Long-Term Cardiovascular Mortality in Patients With Differentiated Thyroid Carcinoma: An Observational Study
Abstract
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.
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Thyroid-cancer patients receiving TSH suppressive doses of L-T4 have increased risk of cardiovascular and all-cause mortality.
“thyroid-cancer patients receiving TSH suppressive doses of L-T4 had increased risk of cardiovascular and all-cause mortality (100).”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [100]
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- Authors
- Klein Hesselink, E. N., Klein Hesselink, M. S., de Bock, G. H., Gansevoort, R. T., Bakker, S. J. L., Vredeveld, E. J., van der Horst-Schrivers, A. N. A., van der Horst, I. C. C., Kamphuisen, P. W., Plukker, J. T. M., Links, T. P., & Lefrandt, J. D.
- Affiliations
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- University Medical Center Groningen (NL)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2013-11-10
- Volume
- 31
- Issue
- 32
- Pages
- 4046-4053
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2142884678
- Cited by
- 183
- References
- 29
- Citations by year
- 2026: 6 · 2025: 20 · 2024: 13 · 2023: 10 · 2022: 16 · 2021: 26 · 2020: 13 · 2019: 11 · 2018: 10 · 2017: 19 · 2016: 12 · 2015: 15 · 2014: 9 · 2013: 3
- FWCI
- 10.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- differentiated thyroid cancer, cardiovascular mortality, all-cause mortality, thyroid-stimulating hormone, TSH suppression, cardiovascular risk factors, cancer recurrence risk, cardiovascular risk stratification, American Thyroid Association guidelines, cardiovascular risk
- MeSH terms
- Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Thyroid Neoplasms, Thyrotropin, Proportional Hazards Models, Kaplan-Meier Estimate
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