CQ49. Does TSH Suppression Therapy After Surgery for Differentiated Thyroid Carcinoma Improve Survival?

AbstractBackground: The aim of this prospective study was to assess the effect of the TSH suppression on both disease-free and overall survivals in patients with nonmetastatic differentiated thyroid cancer (DTC) after total thyroidectomy.Patients & Methods: One hundred and forty eight patients with pathologically proved operable differentiated thyroid carcinoma were enrolled in this prospective study. Levothyroxin (L-T4) therapy was started in doses according to treatment groups. Patients were randomly assigned to receive either postoperative TSH suppression therapy in group I (76 patients) or nonsuppression therapy in group II (72 patients).Results: During the period of follow up with a median 54 months, the disease-free survival for patients without TSH suppression therapy did not reach statistically significant difference comparing with those for patients with the suppression therapy (p=0.09). However, the difference was statistically significant for high-risk patients (p=0.04). On comparing both groups there was no statistically significant difference with regard to overall survival (p=0.17). The age of the patients more than 45 years, tumour size more than 4 cm and high-risk group were significant independent predictors for thyroid carcinoma-related relapse in univariate analysis. However, tumour size was the only significant factor in multivariate analysis.Conclusion: Suppressive treatment with L-T4 therapy in patients with differentiated thyroid carcinoma should be individualised and balanced against the adverse effects. TSH suppression is indicated in patients with high-risk disease or recurrent tumour. Normalisation of serum TSH is preferred for long-term treatment of disease-free elderly patients with DTC and comorbidities.

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TSH Threshold Related to Lower Bone Mineral Density in Postmenopausal Patients Under TSH Suppression Therapy for Differentiated Thyroid Carcinoma

Journal of Clinical Densitometry ◽

10.1016/j.jocd.2015.05.057 ◽

2015 ◽

Vol 18 (3) ◽

pp. 441

Author(s):

Aline Farias ◽

Ludmila Almeida ◽

T.G. Melo ◽

L.V.M. Assumpção ◽

Allan Santos ◽

...

Keyword(s):

Bone Mineral Density ◽

Thyroid Carcinoma ◽

Bone Mineral ◽

Differentiated Thyroid Carcinoma ◽

Lower Bone Mineral Density ◽

Mineral Density ◽

Tsh Suppression ◽

Tsh Suppression Therapy

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Thyroid-stimulating hormone (TSH) suppression in differentiated thyroid carcinoma: Combined treatment with triiodothyronine and thyroxine

European Journal of Cancer ◽

10.1016/0959-8049(94)00428-8 ◽

1994 ◽

Vol 30 (14) ◽

pp. 2184-2185 ◽

Cited By ~ 2

Author(s):

C.L. Maini ◽

R. Sciuto ◽

A. Tofani ◽

I. Rosito ◽

G. Franciotti ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Combined Treatment ◽

Differentiated Thyroid Carcinoma ◽

Thyroid Stimulating Hormone ◽

Tsh Suppression ◽

Stimulating Hormone

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Recurrence of Differentiated Thyroid Carcinoma During Full TSH Suppression: Is the Tumor Now Thyroid Hormone Dependent?

Hormones and Cancer ◽

10.1007/s12672-014-0204-z ◽

2014 ◽

Vol 6 (1) ◽

pp. 7-12 ◽

Cited By ~ 11

Author(s):

Paul J. Davis ◽

Aleck Hercbergs ◽

Mary K. Luidens ◽

Hung-Yun Lin

Keyword(s):

Thyroid Hormone ◽

Thyroid Carcinoma ◽

Differentiated Thyroid Carcinoma ◽

Tsh Suppression

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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

Surgery Today ◽

10.1007/s00595-011-0091-7 ◽

2011 ◽

Vol 42 (7) ◽

pp. 633-638 ◽

Cited By ~ 4

Author(s):

Katsuhiro Tanaka ◽

Hiroshi Sonoo

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Thyroid Surgery ◽

Japanese Society ◽

Papillary Thyroid ◽

Tsh Suppression ◽

Current Trends ◽

Tsh Suppression Therapy

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Recombinant Human Thyrotropin Stimulation of Fluoro-d-Glucose Positron Emission Tomography Uptake in Well-Differentiated Thyroid Carcinoma

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2003-031027 ◽

2004 ◽

Vol 89 (1) ◽

pp. 91-95 ◽

Cited By ~ 133

Author(s):

Bennett B. Chin ◽

Pavni Patel ◽

Christian Cohade ◽

Marge Ewertz ◽

Richard Wahl ◽

...

Keyword(s):

Positron Emission Tomography ◽

Thyroid Carcinoma ◽

Fdg Pet ◽

Residual Disease ◽

Differentiated Thyroid Carcinoma ◽

Emission Tomography ◽

Tsh Suppression ◽

Positron Emission ◽

Well Differentiated ◽

Recombinant Human Thyrotropin

TSH stimulates thyrocyte metabolism, glucose transport, and glycolysis. 2-Deoxy-2-[18F]fluoro-d-glucose (FDG) is a glucose analog used in positron emission tomography (PET) to detect occult well-differentiated thyroid carcinoma. The objective of this study was to examine the effects of recombinant human TSH (rTSH) on FDG PET uptake in patients with residual or recurrent disease. Seven patients with well-differentiated thyroid carcinoma, negative 131-I scintigraphy, and biochemical evidence of residual disease were randomized and prospectively studied with FDG PET both on thyroid hormone suppression and rTSH stimulation within 1 wk. All lesions seen on the TSH suppression scans were seen on the rTSH stimulation studies. rTSH stimulation studies identified four additional lesions not seen on TSH suppression. One patient was positive on rTSH stimulation alone. The mean (2.54 ± 0.72 vs. 1.79 ± 0.88) and maximum (2.49 ± 0.95 vs. 1.74 ± 0.81) lesion to background ratios were significantly higher with rTSH stimulation, compared with TSH suppression (P = 0.02 for both). rTSH stimulation improves the detectability of occult thyroid metastases with FDG PET, compared with scans performed on TSH suppression.

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