Clinical aspects of suppressive therapy with levothyroxine (brief literature review)


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

The article deals with problems of application in clinical practice and major complications of suppressive therapy with levothyroxine in the treatment of differentiated thyroid cancer. Determination of the intensity of suppression of thyrotropin level and duration of suppressive therapy with levothyroxine at the present stage is personified and will depend on the risk of persistence of cancer and comorbid conditions with contraindication to this type of treatment.

Full Text

Restricted Access

About the authors

Tatiana Petrovna Kiseleva

Ural State Medical University

Email: kistapet@mail.ru
MD, professor of Department of faculty therapy and endocrinology

Anastasiya Yurievna Sokolova

Ural State Medical University

Email: sokolovadoc@mail.ru
postgraduate student, assistant of Department of faculty therapy and endocrinology

References

  1. Haugen B.R., Alexander E.K., Bible K.C., Doherty G.M., Mandel S.J., Nikiforov Yu.Ye., Pacini F., Randolph G.W., Sawka A.M., Schlumberger M., Schuff K.G., Sherman S.I., Sosa J.A., Steward D.L., Tuttle R.M., Wartofsky L. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodulesand differentiated thyroid cancer. Thyroid. 2016;26(1):1-133.
  2. Perros P., Boelaert K., Colley S., Evans C., Evans R.M., Gerrard Ba G., Gilbert J., Harrison B., Johnson S.J., Giles T.E., Moss L., Lewington V., Newbold K., Taylor J., Thakker R.V., Watkinson J., Williams G.R. British Thyroid Association guidelines for the management of thyroid cancer. Clin. Endocrinol. 2014;81:1-122.
  3. Европейский консенсус по диагностике и лечению дифференцированного рака щитовидной железы из фолликулярного эпителия. Перевод и предисловие П.О. Румянцева. Клиническая и экспериментальная тиреоидология. 2006;2(3):10-30. [European consensus on diagnosis and treatment of differentiated thyroid cancer of the follicular epithelium. Translation and preface by P.O. Rumyantsev. Clinical and experimental thyroidology. 2006;2(3):10-30. (in Russian)]
  4. Бельцевич Д.Г., Ванушко В.Э., Мельниченко Г.А., Мудунов А.М., Румянцев П.О., Слепцов И.В. Российские клинические рекомендации по диагностике и лечению дифференцированного рака щитовидной железы у взрослых. Проект. Редакция 2016 г. www.endocrincentr.ru. [Beltsevich D.G., Vanushko V.E., Melnichenko G.A., Mudunov A.M., Rumyantsev P.O., Sleptsov I.V. Russian clinical recommendations on diagnostics and treatment of differentiated thyroid cancer in adults. Project. 2016 edition (in Russian)]
  5. Румянцев П.О., Коренев С.В., Румянцева У.В. Современные принципы терапии левотироксином после операции у больных высокодифференцированным раком щитовидной железы. Опухоли головы и шеи. 2013;2:5-8. [Rumyantsev P.O., Korenev S.V., Rumyantseva U.V. Modern principles of therapy with levothyroxine after the operation in patients with well-differentiated thyroid cancer. Tumors of the head and neck. 2013;2:5-8 (in Russian)]
  6. Biondi B., Cooper D.S. Benefits of thyrotropin suppression versus the risk of adverse effects in differentiated thyroid cancer. Thyroid. 2010;20(2):135-46.
  7. Мельниченко Г.А., Трошина Е.А., Ванушко В.Э., Румянцев П.О., Платонова Н.М., Кавтарадзе С.Р. Спорные вопросы лечения дифференцированного рака щитовидной железы. Проблемы эндокринологии. 2008;54(2):14-22. [Melnichenko G.A., Troshina Ye.A., Vanushko V.E., Rumyantsev P.O., Platonov N.M., Kavtaradze R.S. Controversial issues of treatment of differentiated thyroid cancer. Problems of endocrinology. 2008;54(2):14-22 (in Russian)]
  8. Cooper D. TSH suppressive therapy: An overview of long-term clinical consequences. Hormones. 2010;9(1):57-59.
