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Cited by 184Thyroid Cancer Diagnosis and TreatmentThyroid and Parathyroid SurgeryThyroid Disorders and Treatments

Long-term outcomes following therapy in differentiated thyroid carcinoma: NTCTCS registry analysis 1987-2012

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Carhill, Aubrey A., Litofsky, Danielle R., Ross, Douglas S., Jonklaas, Jacqueline, Cooper, David S., Brierley, James D., Ladenson, Paul W., Ain, Kenneth B. +8 more·2015·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2015-1346PMC PMC5393522
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Abstract

Context: Initial treatments for patients with differentiated thyroid cancer are supported primarily by single-institution, retrospective studies, with limited follow-up and low event rates. We report updated analyses of long-term outcomes after treatment in patients with differentiated thyroid cancer. Objective: The objective was to examine effects of initial therapies on outcomes. Design/Setting: This was a prospective multi-institutional registry. Patients: A total of 4941 patients, median follow-up, 6 years, participated. Intervention: Interventions included total/near-total thyroidectomy (T/NTT), postoperative radioiodine (RAI), and thyroid hormone suppression therapy (THST). Main Outcome Measure: Main outcome measures were overall survival (OS) and disease-free survival using product limit and proportional hazards analyses. Results: Improved OS was noted in NTCTCS stage III patients who received RAI (risk ratio [RR], 0.66; P = .04) and stage IV patients who received both T/NTT and RAI (RR, 0.66 and 0.70; combined P = .049). In all stages, moderate THST (TSH maintained subnormal-normal) was associated with significantly improved OS (RR stages I-IV: 0.13, 0.09, 0.13, 0.33) and disease-free survival (RR stages I-III: 0.52, 0.40, 0.18); no additional survival benefit was achieved with more aggressive THST (TSH maintained undetectable-subnormal). This remained true, even when distant metastatic disease was diagnosed during follow-up. Lower initial stage and moderate THST were independent predictors of improved OS during follow-up years 1–3. Conclusions: We confirm previous findings that T/NTT followed by RAI is associated with benefit in high-risk patients, but not in low-risk patients. In contrast with earlier reports, moderate THST is associated with better outcomes across all stages, and aggressive THST may not be warranted even in patients diagnosed with distant metastatic disease during follow-up. Moderate THST continued at least 3 years after diagnosis may be indicated in high-risk patients.

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  • In real clinical practice, undetectable TSH levels are usually maintained for more than 5 years after surgery.

    “However, in the real clinical world, undetectable TSH levels are usually maintained for more than 5 years after surgery (25,26).”

    From Effect of TSH Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis (2021) · cites this paper as [25]

    The Cohort definitions section (page unavailable) describes how undetectable TSH was recorded, and the Outcomes associated with continued THST during follow-up section (page unavailable) analyzes suppression beyond five years. Neither reports that undetectable TSH was usually maintained for more than five years after surgery; searches for that duration and its frequency found no such passage. (LLM, conf=0.72)

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Authors
Carhill, A. A., Litofsky, D. R., Ross, D. S., Jonklaas, J., Cooper, D. S., Brierley, J. D., Ladenson, P. W., Ain, K. B., Fein, H. G., Haugen, B. R., Magner, J., Skarulis, M. C., Steward, D. L., Xing, M., Maxon, H. R., & Sherman, S. I.
Affiliations
  • The University of Texas MD Anderson Cancer Center (US)
  • Harvard University (US)
  • Georgetown University (US)
  • Johns Hopkins University (US)
  • Princess Margaret Cancer Centre (CA)
  • University of Kentucky (US)
  • Sinai Hospital (US)
  • University of Colorado Anschutz (US)
  • Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142
  • National Institutes of Health (US)
  • Departments of Head and Neck Surgery (D.L.S.), Cincinnati, Ohio 45219
  • University of Cincinnati Medical Center (US)
Corresponding author
Sherman, Steven I.
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2015-09-01
Volume
100
Issue
9
Pages
3270-3279
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2015-1346
PMC
PMC5393522
OpenAlex
W2103848753
Cited by
184
References
41
Citations by year
2026: 9 · 2025: 19 · 2024: 16 · 2023: 13 · 2022: 22 · 2021: 20 · 2020: 19 · 2019: 25 · 2018: 14 · 2017: 20 · 2016: 3 · 2015: 4
FWCI
11.88
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Eli Lilly and Company (P30 CA016672)
  • Pfizer
  • Sanofi
  • Exelixis
  • Veracyte
  • Eisai
  • Novo Nordisk
  • University of Texas MD Anderson Cancer Center ((CA016672), P30-CA-016672)
  • National Cancer Institute (NCI Grant P30 CA016672, CA 016672, P30CA016672, P30CA006973)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Keywords
differentiated thyroid cancer, total thyroidectomy, near-total thyroidectomy, radioiodine therapy, thyroid hormone suppression therapy, TSH suppression, overall survival, disease-free survival, distant metastasis, tumor stage, long-term outcomes
MeSH terms
Adult, Aged, Aged, 80 and over, Carcinoma, Papillary, Female, Humans, Iodine Radioisotopes, Male, Middle Aged, Registries, Retrospective Studies, Thyroid Neoplasms, Thyroidectomy, Treatment Outcome, Adenocarcinoma, Follicular, Disease-Free Survival

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