentration and growth of asymptomatic papillary thyroid microcarcinoma. World J Surg 2014; 38:673-8. [PMID: 24233662 DOI: 10.1007/s00268-013-2335-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thyrotropin (TSH) is a known thyroid growth factor. Several studies have suggested its potential role in carcinogenesis and the progression of differentiated thyroid carcinoma. We have been conducting a prospective trial of nonsurgical observation for asymptomatic papillary thyroid microcarcinoma (PMC) since 1995. The aim of this study was to investigate whether serum TSH concentrations can be used to predict PMC growth. METHODS This study examined 415 asymptomatic PMCs.Three hundred twenty-two patients decided to undergo nonsurgical observation by ultrasonography and were followed for ≥ 2 years. RESULTS After a mean of 6.5 years of observation (range 2-22 years), 25 lesions (6 %) had increased in size, 377(91 %) showed no change and 13 (3 %) had decreased in size. Both baseline TSH and mean TSH during follow-up for PMC that increased in size did not differ significantly from those lesions that were unchanged or decreased in size. Increases in size were seen in 0 of 18 (0 %), 15 of 260(6 %), 10 of 126 (8 %), and 0 of 11 (0 %) for PMCs with baseline TSH <0.50, 0.50-1.99, 2.00-3.99, and ≥ 4.00 mIU/L, respectively. A logistic regression model analyzing the association between baseline TSH and outcome showed an odds ratio of 1.01 (95 % confidence interval [CI], 0.66-1.29). No significant correlations were apparent between mean TSH during follow-up and change in PMC volume (r = 0.019, p = 0.70). CONCLUSIONS No significant association between TSH and tumor progression was verified during the nonsurgical observation trial for PMC. TSH is not a good predictor of PMC growth.
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Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 Suppl 1:1-122. [PMID: 24989897 DOI: 10.1111/cen.12515] [Citation(s) in RCA: 714] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Petros Perros
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
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Abstract
Thyroid hormone deficiency can have important repercussions. Treatment with thyroid hormone in replacement doses is essential in patients with hypothyroidism. In this review, we critically discuss the thyroid hormone formulations that are available and approaches to correct replacement therapy with thyroid hormone in primary and central hypothyroidism in different periods of life such as pregnancy, birth, infancy, childhood, and adolescence as well as in adult patients, the elderly, and in patients with comorbidities. Despite the frequent and long term use of l-T4, several studies have documented frequent under- and overtreatment during replacement therapy in hypothyroid patients. We assess the factors determining l-T4 requirements (sex, age, gender, menstrual status, body weight, and lean body mass), the major causes of failure to achieve optimal serum TSH levels in undertreated patients (poor patient compliance, timing of l-T4 administration, interferences with absorption, gastrointestinal diseases, and drugs), and the adverse consequences of unintentional TSH suppression in overtreated patients. Opinions differ regarding the treatment of mild thyroid hormone deficiency, and we examine the recent evidence favoring treatment of this condition. New data suggesting that combined therapy with T3 and T4 could be indicated in some patients with hypothyroidism are assessed, and the indications for TSH suppression with l-T4 in patients with euthyroid multinodular goiter and in those with differentiated thyroid cancer are reviewed. Lastly, we address the potential use of thyroid hormones or their analogs in obese patients and in severe cardiac diseases, dyslipidemia, and nonthyroidal illnesses.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery (B.B.), University of Naples Federico II, 80131 Naples, Italy; and Washington Hospital Center (L.W.), Washington, D.C. 20010
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McLeod DSA. Thyrotropin in the development and management of differentiated thyroid cancer. Endocrinol Metab Clin North Am 2014; 43:367-83. [PMID: 24891167 DOI: 10.1016/j.ecl.2014.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Thyrotropin (TSH) is the major regulator and growth factor of the thyroid. TSH may be important in the development of human thyroid cancer, with both suggestive animal models and clinical evidence, although definitive proof is still required. Applications for TSH in thyroid cancer management include TSH stimulation of radioiodine uptake, enhancement of biochemical monitoring through thyroglobulin measurement, and long-term suppression of TSH with supraphysiologic levothyroxine. This review synthesizes current knowledge of TSH in both the development and management of differentiated thyroid cancer.
