Skip to main content
SpringerLink
Log in

Risks of Thyroid Hormone Suppression for Differentiated Thyroid Cancer in the Elderly

  • Chapter
Book cover Thyroid Cancer

  • 1936 Accesses

Abstract

Suppressive thyroxine (T4) therapy was previously a cornerstone in the management of differentiated thyroid cancer (DTC). Evidence has since demonstrated that complete suppression of serum thyroid-stimulating hormone (TSH) lowers neither mortality nor recurrence rates in low-risk disease, though it does confer benefit in high-risk disease. Subclinical and overt iatrogenic hyperthyroidism may negatively affect cardiovascular and bone health, particularly in the elderly. Thus, individualized serum TSH goals should be made based on comorbidities and risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. SEER cancer statistics review, 1975–2011, National Cancer Institute. Bethesda, MD. Based on November 2013 SEER data submission, released April 2014. http://seer.cancer.gov/csr/1975_2011/

  2. McLeod DS, Sawka AM, Cooper DS. Controversies in primary treatment of low-risk papillary thyroid cancer. Lancet. 2013;381(9871):1046–57.

    Article  PubMed  Google Scholar 

  3. Pujol P, Daures JP, Nsakala N, Baldet L, Bringer J, Jaffiol C. Degree of thyrotropin suppression as a prognostic determinant in differentiated thyroid cancer. J Clin Endocrinol Metab. 1996;81(12):4318–23.

    CAS  PubMed  Google Scholar 

  4. McGriff NJ, Csako G, Gourgiotis L, Lori CG, Pucino F, Sarlis NJ. Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann Med. 2002;34(7–8):554–64.

    Article  CAS  PubMed  Google Scholar 

  5. Cooper DS, Specker B, Ho M, et al. Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: results from the national thyroid cancer treatment cooperative registry. Thyroid. 1998;8(9):737–44.

    Article  CAS  PubMed  Google Scholar 

  6. Jonklaas J, Sarlis NJ, Litofsky D, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006;16(12):1229–42.

    Article  PubMed  Google Scholar 

  7. Hovens GC, Stokkel MP, Kievit J, et al. Associations of serum thyrotropin concentrations with recurrence and death in differentiated thyroid cancer. J Clin Endocrinol Metab. 2007;92(7):2610–15.

    Article  CAS  PubMed  Google Scholar 

  8. Sugitani I, Fujimoto Y. Does postoperative thyrotropin suppression therapy truly decrease recurrence in papillary thyroid carcinoma? A randomized controlled trial. J Clin Endocrinol Metab. 2010;95(10):4576–83.

    Article  CAS  PubMed  Google Scholar 

  9. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov Y, et al. American Thyroid Association Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2015; 24. in press.

    Google Scholar 

  10. Giusti M, Melle G, Fenocchio M, et al. Five-year longitudinal evaluation of quality of life in a cohort of patients with differentiated thyroid carcinoma. J Zhejiang Univ Sci B. 2011;12(3):163–73.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Biondi B, Cooper DS. Benefits of thyrotropin suppression versus the risks of adverse effects in differentiated thyroid cancer. Thyroid. 2010;20(2):135–46.

    Article  CAS  PubMed  Google Scholar 

  12. Boelaert K, Torlinska B, Holder RL, Franklyn JA. Older subjects with hyperthyroidism present with a paucity of symptoms and signs: a large cross-sectional study. J Clin Endocrinol Metab. 2010;95(6):2715–26.

    Article  CAS  PubMed  Google Scholar 

  13. Abonowara A, Quraishi A, Sapp JL, et al. Prevalence of atrial fibrillation in patients taking TSH suppression therapy for management of thyroid cancer. Clin Invest Med. 2012;35(3):E152–6.

    PubMed  Google Scholar 

  14. Flynn RW, Bonellie SR, Jung RT, MacDonald TM, Morris AD, Leese GP. Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab. 2010;95(1):186–93.

