OBJECTIVE: The relation between serum TSH levels and risk for recurrence or thyroid carcinoma-related death in patients with differentiated thyroid carcinoma has only been studied to a limited extent. DESIGN: We conducted a single-center observational study in 366 consecutive patients with differentiated thyroid carcinoma, who had all been treated according to the same protocol for initial therapy and follow-up. Median duration of follow-up was 8.85 yr. METHODS: The relation between summarizing variables of unstimulated serum TSH concentrations (25th, 50th, and 75th percentiles, the percentage of suppressed and unsuppressed TSH values) and risk for recurrence or thyroid carcinoma-related death was analyzed by Cox survival analyses in patients with at least four TSH measurements. RESULTS: In Cox regression analysis, we found a positive association between serum TSH concentrations and risk for thyroid carcinoma-related death and relapse, even in initially cured patients. The median of the individual TSH concentrations was the best indicator for thyroid carcinoma-related death (hazard ratio 2.03; confidence interval 1.22-3.37) and relapse (hazard ratio 1.41; confidence interval 1.03-1.95). A threshold of 2 mU/liter differentiated best between relapse-free survival and thyroid carcinoma-related death or relapse. CONCLUSION: Our study supports current guidelines, which advise to aim at TSH levels in the low normal range in cured low-risk patients, whereas TSH levels should be suppressed in noncured or high-risk patients.
OBJECTIVE: The relation between serum TSH levels and risk for recurrence or thyroid carcinoma-related death in patients with differentiated thyroid carcinoma has only been studied to a limited extent. DESIGN: We conducted a single-center observational study in 366 consecutive patients with differentiated thyroid carcinoma, who had all been treated according to the same protocol for initial therapy and follow-up. Median duration of follow-up was 8.85 yr. METHODS: The relation between summarizing variables of unstimulated serum TSH concentrations (25th, 50th, and 75th percentiles, the percentage of suppressed and unsuppressed TSH values) and risk for recurrence or thyroid carcinoma-related death was analyzed by Cox survival analyses in patients with at least four TSH measurements. RESULTS: In Cox regression analysis, we found a positive association between serum TSH concentrations and risk for thyroid carcinoma-related death and relapse, even in initially cured patients. The median of the individual TSH concentrations was the best indicator for thyroid carcinoma-related death (hazard ratio 2.03; confidence interval 1.22-3.37) and relapse (hazard ratio 1.41; confidence interval 1.03-1.95). A threshold of 2 mU/liter differentiated best between relapse-free survival and thyroid carcinoma-related death or relapse. CONCLUSION: Our study supports current guidelines, which advise to aim at TSH levels in the low normal range in cured low-risk patients, whereas TSH levels should be suppressed in noncured or high-risk patients.
Authors: Aubrey A Carhill; Danielle R Litofsky; Douglas S Ross; Jacqueline Jonklaas; David S Cooper; James D Brierley; Paul W Ladenson; Kenneth B Ain; Henry G Fein; Bryan R Haugen; James Magner; Monica C Skarulis; David L Steward; Mingxhao Xing; Harry R Maxon; Steven I Sherman Journal: J Clin Endocrinol Metab Date: 2015-07-14 Impact factor: 5.958
Authors: Karla Duccini; Marcus Vinicius Leitão de Souza; Ricardo Delfim; Ana Paula Aguiar; Patricia Teixeira; Mario Vaisman Journal: Med Princ Pract Date: 2018-03-07 Impact factor: 1.927
Authors: Bryan R Haugen; Erik K Alexander; Keith C Bible; Gerard M Doherty; Susan J Mandel; Yuri E Nikiforov; Furio Pacini; Gregory W Randolph; Anna M Sawka; Martin Schlumberger; Kathryn G Schuff; Steven I Sherman; Julie Ann Sosa; David L Steward; R Michael Tuttle; Leonard Wartofsky Journal: Thyroid Date: 2016-01 Impact factor: 6.568