Biochemical effects of levothyroxine withdrawal in patients with differentiated thyroid cancer

Papadakis, Georgios; Kalaitzidou, Styliani; Triantafillou, Eleni; Kakava, Kassiani; Drosou, Aspasia; Sapera, Aggeliki; Dogkas, Nikolaos; Παππά, Θεοδώρα; Kaltzidou, Victoria; Villiotou, Vassiliki; Tertipi, Athanasia

doi:10.1530/endoabs.41.ep1106

Cited by 7 publications

(8 citation statements)

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“…To the best of our knowledge, this is the first study to show that normal TSH levels are associated with increased hypercholesterolemia risk in DTC patients receiving levothyroxine after total thyroidectomy. Although changes in the serum lipid levels during thyroxine withdrawal after total thyroidectomy have been assessed in some studies, the risk of hypercholesterolemia during levothyroxine therapy has not been [22,23,24,25]. Owing to the fact that thyroid cancers are detected early these days, leading to a low risk, and that most DTC patients have a favorable clinical course [26], the unsuppressed range of TSH may be applied to many such cases according to current management guidelines [3,4].…”

Section: Discussionmentioning

confidence: 99%

Association between Thyroid-Stimulating Hormone Level after Total Thyroidectomy and Hypercholesterolemia in Female Patients with Differentiated Thyroid Cancer: A Retrospective Study

Lee

Han

et al. 2019

JCM

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Less-intense TSH suppression strategies can be used for differentiated thyroid cancer (DTC) patients with a low recurrence risk, but their metabolic outcomes are not well known. We aimed to evaluate changes in the serum cholesterol levels and the risk of hypercholesterolemia according to postoperative TSH levels in 1092 female DTC patients receiving levothyroxine after total thyroidectomy. The preoperative-to-follow-up change in total cholesterol (TC) levels in the TSH level <0.03, 0.03–0.3, 0.3–2, and 2–5 mIU/L groups was −3.69 mg/dL (p = 0.006), +0.13 mg/dL (p = 0.926), +12.46 mg/dL (p < 0.001), and +16.46 mg/dL (p < 0.001), respectively. When compared with TSH levels of 0.03–0.3 mIU/L, those of 0.3–2 mIU/L were found to be associated with hypercholesterolemia (adjusted odds ratio (AOR) = 1.86 and 5.08 for TC 200–240 and ≥240 vs. <200 mg/dL) and hyper-low-density lipoprotein (LDL)-cholesterolemia (AOR = 2.76 for LDL-cholesterol ≥160 vs. <130 mg/dL). Additionally, TSH levels of 2–5 mIU/dL were associated with hypercholesterolemia (AOR = 2.85 and 6.95 for TC 200–240 and ≥240 vs. <200 mg/dL) and hyper-LDL-cholesterolemia (AOR = 2.08 and 4.17 for LDL-cholesterol 130–159 and ≥160 mg/dL vs. <130 mg/dL). In patients with normal TSH level maintenance following thyroidectomy, TC levels markedly increased, resulting in an increased hypercholesterolemia prevalence. Metabolic derangement risk due to insufficient levothyroxine replacement should be considered in the adoption of less-intense TSH suppression strategies, postoperatively, in DTC patients.

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Section: Discussionmentioning

confidence: 99%

Association between Thyroid-Stimulating Hormone Level after Total Thyroidectomy and Hypercholesterolemia in Female Patients with Differentiated Thyroid Cancer: A Retrospective Study

Lee

Han

et al. 2019

JCM

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“…12 In another large study out of 128 patients with differentiated carcinoma having short term hypothyroidism, 24 (18.8%) had elevated serum creatinine levels whereas in another large study including differentiate thyroid cancer patients, an additional 15% had elevated creatinine during short term iatrogenic hypothyroidism. 5,13 In another small study seven of the 16 patients with primary hypothyroidism had elevated creatinine but all had decreased GFR (<60). Higher rates (55-62.5%) of elevated creatinine have been reported in noniatrogenic severe hypothyroidism which is probably due to prolonged and severe disease.…”

Section: Discussionmentioning

confidence: 97%

“…However, the reports are not consistent and whether hypothyroidism causes hyponatremia is highly debated. 5,6 Few report higher rates of hyponatremia (21%) especially in those with associated elevation of creatinine (45%), whereas others report no or minimal changes in serum sodium levels with severe hypothyroidism. 3,[7][8][9][10][11] It is interesting to know how we started screening all our patients with anasarca and newly-diagnosed renal dysfunction for thyroid dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Evaluate all newly diagnosed mild-moderate renal dysfunction patients for primary hypothyroidism