  9. Jonklaas J., Sarlis N.J., Litofsky D., Ain K.B., Bigos S.T., Brierley J.D., Cooper D.S., Haugen B.R., Ladenson P.W., Magner J., Robbins J., Ross D.S., Skarulis M., Maxon H.R., Sherman S.I. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006;16:1229-42.
  10. Ванушко В.Э., Кузнецов Н.С., Ланщаков К.В. Прогноз хирургического лечения дифференцированного рака щитовидной железы. Проблемы эндокринологии. 2007;6:19-23. [Vanushko V.E., Kuznetsov N.S., Lanshchakov K.V. Prognosis of surgical treatment of differentiated thyroid cancer. Problems of endocrinology. 2007;6:19-23 (in Russian)]
  11. McGriff N.J., Csako G., Gourgiotis L., Lori C.G., Pucino F., Sarlis N.J. Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann. Med. 2002;34(7-8):554-64.
  12. Fiore E., Rago T., Provenzale M.A. Lower levels of TSH are associated with a lower risk of papillary thyroid cancer patients with thyroid nodular disease: thyroid autonomy may play a protective role. J. Endocr. Relat. Cancer. 2009;16(4):1251-60.
  13. Zafon C. TSH treatment - review. Suppressive in thyroid cancer of differentiated. A dogma under review. Endocrinol. Nutr. 2012;59(2):125-30.
  14. Цырлина Е.В., Порозова А.А. Рецепция стероидных гормонов в нормальной и опухолевой тканях щитовидной железы. Клиническая и экспериментальная тиреоидология. 2008;4(3):10-7. [Tsyrlina Ye.V., Porozova A.A. Reception of steroid hormones in normal and malignant thyroid tissue. Clinical and experimental thyroidology. 2008;4(3):10-7 (in Russian)]
  15. Biondi B., Cooper D.S. Benefits of thyrotropin suppression versus the risk of adverse effects in differentiated thyroid cancer. Thyroid. 2010:20(2):135-46.
  16. Biondi B., Cooper D.S. The clinical significance of subclinical thyroid disfuncthion. Endocrine Reviews. 2006;29(1):76-131.
  17. Biondi B., Palmieri E.A., Klain M., Schlumberger M., Filetti S., Lombardi G. Subclinical hyperthyroidism: clinical features and treatment options. Eur. J. Endocrinol. 2005;152:1-9.
  18. Демидова Т.Ю., Дроздова И.Н. Влияние субклинического тиреотоксикоза на сердечно-сосудистую систему. Клиническая и экспериментальная тиреоидология. 2015;2:33-7. [Demidova T.Yu., Drozdova I.N. The influence of subclinical hyperthyroidism on the cardiovascular system. Clinical and experimental thyroidology. 2015;2:33-7 (in Russian)]
  19. Белая Ж.Е., Рожинская Л.Я., Мельниченко Г.А. Влияние манифестного и субклинического тиреотоксикоза на костную систему взрослых. Проблемы эндокринологии. 2007;2:9-15. [Belaya Zh.Ye., Rozhinskaya L.Ya., Melnichenko G.A. Effect of overt and subclinical hyperthyroidism on skeletal system adults. Problems of endocrinology. 2007;2:9-15 (in Russian)]
  20. Chen C.H., Chen J.F., Yang B.Y., Liu R.T., Tung S.C., Chien W.Y., Lu Y.C., Kuo M.C., Hsieh C.J., Wang P.W. Bone mineral density in women receiving thyroxine suppressive therapy for differentiated thyroid carcinoma. J. Formos. Med. Assoc. 2004;103:442-7.
  21. Соколова А.Ю., Киселева Т.П. Динамика антропометрических данных и показателей липидного спектра при супрессивной и заместительной терапии левотироксином. Сборник тезисов II Всероссийского конгресса «Инновационные технологии в эндокринологии» с участием стран СНГ, 25-28 мая 2014 г., Москва, 324 c. [Sokolova A.Yu., Kiseleva T.P. Dynamics of anthropometric data and lipid profile in suppressive and substitution therapy with levothyroxine. Abstracts of II Russian Congress "Innovative technology in endocrinology" with the participation of the CIS countries, May 25-28, 2014, Moscow (in Russian)]
  22. Соколова А.Ю., Киселева Т.П. Супрессивная терапия левотироксином и углеводный обмен у пациентов с раком щитовидной железы в анамнезе (обзор литературы). Вестник Уральской медицинской академической науки. 2013;1(43):88-95. [Sokolova A.Yu., Kiseleva T.P. Suppressive therapy with levothyroxine and carbohydrate metabolism in patients with thyroid cancer in history (literature review). Bulletin of the Ural medical academic science. 2013;1(43):88-95 (in Russian)]