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Affiliation(s)
- Donald S A McLeod
- Department of Internal Medicine & Aged Care, Royal Brisbane & Women's Hospital, Level 3, Dr James Mayne Building, Herston, Queensland 4029, Australia; Department of Endocrinology, Royal Brisbane & Women's Hospital, Level 1, Dr James Mayne Building, Herston, Queensland 4029, Australia; Department of Population Health, QIMR Berghofer Medical Research Institute, Herston Road, Herston, Queensland 4029, Australia.
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Ahn D, Sohn JH, Jeon JH, Jeong JY. Clinical impact of microscopic extrathyroidal extension in patients with papillary thyroid microcarcinoma treated with hemithyroidectomy. J Endocrinol Invest 2014; 37:167-73. [PMID: 24497215 DOI: 10.1007/s40618-013-0025-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/17/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pathologically confirmed microscopic extrathyroidal extension (ETE) is often identified after hemithyroidectomy in patients with papillary thyroid microcarcinoma (PTMC). Without the presence of microscopic ETE, these patients would be optimal candidates for hemithyroidectomy. AIM The present study aimed at evaluating the clinical impact of microscopic ETE on the recurrence of PTMC treated with hemithyroidectomy. SUBJECTS AND METHODS We compared the clinicopathological characteristics and 5-year outcomes for 262 PTMC patients without ETE and 86 with microscopic ETE who were treated with hemithyroidectomy between January 2004 and December 2010. RESULTS The mean tumour size was larger (0.67 vs. 0.54 cm, p < 0.001) and the proportion of tumours measuring ≥0.5 cm was higher (84.9 vs. 66.8 %, p = 0.001) in patients with microscopic ETE as compared with patients without ETE. Occult multifocal disease was more frequent in patients with microscopic ETE than in those without ETE (14.0 vs. 6.5 %, p = 0.030). However, the recurrence rate was not different between the two groups during the mean 55.8-month follow-up period. In addition, univariate and multivariate analyses revealed no meaningful association between recurrence and microscopic ETE in patients with PTMC treated with hemithyroidectomy. CONCLUSIONS Although microscopic ETE was associated with large tumour size and multifocal disease, its clinical impact on disease recurrence was not significant in PTMC patients treated with hemithyroidectomy. Therefore, microscopic ETE identified after hemithyroidectomy would not be an absolute indication for completion thyroidectomy in patients with PTMC.
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Affiliation(s)
- D Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Abstract
The prevalence of papillary thyroid cancer (PTC), particularly of low-risk PTC (MACIS <6), is rising due to the increasingly use of neck imaging techniques, fine-needle aspiration and whole body PET scans. Observational cohort studies carried out in the last two decades suggest that low-risk PTC are being overtreated due to the current management paradigm being built on studies done in the 70s and 80s that still echo in some influential guidelines. With the progressive adoption of total thyroidectomy and central neck dissection as the mainstay of treatment for PTC, and suppressed basal thyroglobulin and neck ultrasound once a year as the essential tools for follow-up, the use of radioiodine ablation, body scans and stimulated thyroglobulin concentrations has become obsolete for the vast majority of patients with low-risk PTC. Future guidelines on the management of differentiated thyroid cancer should discuss separately three different diseases: low-risk PTC, high-risk PTC and follicular cancer.
