Suyeon Park1, Won Gu Kim1, Minkyu Han2, Min Ji Jeon1, Hyemi Kwon1, Mijin Kim1, Tae-Yon Sung3, Tae Yong Kim1, Won Bae Kim1, Suck Joon Hong3, Young Kee Shong1. 1. 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea. 2. 2 Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea. 3. 3 Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
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.
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 TSTpatients and 11% of No-TSTpatients 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 grouppatients. 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.
Authors: Maria Papaleontiou; Debbie W Chen; Mousumi Banerjee; David Reyes-Gastelum; Ann S Hamilton; Kevin C Ward; Megan R Haymart Journal: Thyroid Date: 2021-04-23 Impact factor: 6.506
Authors: Yu-Mi Lee; Min Ji Jeon; Won Woong Kim; Tae-Yon Sung; Ki-Wook Chung; Young Kee Shong; Suck Joon Hong Journal: J Clin Med Date: 2019-08-22 Impact factor: 4.241
Authors: Eun Kyung Lee; Yea Eun Kang; Young Joo Park; Bon Seok Koo; Ki-Wook Chung; Eu Jeong Ku; Ho-Ryun Won; Won Sang Yoo; Eonju Jeon; Se Hyun Paek; Yong Sang Lee; Dong Mee Lim; Yong Joon Suh; Ha Kyoung Park; Hyo-Jeong Kim; Bo Hyun Kim; Mijin Kim; Sun Wook Kim; Ka Hee Yi; Sue K Park; Eun-Jae Jung; June Young Choi; Ja Seong Bae; Joon Hwa Hong; Kee-Hyun Nam; Young Ki Lee; Hyeong Won Yu; Sujeong Go; Young Mi Kang Journal: Endocrinol Metab (Seoul) Date: 2021-05-26