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Thyroid hormone therapy in differentiated thyroid cancer
- Source :
- Endocrine. 66:43-50
- Publication Year :
- 2019
- Publisher :
- Springer Science and Business Media LLC, 2019.
-
Abstract
- Surgery-with or without postoperative radioiodine-is the standard of care for most patients with differentiated thyroid carcinoma (DTC). Thyroid hormone replacement therapy is the mainstay of long-term medical management. Patients treated with total thyroidectomy and some who undergo lobectomy alone require thyroid hormone therapy to restore euthyroidism with normal serum thyroid-stimulating hormone (TSH) levels. Because TSH acts as a growth factor for thyroid follicular cells (including those that are neoplastic), it can potentially affect the onset and/or progression of follicular-cell derived thyroid cancer. For this reason, some patients are placed on thyroid hormone therapy at doses that suppress secretion of TSH (suppression therapy). This mini-review looks at the potential benefits and risks of this practice in patients diagnosed with DTC. Aggressive TSH-suppressive therapy is of little or no benefit to the vast majority of patients with DTC. Practice guidelines, therefore, recommend a graded algorithm in which the potential benefits of suppression are weighed against the associated cardiovascular and skeletal risks. Large randomized controlled studies are needed to confirm the presumed oncological benefits of TSH-suppression and its causal role in adverse cardiac, skeletal, and quality of life effects and to assess the efficacy of TSH normalization in reversing or reducing these effects.
- Subjects :
- Oncology
Thyroid Hormones
endocrine system
medicine.medical_specialty
endocrine system diseases
Hormone Replacement Therapy
Endocrinology, Diabetes and Metabolism
medicine.medical_treatment
Levothyroxine
Thyroid-stimulating hormone
Thyrotropin
030209 endocrinology & metabolism
Thyroid carcinoma
03 medical and health sciences
0302 clinical medicine
Endocrinology
Internal medicine
Diabetes mellitus
medicine
Humans
Thyroid Neoplasms
Thyroid cancer
business.industry
Carcinoma
Thyroid
medicine.disease
medicine.anatomical_structure
Differentiated thyroid carcinoma
030220 oncology & carcinogenesis
TSH replacement therapy
TSH suppressive therapy
Hormone therapy
business
hormones, hormone substitutes, and hormone antagonists
Hormone
medicine.drug
Subjects
Details
- ISSN :
- 15590100 and 1355008X
- Volume :
- 66
- Database :
- OpenAIRE
- Journal :
- Endocrine
- Accession number :
- edsair.doi.dedup.....9bbada3ab02f791495599ac868ba4879