2016

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Background: Hypothyroidism often presents to nephrologists with elevated serum creatinine which may lead to unnecessary evaluation including renal biopsy. Methods: We retrospectively analysed the data of 24 patients who presented to the department of nephrology at our institute with anasarca/facial puffiness or elevated serum creatinine and diagnosed to have hypothyroidism with TSH >40 µIU/ml. Results: Twelve patients presented with generalised edema, eight patients for evaluation of deranged serum creatinine and four patients with both generalised edema and deranged serum creatinine. Age (r=0.696, p<0.001) and serum thyroid stimulating hormone (r=0.504, p=0.012) had significant positive correlation with serum creatinine whereas serum total thyroxine (r=-0.637, p<0.001) and triiodothyronine (r=-0.728, p<0.001) had significant negative correlation. Serum sodium was lower (<136 mmol/L) in eight patients. Age (r=-0.598, p<0.001), serum creatinine (r=-0.624, p<0.001), and serum thyroid stimulating hormone (r=-0.728, p=0.012) had significant negative correlation with serum sodium whereas serum total thyroxine (r=0.869, p<0.001) and triiodothyronine (r=.845, p<0.001) had significant positive correlation. Serum creatinine and sodium normalised in all after levothyroxine replacement. Conclusions: To conclude, hypothyroidism is not an uncommon cause of mild-moderate renal dysfunction and often presents to nephrologists prompting unnecessary investigations including renal biopsy. Hence, all newly diagnosed mild-moderate renal failure patients should be tested to rule out primary hypothyroidism.

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“…Traditionally, this high level has been achieved by withholding thyroxine therapy for 4-6 weeks after NTT or TT, causing endogenous TSH to rise. 52,53 The resultant hypothyroidism can impact the patients quality of life (QoL) and imbalance of several biochemical parameters especially in the elderly [54][55][56][57][58] A highly purified, recombinant form of the naturally occurring human protein TSH, rhTSH, has been developed and used as an alternative to withholding thyroxine to facilitate RAI ablation. 53,59 It is a highly purified, recombinant form of the naturally occurring human protein TSH (rhTSH), produced by recombinant DNA technology.…”

Section: Sodium Iodine Symporter (Nis) Aided Theranostic Concept In Tmentioning

confidence: 99%

Differentiated thyroid cancer theranostics: radioiodine and beyond

Choudhury

Gupta

2018

The British Journal of Radiology

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clinical presenTaTion of differenTiaTed Thyroid cancer Majority of thyroid cancer patients present with a solitary thyroid nodule which is detected most of the time incidentally. The thyroid nodule can be associated with lymph nodes in the neck. Rarely, it may present as hoarseness of voice or symptoms of distant metastasis at presentation. 1 The first investigation is the ultrasound (USG) of neck which can characterize the solitary nodule as cystic, solid or indeterminate. In addition, the vascularity of the nodule can also be assessed with ultrasonography or scintigraphy. USG is capable of detecting other non-palpable nodules which will also help to ascertain the probability of a benign or malignant outcome. 2-7 iniTial TreaTmenT of differenTiaTed Thyroid cancer Differentiated thyroid cancer (DTC) are the tumors arising from the cells lining the thyroid follicles which includes papillary (PTC), follicular (FTC) and Hurthle cell carcinoma (HTC). It generally excludes the tumors arising from para follicular cells. DTC are the commonest type of thyroid malignancy. In recent years, the incidence of these tumors seems to be rising. 8 While surgical resection has remained the gold-standard for their initial treatment, controversies still exist regarding the extent of surgery because of indolent nature of majority of these tumors. 9-16 The study of various prognostic factors has enabled the endocrine surgeons to develop a risk stratification system in order to arrive at

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Biochemical effects of levothyroxine withdrawal in patients with differentiated thyroid cancer

Cited by 7 publications

References 0 publications

Association between Thyroid-Stimulating Hormone Level after Total Thyroidectomy and Hypercholesterolemia in Female Patients with Differentiated Thyroid Cancer: A Retrospective Study

Association between Thyroid-Stimulating Hormone Level after Total Thyroidectomy and Hypercholesterolemia in Female Patients with Differentiated Thyroid Cancer: A Retrospective Study

Evaluate all newly diagnosed mild-moderate renal dysfunction patients for primary hypothyroidism

Differentiated thyroid cancer theranostics: radioiodine and beyond

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