Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Häufige urologisch-sexualmedizinische Themen in der Praxis sind das Thema des MMW-Webinars am 5. Juni von 17.30 bis 19 Uhr. Konkret geht es um die Frage, wann bei Harnwegsinfektionen auf Antibiotika verzichtet werden kann, und um ein Update zur Therapie von Libido- und Potenzstörungen des Mannes. Der dritte Vortrag behandelt sexuell übertragbare Krankheiten. Stellen Sie Ihre Fragen an die Experten und sammeln Sie 2 CME-Punkte. Jetzt gleich anmelden!
Erweiterte Suche
Anmelden
nach oben
Endocrine
Erschienen in: Endocrine 2/2024

12.10.2023 | Review

Differentiated thyroid cancer: a focus on post-operative thyroid hormone replacement and thyrotropin suppression therapy

verfasst von: Benjamin J. Gigliotti, Sina Jasim

Erschienen in: Endocrine | Ausgabe 2/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose

This review focuses on post-operative thyroid hormone replacement and thyrotropin suppression therapy in patients with differentiated thyroid cancer.

Methods

A clinical review.

Results

Differentiated thyroid cancers (DTC), including papillary and follicular thyroid cancers, have an excellent prognosis and their management leverages a unique set of clinical tools arising from homology to the normal thyroid follicular cell. Surgery is the cornerstone of initial management, and post-operative care often requires thyroid hormone replacement therapy, which may be approached with the intent of physiologic normalization or used pharmacologically to suppress TSH as part of a DTC treatment.

