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Long-term cardiovascular mortality in patients with differentiated thyroid carcinoma: An observational study

Klein Hesselink, E., Klein Hesselink, M., de Bock, T., Gansevoort, R., Bakker, S., Vredeveld, E., van der Horst-Schrivers, A. N. A., van der Horst, I., Kamphuisen, P. W., Plukker, J., Links, T. P. & Lefrandt, J., 10-Nov-2013, In : Journal of Clinical Oncology. 31, 32, p. 4046-4053 8 p.

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  • Long-Term Cardiovascular Mortality in Patients With Differentiated Thyroid Carcinoma: An Observational Study

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DOI

Purpose

The primary aim was to study the risk of cardiovascular mortality in patients with differentiated thyroid carcinoma (DTC). Secondary aims were to evaluate all-cause mortality and explore the relation between thyroid-stimulating hormone (TSH; also known as thyrotropin) level and these outcome parameters.

Patients and Methods

Subjects from two cohorts were retrospectively compared by Cox regression analyses; 524 patients with DTC and 1,572 sex-and age-matched controls from a large population-based study in the same geographic region.

Results

Mean age plus or minus standard deviation was 49 +/- 14 years. Median follow-up was 8.5 years (interquartile range [IQR], 4.1 to 15.9 years) for patients with DTC and 10.5 years (IQR, 9.9 to 10.9 years) for controls. One hundred patients with DTC (19.1%) died, 22 (4.2%) as a result of cardiovascular disease, 39 (7.4%) as a result of DTC, and 39 (7.4%) as a result of other/unknown causes. Eighty-five controls (5.4%) died, 24 (1.5%) as a result of cardiovascular disease and 61 (3.9%) as a result of other/unknown causes. Patients with DTC had an increased risk of cardiovascular and all-cause mortality (hazard ratios [HRs], 3.35 [95% CI, 1.66 to 6.74] and 4.40 [95% CI, 3.15 to 6.14], respectively, adjusted for age, sex, and cardiovascular risk factors). Within the DTC group, TSH level was predictive for cardiovascular mortality; the adjusted HR was 3.08 (95% CI, 1.32 to 7.21) for each 10-fold decrease in geometric mean TSH level.

Conclusion

The risk of cardiovascular and all-cause mortality is increased in patients with DTC, independent of age, sex, and cardiovascular risk factors. A lower TSH level is associated with increased cardiovascular mortality, supporting the current European Thyroid Association and the American Thyroid Association guidelines of tempering TSH suppression in patients with low risk of cancer recurrence. Furthermore, patients with DTC may benefit from assessment and treatment of cardiovascular risk factors. (C) 2013 by American Society of Clinical Oncology

Original languageEnglish
Pages (from-to)4046-4053
Number of pages8
JournalJournal of Clinical Oncology
Volume31
Issue number32
Publication statusPublished - 10-Nov-2013

    Keywords

  • EXOGENOUS SUBCLINICAL HYPERTHYROIDISM, THYROTROPIN SUPPRESSION, CANCER, THERAPY, SURVIVAL, DEATH, THYROGLOBULIN, MANAGEMENT, PAPILLARY, OVERT

ID: 13657201