Endocrinol Metab.  2015 Sep;30(3):343-351. 10.3803/EnM.2015.30.3.343.

Weight Changes in Patients with Differentiated Thyroid Carcinoma during Postoperative Long-Term Follow-up under Thyroid Stimulating Hormone Suppression

• Sohn SY
• Joung JY
• Cho YY
• Park SM
• Jin SM
• Chung JH
• Kim SW

• KMID: 2407086
• DOI: http://doi.org/10.3803/EnM.2015.30.3.343

Abstract

BACKGROUND
There are limited data about whether patients who receive initial treatment for differentiated thyroid cancer (DTC) gain or lose weight during long-term follow-up under thyroid stimulating hormone (TSH) suppression. This study was aimed to evaluate whether DTC patients under TSH suppression experience long-term weight gain after initial treatment. We also examined the impact of the radioactive iodine ablation therapy (RAIT) preparation method on changes of weight, comparing thyroid hormone withdrawal (THW) and recombinant human TSH (rhTSH).
METHODS
We retrospectively reviewed 700 DTC patients who underwent a total thyroidectomy followed by either RAIT and levothyroxine (T4) replacement or T4 replacement alone. The control group included 350 age-matched patients with benign thyroid nodules followed during same period. Anthropometric data were measured at baseline, 1 to 2 years, and 3 to 4 years after thyroidectomy. Comparisons were made between weight and body mass index (BMI) at baseline and follow-up.
RESULTS
Significant gains in weight and BMI were observed 3 to 4 years after initial treatment for female DTC but not in male patients. These gains among female DTC patients were also significant compared to age-matched control. Women in the THW group gained a significant amount of weight and BMI compared to baseline, while there was no increase in weight or BMI in the rhTSH group. There were no changes in weight and BMI in men according to RAIT preparation methods.
CONCLUSION
Female DTC patients showed significant gains in weight and BMI during long-term follow-up after initial treatment. These changes were seen only in patients who underwent THW for RAIT.

Keyword

Thyroid neoplasms; Body weight; Thyroid hormones; Thyrotropin

MeSH Terms

Body Mass Index
Body Weight
Female
Follow-Up Studies*
Humans
Iodine
Male
Retrospective Studies
Thyroid Gland*
Thyroid Hormones
Thyroid Neoplasms*
Thyroid Nodule
Thyroidectomy
Thyrotropin Alfa
Thyrotropin*
Thyroxine
Weight Gain
Iodine
Thyroid Hormones
Thyrotropin
Thyrotropin Alfa
Thyroxine

Figure

• 

  Fig. 1 Weight gain by age group in female thyroid cancer patients who underwent thyroid hormone withdrawal before radioactive iodine ablation therapy. The values were evaluated with the Tukey post hoc test for group differences. aP<0.01 for group differences, age ≤40 years versus age 51 to 55 years and age >55 years.

Reference

1. Tigas S, Idiculla J, Beckett G, Toft A. Is excessive weight gain after ablative treatment of hyperthyroidism due to inadequate thyroid hormone therapy? Thyroid. 2000; 10:1107–1111. PMID: 11201857.

2. Dale J, Daykin J, Holder R, Sheppard MC, Franklyn JA. Weight gain following treatment of hyperthyroidism. Clin Endocrinol (Oxf). 2001; 55:233–239. PMID: 11531931.

3. Brunova J, Bruna J, Joubert G, Koning M. Weight gain in patients after therapy for hyperthyroidism. S Afr Med J. 2003; 93:529–531. PMID: 12939927.

4. de la Rosa RE, Hennessey JV, Tucci JR. A longitudinal study of changes in body mass index and total body composition after radioiodine treatment for thyrotoxicosis. Thyroid. 1997; 7:401–405. PMID: 9226210.

5. Hoogwerf BJ, Nuttall FQ. Long-term weight regulation in treated hyperthyroid and hypothyroid subjects. Am J Med. 1984; 76:963–970. PMID: 6731468.

6. Weinreb JT, Yang Y, Braunstein GD. Do patients gain weight after thyroidectomy for thyroid cancer? Thyroid. 2011; 21:1339–1342. PMID: 22066475.

7. Polotsky HN, Brokhin M, Omry G, Polotsky AJ, Tuttle RM. Iatrogenic hyperthyroidism does not promote weight loss or prevent ageing-related increases in body mass in thyroid cancer survivors. Clin Endocrinol (Oxf). 2012; 76:582–585. PMID: 22004309.

8. Jonklaas J, Nsouli-Maktabi H. Weight changes in euthyroid patients undergoing thyroidectomy. Thyroid. 2011; 21:1343–1351. PMID: 22066482.

9. Knudsen N, Laurberg P, Rasmussen LB, Bulow I, Perrild H, Ovesen L, et al. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab. 2005; 90:4019–4024. PMID: 15870128.