Conclusion

Management of DTC and approaches to TSH suppression are tailored to an individual’s risk of DTC recurrence and are adjusted to a patient’s clinical status and comorbidities over time with the goal of mitigating risk and maximizing benefit.
Literatur
1.
M. Pizzato et al. The epidemiological landscape of thyroid cancer worldwide: Globocan estimates for incidence and mortality rates in 2020. Lancet Diabetes Endocrinol. 10(4), 264–272 (2022)PubMedCrossRef
2.
B.R. Haugen et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1), 1–133 (2016)MathSciNetPubMedPubMedCentralCrossRef
3.
L. Davies, H.G. Welch, Current thyroid cancer trends in the United States. JAMA Otolaryngol. Head. Neck Surg. 140(4), 317–322 (2014)PubMedCrossRef
4.
S.H. Nam et al. A comparison of the 7th and 8th editions of the AJCC staging system in terms of predicting recurrence and survival in patients with papillary thyroid carcinoma. Oral. Oncol. 87, 158–164 (2018)PubMedCrossRef
5.
M. Schlumberger, S. Leboulleux, Current practice in patients with differentiated thyroid cancer. Nat. Rev. Endocrinol. 17(3), 176–188 (2021)PubMedCrossRef
6.
R.M. Tuttle et al. Controversies, consensus, and collaboration in the use of (131) I therapy in differentiated thyroid cancer: a joint statement from the American Thyroid Association, the European Association of nuclear medicine, the society of nuclear medicine and molecular imaging, and the European Thyroid Association. Thyroid 29(4), 461–470 (2019)PubMedCrossRef
7.
F. Vaisman et al. Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer. Clin. Endocrinol. (Oxf.) 75(1), 112–119 (2011)PubMedCrossRef
8.
R.M. Tuttle, L. Zhang, A. Shaha, A clinical framework to facilitate selection of patients with differentiated thyroid cancer for active surveillance or less aggressive initial surgical management. Expert Rev. Endocrinol. Metab. 13(2), 77–85 (2018)PubMedPubMedCentralCrossRef
9.
D. De Carlucci Jr et al. Thyroid function after unilateral total lobectomy: risk factors for postoperative hypothyroidism. Arch. Otolaryngol. Head. Neck Surg. 134(10), 1076–1079 (2008)PubMedCrossRef
10.
Z. Li et al. Prevalence of and risk factors for hypothyroidism after hemithyroidectomy: a systematic review and meta-analysis. Endocrine 70(2), 243–255 (2020)PubMedCrossRef
11.
12.
M. Wilson et al. Postoperative thyroid hormone supplementation rates following thyroid lobectomy. Am. J. Surg. 220(5), 1169–1173 (2020)PubMedCrossRef
13.
S. Park et al. Clinical features of early and late postoperative hypothyroidism after lobectomy. J. Clin. Endocrinol. Metab. 102(4), 1317–1324 (2017)PubMedCrossRef
14.
P.R. Larsen, A.M. Zavacki, The role of the iodothyronine deiodinases in the physiology and pathophysiology of thyroid hormone action. Eur. Thyroid J. 1(4), 232–242 (2012)PubMedPubMedCentral
15.
B. Rousset et al. Chapter 2 Thyroid Hormone Synthesis And Secretion, in Endotext, K.R. Feingold, et al., Editors. 2000, MDText.com, Inc. Copyright © 2000-2023, MDText.com, Inc. South Dartmouth (MA)
16.
P. Colucci et al. A review of the pharmacokinetics of levothyroxine for the treatment of hypothyroidism. Eur. Endocrinol. 9(1), 40–47 (2013)PubMedPubMedCentral
17.
E.V. Nagy et al. New formulations of levothyroxine in the treatment of hypothyroidism: trick or treat? Thyroid 31(2), 193–201 (2021)MathSciNetPubMedCrossRef
18.
J. Jonklaas et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid 24(12), 1670–1751 (2014)PubMedPubMedCentralCrossRef
19.
J.G. Watsky, M.A. Koeniger, Prevalence of iatrogenic hyperthyroidism in a community hospital. J. Am. Board Fam. Pr. 11(3), 175–179 (1998)CrossRef
20.
S.K. Krishnan et al. High prevalence of iatrogenic hyperthyroidism in elderly patients with atrial fibrillation in an anticoagulation clinic. Mo Med 108(4), 280–283 (2011)PubMedPubMedCentral
21.
22.
D.J. Halsall, E. English, V.K. Chatterjee, Interference from heterophilic antibodies in TSH assays. Ann. Clin. Biochem. 46(Pt 4), 345–346 (2009)PubMedCrossRef
23.
24.
25.
E.A. McAninch, A.C. Bianco, The swinging pendulum in treatment for hypothyroidism: from (and toward?) combination therapy. Front Endocrinol. (Lausanne) 10, 446 (2019)PubMedCrossRef
26.
27.
J. Jonklaas et al. Evidence-based use of levothyroxine/liothyronine combinations in treating hypothyroidism: a consensus document. Thyroid 31(2), 156–182 (2021)PubMedPubMedCentralCrossRef
28.
M.A. Greer, E.B. Astwood, Treatment of simple goiter with thyroid. J. Clin. Endocrinol. Metab. 13(11), 1312–1331 (1953)PubMedCrossRef
29.
G. Crile Jr, Endocrine dependency of papillary carcinomas of the thyroid. Jama 195(9), 721–724 (1966)PubMedCrossRef
30.
H.W. Balme, Metastatic carcinoma of the thyroid successfully treated with thyroxine. Lancet 263(6816), 812–813 (1954)CrossRef
31.
E.L. Mazzaferri, R.L. Young, Papillary thyroid carcinoma: a 10-year follow-up report of the impact of therapy in 576 patients. Am. J. Med. 70(3), 511–518 (1981)PubMedCrossRef
32.
E.L. Mazzaferri et al. Papillary thyroid carcinoma: the impact of therapy in 576 patients. Med. (Baltim.) 56(3), 171–196 (1977)CrossRef
33.
N.J. McGriff et al. Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann. Med. 34(7-8), 554–564 (2002)PubMedCrossRef
34.
B. Biondi, D.S. Cooper, Thyroid hormone suppression therapy. Endocrinol. Metab. Clin. North Am. 48(1), 227–237 (2019)PubMedCrossRef
35.
B. Biondi et al. Cardiac effects of long-term thyrotropin-suppressive therapy with levothyroxine. J. Clin. Endocrinol. Metab. 77(2), 334–338 (1993)PubMed
36.
E.N. Klein Hesselink et al. Increased risk of atrial fibrillation after treatment for differentiated thyroid carcinoma. J. Clin. Endocrinol. Metab. 100(12), 4563–4569 (2015)PubMedCrossRef
37.
N. Pajamaki et al. Long-term cardiovascular morbidity and mortality in patients treated for differentiated thyroid cancer. Clin. Endocrinol. (Oxf.) 88(2), 303–310 (2018)PubMedCrossRef
38.
