Dataset Information

Association between Thyroid-Stimulating Hormone Level after Total Thyroidectomy and Hypercholesterolemia in Female Patients with Differentiated Thyroid Cancer: A Retrospective Study.

ABSTRACT: Less-intense TSH suppression strategies can be used for differentiated thyroid cancer (DTC) patients with a low recurrence risk, but their metabolic outcomes are not well known. We aimed to evaluate changes in the serum cholesterol levels and the risk of hypercholesterolemia according to postoperative TSH levels in 1092 female DTC patients receiving levothyroxine after total thyroidectomy. The preoperative-to-follow-up change in total cholesterol (TC) levels in the TSH level <0.03, 0.03-0.3, 0.3-2, and 2-5 mIU/L groups was -3.69 mg/dL (p = 0.006), +0.13 mg/dL (p = 0.926), +12.46 mg/dL (p < 0.001), and +16.46 mg/dL (p < 0.001), respectively. When compared with TSH levels of 0.03-0.3 mIU/L, those of 0.3-2 mIU/L were found to be associated with hypercholesterolemia (adjusted odds ratio (AOR) = 1.86 and 5.08 for TC 200-240 and ?240 vs. <200 mg/dL) and hyper-low-density lipoprotein (LDL)-cholesterolemia (AOR = 2.76 for LDL-cholesterol ?160 vs. <130 mg/dL). Additionally, TSH levels of 2-5 mIU/dL were associated with hypercholesterolemia (AOR = 2.85 and 6.95 for TC 200-240 and ?240 vs. <200 mg/dL) and hyper-LDL-cholesterolemia (AOR = 2.08 and 4.17 for LDL-cholesterol 130-159 and ?160 mg/dL vs. <130 mg/dL). In patients with normal TSH level maintenance following thyroidectomy, TC levels markedly increased, resulting in an increased hypercholesterolemia prevalence. Metabolic derangement risk due to insufficient levothyroxine replacement should be considered in the adoption of less-intense TSH suppression strategies, postoperatively, in DTC patients.

SUBMITTER: Lee YK

PROVIDER: S-EPMC6723726 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Association between Thyroid-Stimulating Hormone Level after Total Thyroidectomy and Hypercholesterolemia in Female Patients with Differentiated Thyroid Cancer: A Retrospective Study.

Lee Young Ki YK Lee Hokyou H Han Seunghee S Jung Hyein H Shin Dong Yeob DY Nam Kee-Hyun KH Chung Woong Youn WY Lee Eun Jig EJ

Journal of clinical medicine 20190725 8

Less-intense TSH suppression strategies can be used for differentiated thyroid cancer (DTC) patients with a low recurrence risk, but their metabolic outcomes are not well known. We aimed to evaluate changes in the serum cholesterol levels and the risk of hypercholesterolemia according to postoperative TSH levels in 1092 female DTC patients receiving levothyroxine after total thyroidectomy. The preoperative-to-follow-up change in total cholesterol (TC) levels in the TSH level <0.03, 0.03-0.3, 0.3 ...[more]

PMID: 31349714

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Project description:BackgroundIn an era of rising differentiated thyroid cancer incidence, the rate and impact of neck reoperation may inform the intensity of earlier interventions and surveillance. This study sought to define predictors of neck reoperation and to assess its impact on survival.MethodsUsing the California Cancer Registry linked to the California Office of Statewide Health Planning and Development records, a retrospective cohort study was performed of 24,230 patients with total or near-total thyroidectomy for papillary or follicular thyroid cancer between 1991 and 2008 and follow-up through 2013. The primary outcome was neck reoperation 91 days to 5 years after the initial thyroid surgery. Using logistic and Cox proportional hazards regression, the impact of sociodemographics, tumor staging, and hospital thyroid cancer surgery volume on neck reoperation and survival was determined.ResultsNeck reoperation was identified in 1231 (5.1%) patients in increasing odds from 1991 to 2008. In multivariable models, male sex, papillary thyroid cancer, and advancing tumor stage were associated with neck reoperation. Among men, neck reoperation was associated with Asian/Pacific Islander (odds ratio [OR] = 1.44 [confidence interval (CI) 1.07-1.94]) race/ethnicity. Among women, neck reoperation was associated with younger age (15-34 years; OR = 1.50 [CI 1.17-1.92] versus ≥55 years), and Asian/Pacific Islander (OR = 1.24 [CI 1.02-1.51]) or Hispanic (OR = 1.20 [CI 1.00-1.44]) race/ethnicity. After controlling for baseline characteristics, neck reoperation predicted worse thyroid cancer-specific survival (hazard ratio = 4.26 [CI 3.50-5.19]). The effect differed between men and women, and was most pronounced among women who received radioiodine in initial treatment (hazard ratio = 8.32 [CI 6.14-11.27]).ConclusionsNeck reoperation is becoming increasingly frequent and is strongly predictive of mortality. Advancing tumor stage, Asian/Pacific Islander race/ethnicity, male sex, as well as younger age and Hispanic ethnicity among women predict a higher risk for neck reoperation and subsequent mortality, reflecting a higher risk of persistent or more biologically aggressive disease.

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

Project description:ObjectivesWe assessed thyroid-stimulating hormone (TSH) suppression effects on bone mineral density (BMD) in postmenopausal women who underwent thyroidectomy.Data sourcesPubMed, EMBASE, Cochrane Library, Web of Science and SCOPUS were searched from inception to 24 February 2021.Study selectionCase-control studies were included.Data extraction and synthesisTwo authors independently reviewed the studies, extracted the data and performed meta-analysis of eligible studies.Research design and methodsStudies evaluating BMD in postmenopausal women with thyroid cancer who had thyroidectomy and levothyroxine therapy were included. Differences in BMD were presented as standardised mean differences (SMDs). Meta-analyses were conducted using a random-effects model.ResultsAnalysis of 16 case-control studies (426 patients and 701 controls without thyroid cancer) showed that stringent TSH suppression (TSH <0.10 mIU/L) after thyroidectomy had deleterious effects on the BMD of the lumbar spine in postmenopausal women compared with controls (SMD -0.55; 95% CI -0.99 to -0.10; I2=75.8%). There was no significant difference in patients with moderate TSH suppression (TSH 0.10-0.49 mIU/L). TSH suppression in postmenopausal women was not significantly associated with lower femoral neck BMD. Subgroup analysis of the lumbar spine showed that the association between stringent TSH suppression and lower BMD was consistent among studies with >10 years of follow-up (SMD -0.32; 95% CI -0.50 to -0.14). Subgroup analysis of the femoral neck showed that total thyroidectomy was related to detrimental effects on the BMD of the femoral neck (SMD -0.60; 95% CI -0.89 to -0.31; I2=90.4%), but near-total thyroidectomy was not (SMD 0.00; 95% CI -0.30 to 0.30; I2=55.6%).ConclusionsStringent TSH suppression had deleterious effects on the BMD of the lumbar spine after thyroidectomy in postmenopausal women. Further studies are needed to determine whether stringent TSH suppression after thyroidectomy increases the fracture risk.

Dataset Information

Association between Thyroid-Stimulating Hormone Level after Total Thyroidectomy and Hypercholesterolemia in Female Patients with Differentiated Thyroid Cancer: A Retrospective Study.

Publications

Association between Thyroid-Stimulating Hormone Level after Total Thyroidectomy and Hypercholesterolemia in Female Patients with Differentiated Thyroid Cancer: A Retrospective Study.

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