Long-term treatment-related morbidity in differentiated thyroid cancer: a systematic review of the literature.

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL Pragmatic and Observational Research Pub Date : 2017-05-16 eCollection Date: 2017-01-01 DOI:10.2147/POR.S130510
William Ae Parker, Ovie Edafe, Sabapathy P Balasubramanian
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引用次数: 15

Abstract

Background: Differentiated thyroid cancer (DTC) occurs in relatively young patients and is associated with a good prognosis and long survival. The management of this disease involves thyroidectomy, radioiodine therapy, and long-term thyroid-stimulating hormone suppression therapy (THST). The long-term effects of the treatment and the interaction between subclinical hyperthyroidism and long-term hypoparathyroidism are poorly understood. This review sought to examine the available evidence.

Methods: A PubMed search was carried out using the search terms "Thyroid Neoplasms" AND ("Thyroxine" OR "Hypocalcemia" OR "Thyrotropin"). Original English language articles published in the last 30 years studying the morbidity from thyroid-stimulating hormone (TSH) suppression and hypoparathyroidism following a surgery for DTC were retrieved and reviewed by 2 authors.

Results: Of the 3,000 results, 66 papers including 4,517 patients were selected for the present study. Studies reported on a range of skeletal (included in 34 studies, 1,647 patients), cardiovascular (17 studies, 957 patients), psychological (10 studies, 663 patients), and other outcomes (10 studies, 1,348 patients). Nine of 26 studies on patients who underwent THST showed a reduction in bone density, and 13 of 23 studies showed an increase in bone turnover markers. Skeletal effects were more marked in postmenopausal women. There was no evidence of increased fracture risk, and only little data were available on hypoparathyroidism. Four of five studies showed an increased left ventricular mass index on echocardiography, and one study showed a higher prevalence of atrial fibrillation (AF). There was little difference in basic physiological parameters and limited literature regarding symptoms or significant events. Six studies showed associations between long-term TSH suppression and impaired quality of life. Impaired glucose metabolism and prothrombotic states were also found in DTC patients.

Conclusion: There is limited literature regarding long-term DTC treatment-related morbidity, particularly regarding the effects of long-term hypocalcemia. Most studies have focused on surrogate markers and not on clinical outcomes. A large prospective study on defined clinical outcomes would help characterize the morbidity of treatment and stimulate research on tailoring treatment strategies.

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分化型甲状腺癌的长期治疗相关发病率:文献系统综述
背景:分化型甲状腺癌(DTC)多见于相对年轻的患者,预后良好,生存期长。本病的治疗包括甲状腺切除术、放射性碘治疗和长期促甲状腺激素抑制治疗(THST)。治疗的长期效果以及亚临床甲亢和长期甲状旁腺功能减退之间的相互作用尚不清楚。这篇综述试图审查现有的证据。方法:使用检索词“甲状腺肿瘤”和(“甲状腺素”或“低钙血症”或“促甲状腺素”)进行PubMed检索。2位作者对近30年来发表的关于DTC术后促甲状腺激素(TSH)抑制和甲状旁腺功能低下发病率的英文原文进行了检索和综述。结果:从3000篇研究结果中,选择66篇论文,4517例患者纳入本研究。研究报告了一系列骨骼(34项研究,1647例患者)、心血管(17项研究,957例患者)、心理(10项研究,663例患者)和其他结果(10项研究,1348例患者)。26项对THST患者的研究中有9项显示骨密度降低,23项研究中有13项显示骨转换标志物增加。对骨骼的影响在绝经后妇女中更为明显。没有证据表明骨折风险增加,只有很少的数据可用于甲状旁腺功能低下。五项研究中的四项显示超声心动图显示左心室质量指数增加,一项研究显示心房颤动(AF)的患病率更高。基本生理参数差异不大,有关症状或重大事件的文献有限。六项研究表明长期TSH抑制与生活质量受损之间存在关联。在DTC患者中也发现糖代谢和血栓形成前状态受损。结论:关于长期DTC治疗相关发病率的文献有限,特别是关于长期低钙血症的影响。大多数研究关注的是替代标记物,而不是临床结果。一项针对明确临床结果的大型前瞻性研究将有助于表征治疗的发病率,并刺激对定制治疗策略的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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Pragmatic and Observational Research
Pragmatic and Observational Research MEDICINE, GENERAL & INTERNAL-
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期刊介绍: Pragmatic and Observational Research is an international, peer-reviewed, open-access journal that publishes data from studies designed to closely reflect medical interventions in real-world clinical practice, providing insights beyond classical randomized controlled trials (RCTs). While RCTs maximize internal validity for cause-and-effect relationships, they often represent only specific patient groups. This journal aims to complement such studies by providing data that better mirrors real-world patients and the usage of medicines, thus informing guidelines and enhancing the applicability of research findings across diverse patient populations encountered in everyday clinical practice.
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