10. Svare A, Nilsen TI, Bjoro T, Asvold BO, Langhammer A. Serum TSH related to measures of body mass: longitudinal data from the HUNT Study, Norway. Clin Endocrinol (Oxf). 2011; 74:769–775. PMID: 21521278.

11. Fox CS, Pencina MJ, D'Agostino RB, Murabito JM, Seely EW, Pearce EN, et al. Relations of thyroid function to body weight: cross-sectional and longitudinal observations in a community-based sample. Arch Intern Med. 2008; 168:587–592. PMID: 18362250.

12. Zimmermann-Belsing T, Brabant G, Holst JJ, Feldt-Rasmussen U. Circulating leptin and thyroid dysfunction. Eur J Endocrinol. 2003; 149:257–271. PMID: 14514340.

13. Leonhardt U, Ritzel U, Schafer G, Becker W, Ramadori G. Serum leptin levels in hypo- and hyperthyroidism. J Endocrinol. 1998; 157:75–79. PMID: 9614360.

14. Feldt-Rasmussen U. Thyroid and leptin. Thyroid. 2007; 17:413–419. PMID: 17542671.

15. Wolf M, Weigert A, Kreymann G. Body composition and energy expenditure in thyroidectomized patients during short-term hypothyroidism and thyrotropin-suppressive thyroxine therapy. Eur J Endocrinol. 1996; 134:168–173. PMID: 8630514.

16. Jonklaas J, Davidson B, Bhagat S, Soldin SJ. Triiodothyronine levels in athyreotic individuals during levothyroxine therapy. JAMA. 2008; 299:769–777. PMID: 18285588.

17. Escobar-Morreale HF, Obregon MJ, Escobar del Rey F, Morreale de Escobar G. Replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroidism in all tissues, as studied in thyroidectomized rats. J Clin Invest. 1995; 96:2828–2838. PMID: 8675653.

18. Gullo D, Latina A, Frasca F, Le Moli R, Pellegriti G, Vigneri R. Levothyroxine monotherapy cannot guarantee euthyroidism in all athyreotic patients. PLoS One. 2011; 6:e22552. PMID: 21829633.

19. Lovejoy JC. The influence of sex hormones on obesity across the female life span. J Womens Health. 1998; 7:1247–1256. PMID: 9929857.

20. Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab. 2003; 88:2404–2411. PMID: 12788835.

21. Park HA, Park JK, Park SA, Lee JS. Age, menopause, and cardiovascular risk factors among korean middle-aged women: the 2005 Korea National Health and Nutrition Examination Survey. J Womens Health (Larchmt). 2010; 19:869–876. PMID: 20350203.

22. Regalbuto C, Alagona C, Maiorana R, Di Paola R, Cianci M, Alagona G, et al. Acute changes in clinical parameters and thyroid function peripheral markers following L-T4 withdrawal in patients totally thyroidectomized for thyroid cancer. J Endocrinol Invest. 2006; 29:32–40. PMID: 16553031.

23. Shin DY, Kim KJ, Cho Y, Park KH, Hwang S, Chung WY, et al. Body mass index is associated with hypercholesterolemia following thyroid hormone withdrawal in thyroidectomized patients. Int J Endocrinol. 2014; 2014:649016. PMID: 25114682.

24. Chrisoulidou A, Pazaitou-Panayiotou K, Kaprara A, Platoyiannis D, Lafaras C, Boudina M, et al. Effects of thyroxine withdrawal in biochemical parameters and cardiac function and structure in patients with differentiated thyroid cancer. Minerva Endocrinol. 2006; 31:173–178. PMID: 16682940.

25. Reinehr T, Andler W. Thyroid hormones before and after weight loss in obesity. Arch Dis Child. 2002; 87:320–323. PMID: 12244007.

26. Kok P, Roelfsema F, Langendonk JG, Frolich M, Burggraaf J, Meinders AE, et al. High circulating thyrotropin levels in obese women are reduced after body weight loss induced by caloric restriction. J Clin Endocrinol Metab. 2005; 90:4659–4663. PMID: 15914521.

27. Reinehr T, Isa A, de Sousa G, Dieffenbach R, Andler W. Thyroid hormones and their relation to weight status. Horm Res. 2008; 70:51–57. PMID: 18493150.

28. Arterburn D, Ichikawa L, Ludman EJ, Operskalski B, Linde JA, Anderson E, et al. Validity of clinical body weight measures as substitutes for missing data in a randomized trial. Obes Res Clin Pract. 2008; 2:277–281. PMID: 19956347.

29. DiMaria-Ghalili RA. Medical record versus researcher measures of height and weight. Biol Res Nurs. 2006; 8:15–23. PMID: 16766625.