  23. Соколова А.Ю., Киселева Т.П. Качество жизни при разных уровнях супрессии тиреотропина у пациентов после хирургического лечения дифференцированного рака щитовидной железы. Вестник уральской академической медицинской науки. 2015;1:50-7. [Sokolova A.Yu., Kiseleva T.P. Quality of life at different levels of suppression of thyrotropin in patients after surgical treatment of differentiated thyroid cancer. Bulletin of the Ural medical academic science. 2015;1:50-7 (in Russian)]
  24. Batrinos M.L. The problem of exogenous subclinical hyperthyroidism. Hormones (Athens). 2006;5(2):119-25.
  25. Свиридонова М.А., Ильин А.В., Фадеев В.В. Циркадианная вариабельность уровня ТТГ на фоне супрессивной терапии левотироксином. Клиническая и экспериментальная тиреоидология. 2011 ;7(1 ):55-7. [Sviridonova M.A., Ilyin V.A., Fadeev V.V. Circadian variability of TSH level on the background of suppressive therapy with levothyroxine. Clinical and experimental thyroidology. 2011;7(1):55-7 (in Russian)]
  26. Tanaka K., Sonoo H. Current trends in TSH suppression therapy for patients with papillary thyroid carcinoma in Japan: results of a questionnaire distributed to councilors of the Japanese society of thyroid surgery. Surg. Today. 2011;42(7):633-8.
  27. Sugitani I., Fujimoto Y. Effect of postoperative thyrotropin suppressive therapy on bone mineral density in patients with papillary thyroid carcinoma: a prospective controlled study. Surgery. 2011;150:1250-7.
  28. Cooper D. The working group ETA for the study of thyroid cancer. Materials of the 32nd Congress of the European thyroid Federation Association. Thyroid International. 2008;1:5.
  29. Шульгина В.Ю., Фадеев В.В., Мельниченко Г.А. Поражение миокарда при тиреотоксикозе: особенности течения, исходы, отдаленный прогноз. Клиническая и экспериментальная тиреоидология. 2006;2(4):21-30. [Shulgin V.Yu., Fadeev V.V., Melnichenko G.A. Lesions of the myocardium in thyrotoxicosis: features of the course, outcome, long-term prognosis. Clinical and experimental thyroidology. 2006;2(4):21-30 (in Russian)]
  30. Gen R., Akbay E., Camsari A., Ozcan T. P-wave dispersion in exogenous endogenous and subclinical hyperthyroidism. J. Endocrinol Invest. 2010;33(2):88-91.
  31. Owecki M., Michalak A., Nikisch E., Sowinski J. Prolonged ventricular repolarization measured by corrected QT interval (QTc) in subclinical hyperthyroidism. Horm. Metab Res. 2006;38(1):44-7.
  32. Biondi B., Fazio S., Carella C., Sabatini D., Amato G., Cittadini A., Bellastella A., Lombardi G., Saccà L. Control of adrenergic overactivity by beta-blockade improves the quality of life in patients receiving longterm suppressive therapy with levothyroxine. J. Clin. Endocrinol Metab. 1994;78:1028-33.
  33. Biondi B., Fazio S., Cuocolo A., Sabatini D., Nicolai E., Lombardi G., Salvatore M., Saccà L. Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine. J. Clin. Endocrinol. Metab. 1996;81:4224-8.
  34. Dörr M., Ittermann T., Aumann N., Obst A., Reffelmann T., Nauck M., Wallaschofski H., Felix S.B., Völzke H. Subclinical hyperthyroidism is not associated with progression of cardiac mass and development of left ventricular hypertrophy in middle-aged and older subjects: results from a 5-year follow-up. Clin. Endocrinol. (Oxf). 2010;73(6):821-6.
  35. Abdulrahman R.M., Delgado V., Ng A.C., Ewe S.H., Bertini M., Holman E.R., Hovens G.C., Pereira A.M., Romijn J.A., Bax J.J., Smit J.W. Abnormal cardiac contractility in long exogenous-term subclinical hypothyroid patients as demonstrated by twodimensional speckle tracking imaging echocardiography. Eur. J. Endocrinol, 2010.;163(3):435-41.
  36. Taillard V., Sardinoux M., Oudot C., Fesler P., Rugale C., Raingeard I., Renard E., Ribstein J., du Cailar G. Early detection of isolated left ventricular diastolic dysfunction in differentiated thyroid carcinoma patients on TSH-suppressive therapy. J. Clin. Endocrinol. (Oxf). 2011;75(5):709-14.
  37. Ochs N., Auer R., Bauer D.C. Meta-analysis: Subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann. Intern. Med. 2008;148(11):832-45.
  38. Yang L., Jiang D., Qi W., Zhang T., Feng Y., Gao L., Zhao J. Subclinical hyperthyroidism and the risk of cardiovascular events and all-cause mortality: an updated meta-analysis of cohort studies. Eur. J. Endocrinol. 2012;167(1):75-84.
  39. Boekholdt S.M., Titan S.M., Wiersinga W.M. Initial thyroid status and cardiovascular risk factors: the EPIC-Norfolk prospective population study. Clin. Endocrinol. 2010;72(3):404-10.
  40. Cappola A.R., Fried L.P., Arnold A.M. Thyroid status, cardiovascular risk and mortality in older adults. J. of the American Medical Association. 2006;295(9):1033-41.
  41. Ittermann T., Haring R., Sauer S., Wallaschofski H., Dörr M., Nauck M., Völzke H. Decreased serum TSH levels are not associated with mortality in the adult northeast German population. Eur. J. Endocrinol. 2010;162(3):579-85.
  42. Mittal A., Poudel B., Pandeya D.R., Gupta S.P., Sathian B., Yadav S.K. Metabolic changes enhance the cardiovascular risk with differentiated thyroid carcinoma - a case control from Manipal Teaching Hospital of Nepal. Asian. Pac. J. Cancer Prev. 2012;13(5):2335-8.
  43. Peppa M., Betsi G., Dimitraidis G. Lipid abnormalities and cardiometabolic risk in patients with overt and subclinical thyroid disease. J. of Lipids. 2011;2011:575840.
  44. Brenta G. Why can insulin resistance be a natural consequence of thyroid dysfunction? J. Thyroid Res. 201 1:152850.
  45. Белая Ж.Е., Рожинская Л.Я., Мельниченко Г.А. Современные представления о действии тиреоидных гормонов и тиреотропного гормона на костную ткань. Проблемы эндокринологии. 2006;52(2):48-54. [Belaya Zh.Ye., Rozhinskaya L.Ya., Melnichenko G.A. Modern views on the action of thyroid hormones and thyroid stimulating hormone on bone. Problems of endocrinology. 2006;52(2):48-54 (in Russian)]
  46. Baqi L., Payer J., Killinger Z., Susienkova K., Jackuliak P., Cierny D., Langer P. The level of TSH appeared favourable in maintaining bone mineral density in postmenopausal women. Endocr. Regul. 2010;44(1):9-15.
  47. Faber J., Galloe A.M. Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a metaanalysis. Eur. J. Endocrinol. 1994;130:350-6.
  48. Uzzan B., Campos J., Cucherat M. Et al. Effects on bone mass of long term treatment with thyroid hormones: a meta-analysis. J. Clin. Endocrinol. Metab. 1996;81:4278-89.
  49. Schneider R., Reiners C. The effect of levothyroxine therapy on bone mineral density: a systematic review of the literature. Exp. Clin. Endocrinol. Diabet, 2003;11 1:455-70.
  50. Mikosch P., Obermayer-Pietsch B., Jost R., Jauk B., Gallowitsch H.J., Kresnik E., Leb G., Lind P. Bone metabolism in patients with differentiated thyroid carcinoma receiving suppressive levothyroxine treatment. Thyroid. 2003;13(4):347-56.
  51. Belaya Z.E., Melnichenko G.A., Rozhinskay L.Y., Fadeev V.V. et al. Subclinical hyperthyroidism of variable etiology and its influence on bone in postmenopausal women. Hormones Case (Athens). 2007;6(1):62-70.
  52. Kung A.W., Yeung S.S. Prevention of bone loss induced by thyroxine suppressive therapy in postmenopausal women: the effect of calcium and calcitonin. J. Clin. Endocrinol. Metab. 1996;81:1232-6.
  53. Rosen H.N., Moses A.C., Garber J., Ross D.S., Lee S.L., Ferguson L., Chen V., Lee K., Greenspan S.L. Randomized trial of pamidronate in patients with thyroid cancer: bone density is not reduced by suppressive doses of thyroxine, but is increased by cyclic intravenous pamidronate. J. Clin. Endocrinol. Metab. 1998;83:2324-30.

Supplementary files

Supplementary Files
Action
1. JATS XML

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies