Int J Thyroidol.  2016 May;9(1):19-28. 10.11106/ijt.2016.9.1.19.

High Serum Levels of Thyroid-Stimulating Hormone and Sustained Weight Gain in Patients with Thyroid Cancer Undergoing Radioiodine Therapy

• Seo HJ
• Chung JK
• Kang KW
• Kim EE
• Cheon GJ
• Paeng JC
• Lee DS
• Park YJ
• Park DJ
• Choe JG

• KMID: 2164912
• DOI: http://doi.org/10.11106/ijt.2016.9.1.19

Abstract

BACKGROUND AND OBJECTIVES
The extent of weight gain and its association with clinical factors in patients undergoing radioiodine therapy for differentiated thyroid cancer remain unclear. We analyzed clinical factors related to sustained weight gain after serum thyroid-stimulating hormone (TSH) stimulation for radioiodine (I-131) therapy.
MATERIALS AND METHODS
The study population included 301 adult patients who underwent total thyroidectomy followed by radioiodine therapy and visited the thyroid clinic regularly. Group 1 received a single radioiodine therapy treatment, while group 2 received multiple radioiodine treatment. Data on transient weight gain, defined as weight gain that resolved (±5%) within 1 year after radioiodine therapy, were collected from medical records. Sustained weight gain was defined as body mass index after treatment (BMI(post)) - BMI before treatment (BMI(pre)) ≥2 kg/m2 more than 1 year following radioiodine therapy. Subjective symptoms were scored by questionnaire. Logistic regression analysis was performed using various clinical and laboratory factors to identify risk factors associated with sustained weight gain.
RESULTS
Two hundred and fifty-nine (86%) patients showed transient weight gain and 23 (8%) patients showed sustained weight gain. TSH at therapy and T4-on TSH differed significantly in all patients and in the patients in group 1 with sustained weight gain. The proportion of patients with basal BMI≥25 kg/m2 in group 1 with sustained weight gain also differed significantly. Univariate analysis revealed that high serum levels of TSH at therapy (≥100 µIU/mL) and hypercholesterolemia were associated with sustained weight gain in group 1. Multivariate analysis showed that TSH at therapy levels ≥100 µIU/mL was associated with sustained weight gain in group 1. Of 283 patients remaining after excluding those with insufficient TSH suppression during follow-up, T4-on TSH levels were lower in the sustained weight gain group compared to those without sustained weight gain. TSH at therapy levels ≥100 µIU/mL were significantly associated with sustained weight gain in multivariate analysis.
CONCLUSION
Most patients (86%) had transient weight gain after TSH at therapy, while 8% of patients showed sustained weight gain. Univariate and multivariate analysis revealed relatively high TSH levels (≥100 µIU/mL) to be a risk factor for patients that received a single dose of radioiodine therapy. Insufficient T4 dose was not associated with sustained weight gain.

Keyword

Radioiodine therapy; I-131; Weight gains; TSH at therapy; Hypercholesterolemia

MeSH Terms

Adult
Body Mass Index
Follow-Up Studies
Humans
Hypercholesterolemia
Logistic Models
Medical Records
Multivariate Analysis
Risk Factors
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Thyrotropin*
Weight Gain*
Thyrotropin

Figure

• 

  Fig. 1. Number of patients with and without sustained weight gain according to subjective symptom scores. Subjective discomfort scores were categorized using a visual analog scale: 1, none; 2, mild; 3, moderate; 4, severe; and 5, extreme discomfort. The numbers of patients with and without sustained weight gain for each score were: 115 vs. 2 (1.7%) in score 1, 42 vs. 4 (8.7%) in score 2, 97 vs. 3 (3%) in score 3, 22 vs. 8 (26.7%) in score 4, and 2 vs. 6 (75%) in score 5.

• 

  Fig. 2. ROC curves for the evaluation TSH cutoff values. (A) The TSH at therapy cutoff value overall was 87.35 μ IU/mL (sensitivity 100 and specificity 27.17). (B) The TSH at therapy cutoff value in group 1 was 100 μIU/mL (sensitivity 100 and specificity 47.54). (C) The T4-on TSH cutoff value overall was 1.73 μIU/mL (sensitivity 30.43 and specificity 82.37). (D) The T4-on TSH cutoff value in group 1 was ＞0.90 μ IU/mL (sensitivity 100 and specificity 27.17).

• 

  Fig. 3. TSH at therapy levels differed significantly between patients in group 1 with (185.8±109.9 μ IU/mL) and without sustained weight gain (112.9±62.4 μIU/mL) (p=0.015). The central box in the plot represents the TSH at therapy values from the lower to upper quartiles (25 to 75 percentiles). The middle line represents the median of stimulated TSH. The horizontal line extends from the minimum to the maximum value, excluding outlier values, which are displayed as separate points.

• 

  Fig. 4. Proportions of sustained weight gain (BMI post− BMI pre≥2 kg/m2) were higher in TSH at therapy levels ≥100 μ IU/mL in group 1, group 2, and overall. The values for the pro-portions of patients in groups 1 and 2 with sustained weight gain for TSH at therapy levels above and below 100 μ IU/mL were 5% and 18%, and 3% and 8%, respectively, and 3% and 10% overall.

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