A. Abonowara et al. Prevalence of atrial fibrillation in patients taking TSH suppression therapy for management of thyroid cancer. Clin. Invest. Med. 35(3), E152–E156 (2012)PubMedCrossRef
39.
E.N. Klein Hesselink et al. Long-term cardiovascular mortality in patients with differentiated thyroid carcinoma: an observational study. J. Clin. Oncol. 31(32), 4046–4053 (2013)PubMedCrossRef
40.
K.A. Heemstra et al. The effects of thyrotropin-suppressive therapy on bone metabolism in patients with well-differentiated thyroid carcinoma. Thyroid 16(6), 583–591 (2006)PubMedCrossRef
41.
42.
43.
S. Tagay et al. Health-related quality of life, anxiety and depression in thyroid cancer patients under short-term hypothyroidism and TSH-suppressive levothyroxine treatment. Eur. J. Endocrinol. 153(6), 755–763 (2005)PubMedCrossRef
44.
M.H. Samuels et al. The effects of levothyroxine replacement or suppressive therapy on health status, mood, and cognition. J. Clin. Endocrinol. Metab. 99(3), 843–851 (2014)PubMedPubMedCentralCrossRef
45.
S. Diessl et al. Impact of moderate vs stringent TSH suppression on survival in advanced differentiated thyroid carcinoma. Clin. Endocrinol. (Oxf.) 76(4), 586–592 (2012)PubMedCrossRef
46.
S. Leboulleux et al. Thyroidectomy without radioiodine in patients with low-risk thyroid cancer. N. Engl. J. Med. 386(10), 923–932 (2022)PubMedCrossRef
47.
A.A. Carhill et al. Long-term outcomes following therapy in differentiated thyroid carcinoma: NTCTCS registry analysis 1987–2012. J. Clin. Endocrinol. Metab. 100(9), 3270–3279 (2015)PubMedPubMedCentralCrossRef
48.
G.C. Hovens et al. Associations of serum thyrotropin concentrations with recurrence and death in differentiated thyroid cancer. J. Clin. Endocrinol. Metab. 92(7), 2610–2615 (2007)PubMedCrossRef
49.
L. Bischoff, M.R. Haymart, Optimal thyrotropin following lobectomy for papillary thyroid cancer: does it exist? Thyroid 32(2), 117–118 (2022)PubMedCrossRef
50.
M.A. Schumm et al. Frequency of thyroid hormone replacement after lobectomy for differentiated thyroid cancer. Endocr. Pr. 27(7), 691–697 (2021)CrossRef
51.
J.H. Park et al. The prognostic value of serum thyroid-stimulating hormone level post-lobectomy in low- and intermediate-risk papillary thyroid carcinoma. J. Surgical Oncol. 118(3), 390–396 (2018)CrossRef
52.
S. Xu et al. Optimal serum thyrotropin level for patients with papillary thyroid carcinoma after lobectomy. Thyroid 32(2), 138–144 (2022)MathSciNetPubMedCrossRef
53.
M.C. Lee et al. Postoperative thyroid-stimulating hormone levels did not affect recurrence after thyroid lobectomy in patients with papillary thyroid cancer. Endocrinol. Metab. (Seoul.) 34(2), 150–157 (2019)PubMedCrossRef
54.
E.K. Lee et al. A multicenter, randomized, controlled trial for assessing the usefulness of suppressing thyroid stimulating hormone target levels after thyroid lobectomy in low to intermediate risk thyroid cancer patients (MASTER): a study protocol. Endocrinol. Metab. (Seoul.) 36(3), 574–581 (2021)PubMedCrossRef
55.
H.I. Kim et al. Effect of TSH levels during active surveillance of PTMC according to age. Endocr. Relat. Cancer 29(4), 191–200 (2022)MathSciNetPubMedCrossRef
56.
I. Sugitani, Y. Fujimoto, K. Yamada, Association between serum thyrotropin concentration and growth of asymptomatic papillary thyroid microcarcinoma. World J. Surg. 38(3), 673–678 (2014)PubMedCrossRef
57.
Y. Ito et al. Thyroid-stimulating hormone, age, and tumor size are risk factors for progression during active surveillance of low-risk papillary thyroid microcarcinoma in adults. World J. Surg. 47(2), 392–401 (2023)PubMedCrossRef
58.
H.I. Kim et al. High serum TSH level is associated with progression of papillary thyroid microcarcinoma during active surveillance. J. Clin. Endocrinol. Metab. 103(2), 446–451 (2018)PubMedCrossRef
59.
M. Yamamoto, A. Miyauchi, Y. Ito, M. Fujishima, T. Sasaki, T. Kudo, Active Surveillance Outcomes of Patients with Low-Risk Papillary Thyroid Microcarcinoma According to Levothyroxine Treatment Status. Thyroid. 2023. https://​doi.​org/​10.​1089/​thy.​2023.​0046. Epub ahead of print
60.
A. Matrone et al. Postoperative thyroglobulin and neck ultrasound in the risk restratification and decision to perform 131I ablation. J. Clin. Endocrinol. Metab. 102(3), 893–902 (2017)PubMed
61.
M. Mujammami et al. Long-term outcomes of patients with papillary thyroid cancer undergoing remnant ablation with 30 milliCuries radioiodine. Thyroid 26(7), 951–958 (2016)PubMedCrossRef
62.
R. Forleo et al. Minimal extrathyroidal extension in predicting 1-year outcomes: a longitudinal multicenter study of low-to-intermediate-risk papillary thyroid carcinoma (ITCO#4). Thyroid 31(12), 1814–1821 (2021)PubMedCrossRef
63.
V. Harries et al. Does macroscopic extrathyroidal extension to the strap muscles alone affect survival in papillary thyroid carcinoma? Surgery 171(5), 1341–1347 (2022)PubMedCrossRef
64.
H. Kim, H. Kwon, B.I. Moon, Association of multifocality with prognosis of papillary thyroid carcinoma: a systematic review and meta-analysis. JAMA Otolaryngol. Head. Neck Surg. 147(10), 847–854 (2021)PubMedCrossRef
65.
Z.F. Khan et al. Margin positivity and survival outcomes: a review of 14,471 patients with 1-cm to 4-cm papillary thyroid carcinoma. J. Am. Coll. Surg. 232(4), 545–550 (2021)PubMedCrossRef
66.
Y. Tao et al. BRAF V600E status sharply differentiates lymph node metastasis-associated mortality risk in papillary thyroid cancer. J. Clin. Endocrinol. Metab. 106(11), 3228–3238 (2021)PubMedPubMedCentralCrossRef
67.
M. Papaleontiou et al. Thyrotropin suppression for papillary thyroid cancer: a physician survey study. Thyroid, 2021.
Metadaten
Titel
Differentiated thyroid cancer: a focus on post-operative thyroid hormone replacement and thyrotropin suppression therapy
verfasst von
Benjamin J. Gigliotti
Sina Jasim
Publikationsdatum
12.10.2023
Verlag
Springer US
Erschienen in
Endocrine / Ausgabe 2/2024
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-023-03548-8

