Endocrinol Metab.  2019 Jun;34(2):150-157. 10.3803/EnM.2019.34.2.150.

Postoperative Thyroid-Stimulating Hormone Levels Did Not Affect Recurrence after Thyroid Lobectomy in Patients with Papillary Thyroid Cancer

Affiliations
  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea.
  • 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. chorong24@gmail.com
  • 3Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea. hoonsung80@gmail.com

Abstract

BACKGROUND
Thyroid-stimulating hormone (TSH) suppression is recommended for patients who undergo thyroidectomy for differentiated thyroid cancer (DTC). However, the impact of TSH suppression on clinical outcomes in low-risk DTC remains uncertain. Therefore, we investigated the effects of postoperative TSH levels on recurrence in patients with low-risk DTC after thyroid lobectomy.
METHODS
Patients (n=1,528) who underwent thyroid lobectomy for papillary thyroid carcinoma between 2000 and 2012 were included in this study. According to the mean and dominant TSH values during the entire follow-up period or 5 years, patients were divided into four groups (<0.5, 0.5 to 1.9, 2.0 to 4.4, and ≥4.5 mIU/L). Recurrence-free survival was compared among the groups.
RESULTS
During the 5.6 years of follow-up, 21 patients (1.4%) experienced recurrence. Mean TSH levels were within the recommended low-normal range (0.5 to 1.9 mIU/L) during the total follow-up period or 5 years in 38.1% or 36.0% of patients. The mean and dominant TSH values did not affect recurrence-free survival. Adjustment for other risk factors did not alter the results.
CONCLUSION
Serum TSH levels did not affect short-term recurrence in patients with low-risk DTC after thyroid lobectomy. TSH suppression should be conducted more selectively.

Keyword

Thyroid cancer, papillary; Recurrence; Thyroid neoplasms; Thyrotropin

MeSH Terms

Follow-Up Studies
Humans
Recurrence*
Risk Factors
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Thyrotropin*
Thyrotropin

Figure

  • Fig. 1 Kaplan-Meier curves of recurrence-free survival (RFS). (A) Tumor size. (B) Mean thyroid-stimulating hormone levels for 5 years after surgery (TSH5yrs) values. (C) Dominant TSH5yrs values. (D) Levothyroxine use.

  • Fig. 2 Forest plot for recurrence-free survival according to the mean thyroid-stimulating hormone (TSH) values during the total follow-up period or 5 years. In multivariate Cox regression analysis, known risk factors including age, sex, tumor size, multiplicity, extrathyroidal extension, and lymph node metastasis were adjusted. (A) Univariate Cox regression analysis with mean TSH values were calculated (TSHtotal) values. (B) Multivariate Cox regression analysis with mean TSHtotal values. (C) Univariate Cox regression analysis with mean TSH levels for 5 years after surgery (TSH5yrs) values. (D) Multivariate Cox regression analysis with mean TSH5yrs values. HR, hazard ratio; CI, confidence interval.


Cited by  2 articles

Annual Neck Ultrasonography Surveillance between 3 to 12 Years after Thyroid Lobectomy for Papillary Thyroid Microcarcinoma
Jin Gu Kang, Jung Eun Choi, Soo Jung Lee, Su Hwan Kang
Int J Thyroidol. 2020;13(2):142-149.    doi: 10.11106/ijt.2020.13.2.142.

A Multicenter, Randomized, Controlled Trial for Assessing the Usefulness of Suppressing Thyroid Stimulating Hormone Target Levels after Thyroid Lobectomy in Low to Intermediate Risk Thyroid Cancer Patients (MASTER): A Study Protocol
Eun Kyung Lee, Yea Eun Kang, Young Joo Park, Bon Seok Koo, Ki-Wook Chung, Eu Jeong Ku, Ho-Ryun Won, Won Sang Yoo, Eonju Jeon, Se Hyun Paek, Yong Sang Lee, Dong Mee Lim, Yong Joon Suh, Ha Kyoung Park, Hyo-Jeong Kim, Bo Hyun Kim, Mijin Kim, Sun Wook Kim, Ka Hee Yi, Sue K. Park, Eun-Jae Jung, June Young Choi, Ja Seong Bae, Joon Hwa Hong, Kee-Hyun Nam, Young Ki Lee, Hyeong Won Yu, Sujeong Go, Young Mi Kang
Endocrinol Metab. 2021;36(3):574-581.    doi: 10.3803/EnM.2020.943.


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