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

• Lee MC
• Kim MJ
• Choi HS
• Cho SW
• Lee GH
• Park YJ
• Park DJ

• KMID: 2450515
• DOI: http://doi.org/10.3803/EnM.2019.34.2.150

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.

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