Weitere Artikel der Ausgabe 2/2024

Endocrine 2/2024 Zur Ausgabe

Original Article

Does gamma-glutamyltransferase correlate with liver tumor burden in neuroendocrine tumors?

Original Article

The mystery of transient pregnancy-induced cushing’s syndrome: a case report and literature review highlighting GNAS somatic mutations and LHCGR overexpression

Original Article

A role of NR4A2 in Graves’ disease: regulation of Th17/Treg

Original Article

Weight loss response in patients with obesity treated with injectable semaglutide in a real-world setting

Original Article

A cadaveric anatomical study of the adrenals: vascular relationship

Brief report

Increased anxiety and emotional lability in a patient with SDHB gene mutation paraganglioma: a call to multidisciplinary approach

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

29.05.2024 Larynxkarzinom Nachrichten

Fast ein Viertel der Personen mit mäßig dysplastischen Stimmlippenläsionen entwickelt einen Kehlkopftumor. Solche Personen benötigen daher eine besonders enge ärztliche Überwachung.

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

29.05.2024 Herzinfarkt Nachrichten

Bei Menschen mit Typ-2-Diabetes sind die Chancen, einen Myokardinfarkt zu überleben, in den letzten 15 Jahren deutlich gestiegen – nicht jedoch bei Betroffenen mit Typ 1.

15% bedauern gewählte Blasenkrebs-Therapie

29.05.2024 Urothelkarzinom Nachrichten

Ob Patienten und Patientinnen mit neu diagnostiziertem Blasenkrebs ein Jahr später Bedauern über die Therapieentscheidung empfinden, wird einer Studie aus England zufolge von der Radikalität und dem Erfolg des Eingriffs beeinflusst.

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise