Journal of Surgery Concepts & Practice >

2023 , Vol. 28 >Issue 06: 507 - 511

DOI: https://doi.org/10.16139/j.1007-9610.2023.06.04

Experts forum

Consensus and controversy in postoperative thyroid stimulating hormone suppression therapy for differentiated thyroid carcinoma

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  • Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Received date: 2023-10-08

  Online published: 2024-03-04

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Abstract

Differentiated thyroid carcinoma (DTC) is the most common thyroid carcinoma, with a generally favorable prognosis for most patients. At present, Surgery, 131I and thyroid stimulating hormone (TSH) suppression are the main therapeutic means among which, TSH suppression therapy plays an important role in the postoperative management of DTC patients, which has the effect of decreasing the risk of recurrence, slowing down the progression of the disease, and improving long-term survival. However, excessive TSH suppression can increase the risk of adverse events in the cardiovascular and skeletal systems. Currently, there is ongoing debate regarding the optimal target range for serum TSH suppression in patients of all types. In clinical practice, it is important to carefully balance the benefits and potential risks of TSH suppression, and to personalize the target range for serum TSH based on dynamic assessments during patient follow-up. This article aimed to discuss the intensity, benefits, and risks of TSH suppression after surgery for DTC patients, as well as the current controversies about this topic.

Key words： Differentiated thyroid carcinoma; Postoperative management; Thyroid stimulating hormone suppression therapy

Cite this article

LIU Jie, XIAN Keyao . Consensus and controversy in postoperative thyroid stimulating hormone suppression therapy for differentiated thyroid carcinoma[J]. Journal of Surgery Concepts & Practice, 2023 , 28(06) : 507 -511 . DOI: 10.16139/j.1007-9610.2023.06.04

References

[1] CHEN D W, LANG B H H, MCLEOD D S A. Thyroid cancer[J]. Lancet, 2016, 388(10061):2783-2795.
[2] 中华医学会内分泌学分会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南(第二版)[J]. 国际内分泌代谢杂志, 2023, 43(2):149-194.
  Endocrinology Branch of the Chinese Medical Association, Thyroid and Metabolic Surgery Group of the Surgery Society of the Chinese Medical Association, Head and Neck Tumor Professional Committee of China Anti-Cancer Association, et al. Diagnosis and treatment guidelines for thyroid nodules and differentiated thyroid cancer (second edition)[J]. Int J Endocrinol Metabolism, 2023, 43(2):149-194.
[3] 赫捷, 李进, 程颖. 中国临床肿瘤学会(CSCO)分化型甲状腺癌诊疗指南2021[J]. 肿瘤预防与治疗, 2021, 34(12):1164-1201.
  HE J, LI J, CHEN Y. Chinese Society of Clinical Onco-logy (CSCO) diagnosis and treatment guidelines for differentiated thyroid cancer 2021[J]. J Cancer Control Treat, 2021, 34(12):1164-1201.
[4] HAUGEN B R, ALEXANDER E K, BIBLE K C, 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[J]. Thyroid, 2016, 26(1):1-133.
[5] HURLEY J R. Historical note: TSH suppression for thyroid cancer[J]. Thyroid, 2011, 21(11):1175-1176.
[6] MAZZAFERRI E L, JHIANG S M. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer[J]. Am J Med, 1994, 97(5):418-428.
[7] 中国抗癌协会甲状腺癌专业委员会. 中国抗癌协会甲状腺癌整合诊治指南(2022精简版)[J]. 中国肿瘤临床, 2023, 50(7):325-330.
  Thyroid Cancer Professional Committee of China Anti-Cancer Association. Integrated diagnosis and treatment guidelines for thyroid cancer of China Anti-Cancer Association (2022 Simplified Edition)[J]. Chin J Clin Oncol, 2023, 50(7):325-330.
[8] 田文, 张浩. 分化型甲状腺癌术后管理中国专家共识(2020版)[J]. 中国实用外科杂志, 2020, 40(9):1021-1028.
  TIAN W, ZHANG H. Chinese expert consensus on postoperative management of differentiated thyroid cancer (2020 edition)[J]. Chin J Pract Surg, 2020, 40(9):1021-1028.
[9] 程若川. 分化型甲状腺癌术后促甲状腺激素抑制治疗现状和思考[J]. 中国实用外科杂志, 2023, 43(4):391-396.
  CHENG R C. Current status and considerations of post-operative thyroid stimulating hormone inhibition therapy for differentiated thyroid cancer[J]. Chin J Pract Surg, 2023, 43(4):391-396.
[10] MING J, ZHU J Q, ZHANG H, et al. A multicenter, prospective study to observe the initial management of patients with differentiated thyroid cancer in China (DTCC study)[J]. BMC Endocr Disord, 2021, 21(1):208.
[11] PRAW S S, BRENT G A. Approach to the patient with a suppressed TSH[J]. J Clin Endocrinol Metab, 2023, 108(2):472-482.
[12] BIONDI B, COOPER D S. Benefits of thyrotropin suppression versus the risks of adverse effects in differentiated thyroid cancer[J]. Thyroid, 2010, 20(2):135-146.
[13] FREUDENTHAL B, WILLIAMS G R. Thyroid stimulating hormone suppression in the long-term follow-up of differentiated thyroid cancer[J]. Clin Oncol (R Coll Radiol), 2017, 29(5):325-328.
[14] GRANI G, RAMUNDO V, VERRIENTI A, et al. Thyroid hormone therapy in differentiated thyroid cancer[J]. Endocrine, 2019, 66(1):43-50.
[15] HEEMSTRA K A, HAMDY N A, ROMIJN J A, et al. The effects of thyrotropin-suppressive therapy on bone metabolism in patients with well-differentiated thyroid carcinoma[J]. Thyroid, 2006, 16(6):583-591.
[16] KU E J, YOO W S, LEE E K, et al. Effect of TSH suppression therapy on bone mineral density in differentiated thyroid cancer: a systematic review and meta-analysis[J]. J Clin Endocrinol Metab, 2021, 106(12):3655-3667.
[17] BIONDI B, COOPER D S. Thyroid hormone suppression therapy[J]. Endocrinol Metab Clin North Am, 2019, 48(1):227-237.
[18] LAMARTINA L, GRANI G, DURANTE C, et al. Follow-up of differentiated thyroid cancer - what should (and what should not) be done[J]. Nat Rev Endocrinol, 2018, 14(9):538-551.
[19] XIA Q, DONG S, BIAN P D, et al. Effects of endocrine therapy on the prognosis of elderly patients after surgery for papillary thyroid carcinoma[J]. Eur Arch Otorhinola-ryngol, 2016, 273(4):1037-1043.
[20] JONKLAAS J, SARLIS N J, LITOFSKY D, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy[J]. Thyroid, 2006, 16(12):1229-1242.
[21] KLUBO-GWIEZDZINSKA J, AUH S, GERSHENGORN M, et al. Association of thyrotropin suppression with survival outcomes in patients with intermediate and high-risk differentiated thyroid cancer[J]. JAMA Netw Open, 2019, 2(2):e187754.
[22] ABIRI A, GOSHTASBI K, TORABI S J, et al. Outcomes and trends of treatments in high-risk differentiated thyroid cancer[J]. Otolaryngol Head Neck Surg, 2023, 168(4):745-753.
[23] COOPER D S, SPECKER B, HO M, et al. Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: results from the National Thyroid Cancer Treatment Cooperative Registry[J]. Thyroid, 1998, 8(9):737-744.
[24] CARHILL A A, LITOFSKY D R, ROSS D S, et al. Long-term outcomes following therapy in differentiated thyroid carcinoma: NTCTCS registry analysis 1987-2012[J]. J Clin Endocrinol Metab, 2015, 100(9):3270-3279.
[25] HOVENS G C, STOKKEL M P, KIEVIT J, et al. Associations of serum thyrotropin concentrations with recurrence and death in differentiated thyroid cancer[J]. J Clin Endocrinol Metab, 2007, 92(7):2610-2615.
[26] SUGITANI I, FUJIMOTO Y. Does postoperative thyrotropin suppression therapy truly decrease recurrence in papi-llary thyroid carcinoma? A randomized controlled trial[J]. J Clin Endocrinol Metab, 2010, 95(10):4576-4583.
[27] PARK S, KIM W G, HAN M, et al. Thyrotropin suppressive therapy for low-risk small thyroid cancer: a propensity score-matched cohort study[J]. Thyroid, 2017, 27(9):1164-1170.
[28] XU S, HUANG Y, HUANG H, et al. Optimal serum thyrotropin level for patients with papillary thyroid carcinoma after lobectomy[J]. Thyroid, 2022, 32(2):138-144.
[29] PARK J H, LEE Y M, LEE Y H, et al. The prognostic value of serum thyroid-stimulating hormone level post-lobectomy in low- and intermediate-risk papillary thyroid carcinoma[J]. J Surg Oncol, 2018, 118(3):390-396.
[30] LEE E K, KANG Y E, PARK Y J, 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[J]. Endocrinol Metab (Seoul), 2021, 36(3):574-581.
[31] ULLMANN T M, PAPALEONTIOU M, SOSA J A. Current controversies in low-risk differentiated thyroid cancer: reducing overtreatment in an era of overdiagnosis[J]. J Clin Endocrinol Metab, 2023, 108(2):271-280.
[32] VERBURG F A, LUSTER M. Thyroid cancer: balancing benefit and risk in TSH management of DTC[J]. Nat Rev Endocrinol, 2018, 14(3):136-137.
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