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Affiliation(s)
- Antonio Sitges-Serra
- a Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain
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Klein Hesselink EN, Klein Hesselink MS, de Bock GH, Gansevoort RT, Bakker SJ, Vredeveld EJ, van der Horst-Schrivers AN, van der Horst IC, Kamphuisen PW, Plukker JT, Links TP, Lefrandt JD. Long-Term Cardiovascular Mortality in Patients With Differentiated Thyroid Carcinoma: An Observational Study. J Clin Oncol 2013; 31:4046-53. [DOI: 10.1200/jco.2013.49.1043] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The primary aim was to study the risk of cardiovascular mortality in patients with differentiated thyroid carcinoma (DTC). Secondary aims were to evaluate all-cause mortality and explore the relation between thyroid-stimulating hormone (TSH; also known as thyrotropin) level and these outcome parameters. Patients and Methods Subjects from two cohorts were retrospectively compared by Cox regression analyses; 524 patients with DTC and 1,572 sex- and age-matched controls from a large population-based study in the same geographic region. Results Mean age plus or minus standard deviation was 49 ± 14 years. Median follow-up was 8.5 years (interquartile range [IQR], 4.1 to 15.9 years) for patients with DTC and 10.5 years (IQR, 9.9 to 10.9 years) for controls. One hundred patients with DTC (19.1%) died, 22 (4.2%) as a result of cardiovascular disease, 39 (7.4%) as a result of DTC, and 39 (7.4%) as a result of other/unknown causes. Eighty-five controls (5.4%) died, 24 (1.5%) as a result of cardiovascular disease and 61 (3.9%) as a result of other/unknown causes. Patients with DTC had an increased risk of cardiovascular and all-cause mortality (hazard ratios [HRs], 3.35 [95% CI, 1.66 to 6.74] and 4.40 [95% CI, 3.15 to 6.14], respectively, adjusted for age, sex, and cardiovascular risk factors). Within the DTC group, TSH level was predictive for cardiovascular mortality; the adjusted HR was 3.08 (95% CI, 1.32 to 7.21) for each 10-fold decrease in geometric mean TSH level. Conclusion The risk of cardiovascular and all-cause mortality is increased in patients with DTC, independent of age, sex, and cardiovascular risk factors. A lower TSH level is associated with increased cardiovascular mortality, supporting the current European Thyroid Association and the American Thyroid Association guidelines of tempering TSH suppression in patients with low risk of cancer recurrence. Furthermore, patients with DTC may benefit from assessment and treatment of cardiovascular risk factors.
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Affiliation(s)
- Esther N. Klein Hesselink
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Geertruida H. de Bock
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ron T. Gansevoort
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan J.L. Bakker
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eline J. Vredeveld
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Iwan C.C. van der Horst
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter W. Kamphuisen
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - John T.M. Plukker
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thera P. Links
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joop D. Lefrandt
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Abstract
In many parts of the world, incidence of papillary thyroid cancer is increasing faster than any other malignancy. Most papillary thyroid cancers that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. Papillary thyroid cancer is a clinical challenge because it is difficult to prove benefit from the traditional therapeutic triad for this disorder (ie, total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid-stimulating hormone with levothyroxine). However, risk of disease recurrence might be reduced by these therapies in a subset of patients with more aggressive disease. In the past decade, professional societies and other groups have established evidence-based clinical practice guidelines for management of papillary thyroid cancer, but these efforts have been made difficult by a paucity of randomised controlled trials. In this review, we summarise epidemiological data for disease incidence, discuss some controversies in disease management, and outline a therapeutic framework founded in the best available medical evidence and existing recommendations from clinical practice guidelines.
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Affiliation(s)
- Donald S A McLeod
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Controversies in the management and followup of differentiated thyroid cancer: beyond the guidelines. J Thyroid Res 2012; 2012:512401. [PMID: 23326756 PMCID: PMC3544283 DOI: 10.1155/2012/512401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/12/2012] [Indexed: 01/21/2023] Open
Abstract
Thyroid cancer is among the most common endocrine malignancies. Genetic and environmental factors play an important role in the pathogenesis of differentiated thyroid cancer. Both have good prognosis but with frequent recurrences. Cancer staging is an essential prognostic part of cancer management. There are multiple controversies in the management and followup of differentiated thyroid cancer. Debate still exists with regard to the optimal surgical approach but trends toward a more conservative approach, such as lobectomy, are being more favored, especially in papillary thyroid cancer, of tumor sizes less than 4 cm, in the absence of other high-risk suggestive features. Survival of patients with well-differentiated thyroid cancer was adversely affected by lymph node metastases. Prophylactic central LN dissection did improve accuracy in staging and decrease postop TG level, but it had no effect on small-sized tumors. Conservative approach was more applied with regard to the need and dose of radioiodine given postoperatively. There have been several advancements in the management of radioiodine resistant advanced differentiated thyroid cancers. Appropriate followup is required based on risk stratification of patients postoperatively. Many studies are still ongoing in order to reach the optimal management and followup of differentiated thyroid cancer.
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Diessl S, Holzberger B, Mäder U, Grelle I, Smit JWA, Buck AK, Reiners C, Verburg FA. Impact of moderate vs stringent TSH suppression on survival in advanced differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2012; 76:586-92. [PMID: 22059804 DOI: 10.1111/j.1365-2265.2011.04272.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess (i) the influence of Thyrotropin (TSH) suppression at a level of <0·1 mU/l and (ii) whether FT3 and FT4 levels have a prognostic significance independently of TSH values with regard to survival in patients with differentiated thyroid carcinoma (DTC) and distant metastases. PATIENTS AND METHODS In a retrospective patient chart study, we reviewed survival in 157 DTC patients with distant metastases treated between September 1985 and 1 July 2010. Patients with at least three available FT3 and FT4 values during TSH suppression were eligible. RESULTS Fifty-three of 157 patients died from DTC. DTC-specific survival was significantly better in patients with a median TSH level ≤0·1 mU/l (median survival 15·8 years) than those with a non-suppressed TSH level (median survival 7·1 years; P < 0·001). However, there was no further improvement in survival caused by TSH suppression to a level ≤ 0·03 mU/l (P = 0·24). FT3 and FT4 levels were also significantly associated with poorer survival; of these, only the prognostic value of FT3 was independent from that of TSH levels. CONCLUSION The care of patients with DTC and distant metastases is like walking an endocrinological tightrope: non-suppressed TSH levels, that is, >0·1 mU/l, are associated with an impaired prognosis. There is, however, no prognostic benefit from suppressing TSH to levels lower than 0·1 mU/l. On the contrary, an improvement in prognosis might be achieved by keeping FT3 levels as low as possible.
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Affiliation(s)
- Stefanie Diessl
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
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Hotomi M, Sugitani I, Toda K, Kawabata K, Fujimoto Y. A Novel Definition of Extrathyroidal Invasion for Patients with Papillary Thyroid Carcinoma for Predicting Prognosis. World J Surg 2012; 36:1231-40. [PMID: 22402972 DOI: 10.1007/s00268-012-1518-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Muneki Hotomi
- Division of Head and Neck, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
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83
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Tratamiento supresor de la TSH en el cáncer diferenciado de tiroides. Un dogma en revisión. ACTA ACUST UNITED AC 2012; 59:125-30. [DOI: 10.1016/j.endonu.2011.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/14/2011] [Accepted: 10/17/2011] [Indexed: 11/24/2022]
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84
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Current trends in TSH suppression therapy for patients with papillary thyroid carcinoma in Japan: results of a questionnaire distributed to councilors of the Japanese Society of Thyroid Surgery. Surg Today 2011; 42:633-8. [DOI: 10.1007/s00595-011-0091-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 05/20/2011] [Indexed: 10/14/2022]
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85
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Effect of postoperative thyrotropin suppressive therapy on bone mineral density in patients with papillary thyroid carcinoma: A prospective controlled study. Surgery 2011; 150:1250-7. [DOI: 10.1016/j.surg.2011.09.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 09/13/2011] [Indexed: 11/17/2022]
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86
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Tanaka K, Sonoo H, Saito W, Ohta Y, Shimo T, Sohda M, Yamamoto Y, Kurebayashi J. Analysis of clinical outcome of patients with poorly differentiated thyroid carcinoma. ISRN ENDOCRINOLOGY 2011; 2011:308029. [PMID: 22363874 PMCID: PMC3262634 DOI: 10.5402/2011/308029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 02/06/2011] [Indexed: 11/23/2022]
Abstract
Background. We retrospectively analyzed whether poor differentiation is the independent prognostic factor for thyroid carcinoma or not. Methods. The subjects were 29 patients with PDTC who were treated between April 1996 and March 2006 to compare with those of well-differentiated papillary carcinoma patients (n = 227). Results. The relapse free (RFS), distant relapse-free survival and cause-specific survival, rates were significantly lower in patients with PDTC (P < .0001, P < .001, and P < .05). After classification into focal (<10%) and diffuse type (over 10%) of PDTC, there were no significant differences in RFS and cause-specific survival due to component type or proportion of poorly differentiated component. On multivariate analysis, poor differentiation (P < .0005, RR = 4.456, 95% CI; 1.953–10.167) and extrathyroidal infiltration (P < .05, RR = 2.898, 95% CI; 1.278–6.572) showed a significant impact on DFS, and poor differentiation (P < .05, RR = 9.343, 1.314–66.453) and age (P < .005, RR = 1.306, 1.103–1.547) significantly impacted cause-specific survival. Conclusion. Poor differentiation was an independent factor for survival. Distant relapse was significantly more common among PDTC patients, and systemic therapy might be warranted.
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Affiliation(s)
- Katsuhiro Tanaka
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
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