Abstract
Context
Thyroid dysfunction is associated with an increased risk of cardiovascular disease (CVD) in the general population; however, it remains controversial whether differentiated thyroid cancer (DTC) treatment, including thyroidectomy and thyroid-stimulating hormone suppression, further increases the risk of CVD. This study aimed to evaluate the risk of CVD in patients with DTC.
Evidence acquisition
We performed a review of observational studies on associations between DTC and cardiovascular outcomes, indexed in MEDLINE, EMBASE, and Web of Science. We excluded studies that evaluated CVD as comorbidity before DTC diagnosis and those that used active surveillance without thyroidectomy as an intervention. Risk estimates were pooled using random- and fixed-effects models when three or more studies reported on the outcome of interest. Echocardiographic and hemodynamic parameters were examined.
Evidence synthesis
Eighteen studies were included in the quantitative analysis (193,320 cases with DTC and 225,575 healthy controls). DTC was associated with an increased risk of atrial fibrillation (pooled risk ratio [RR]=1.55 [95% confidence interval: 1.30‒1.84]), coronary artery disease (RR=1.10 [1.00‒1.21]), cerebrovascular accidents (RR=1.15 [1.09‒1.20]), and all-cause mortality (RR=1.95 [1.03‒3.69]). DTC was associated with higher diastolic blood pressure (standardized mean difference [SMD], 0.22 [0.01‒0.42]), heart rate (0.37 [0.17‒0.57]), left ventricular mass index (0.66 [0.45‒0.88]), and interventricular septal thickness (0.91 [0.33‒1.49]) and lower early to late ventricular filling velocities (-0.42 [-0.79‒(-0.05)]), but not with ejection fraction.
Conclusions
Patients with DTC are at an increased risk of atrial fibrillation, CVD, increased heart rate, and left ventricular mass development.
893 Left ventricular mass and transvalvular gradient versus heart rate variability in children with aortic valve stenosis