    Article  CAS  PubMed  Google Scholar 

  15. Bauer DC, Rodondi N, Stone KL, Hillier TA, Study of Osteoporotic Fractures Research Group: Universities of California (San Francisco), Pittsburgh, Minnesota (Minneapolis), Kaiser Permanente Center for Health Research, Portland. Thyroid hormone use, hyperthyroidism and mortality in older women. Am J Med. 2007;120(4):343–9.

    Article  CAS  PubMed  Google Scholar 

  16. Klein Hesselink EN, Klein Hesselink MS, de Bock GH, et al. Long-term cardiovascular mortality in patients with differentiated thyroid carcinoma: an observational study. J Clin Oncol. 2013;31(32):4046–53.

    Article  PubMed  Google Scholar 

  17. Yang L, Shen W, Sakamoto N. Population-based study evaluating and predicting the probability of death resulting from thyroid cancer and other causes among patients with thyroid cancer. J Clin Oncol. 2013;31(4):468–74.

    Article  PubMed  Google Scholar 

  18. Heemstra KA, Hamdy NA, Romijn JA, Smit JW. The effects of thyrotropin-suppressive therapy on bone metabolism in patients with well-differentiated thyroid carcinoma. Thyroid. 2006;16(6):583–91.

    Article  CAS  PubMed  Google Scholar 

  19. Waring AC, Harrison S, Fink HA, et al. A prospective study of thyroid function, bone loss, and fractures in older men: the MrOS study. J Bone Miner Res. 2013;28(3):472–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Quan ML, Pasieka JL, Rorstad O. Bone mineral density in well-differentiated thyroid cancer patients treated with suppressive thyroxine: a systematic overview of the literature. J Surg Oncol. 2002;79(1):62–9. discussion 69–70.

    Article  CAS  PubMed  Google Scholar 

  21. Bauer DC, Ettinger B, Nevitt MC, Stone KL, Study of Osteoporotic Fractures Research Group. Risk for fracture in women with low serum levels of thyroid-stimulating hormone. Ann Intern Med. 2001;134(7):561–8.

    Article  CAS  PubMed  Google Scholar 

  22. Wirth CD, Blum MR, da Costa BR, et al. Subclinical thyroid dysfunction and the risk for fractures: a systematic review and meta-analysis. Ann Intern Med. 2014;161(3):189–99.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Faber J, Galloe AM. Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a meta-analysis. Eur J Endocrinol. 1994;130(4):350–6.

    Article  CAS  PubMed  Google Scholar 

  24. Uzzan B, Campos J, Cucherat M, Nony P, Boissel JP, Perret GY. Effects on bone mass of long term treatment with thyroid hormones: a meta-analysis. J Clin Endocrinol Metab. 1996;81(12):4278–89.

    CAS  PubMed  Google Scholar 

  25. Kung AW, Yeung SS. Prevention of bone loss induced by thyroxine suppressive therapy in postmenopausal women: the effect of calcium and calcitonin. J Clin Endocrinol Metab. 1996;81(3):1232–6.

    CAS  PubMed  Google Scholar 

  26. Panico A, Lupoli GA, Fonderico F, et al. Osteoporosis and thyrotropin-suppressive therapy: reduced effectiveness of alendronate. Thyroid. 2009;19(5):437–42.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins Hospital, 1830 E. Monument St, Suite 333, Baltimore, MD, 21287, USA

    Swaytha Yalamanchi MD & David Cooper MD

Authors
  1. Swaytha Yalamanchi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Cooper MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Cooper MD .

Editor information

Editors and Affiliations

  1. Johns Hopkins University, Baltimore, Maryland, USA

    David S. Cooper

  2. Department of Internal Medicine, University of Rome, Rome, Roma, Italy

    Cosimo Durante

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Yalamanchi, S., Cooper, D. (2016). Risks of Thyroid Hormone Suppression for Differentiated Thyroid Cancer in the Elderly. In: Cooper, D., Durante, C. (eds) Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-22401-5_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-22401-5_18

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22400-8

  • Online ISBN: 978-3-319-22401-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation