Clinical Thyroidology for the Public summarizes selected research studies discussed in the previous month’s issue of Clinical Thyroidology, an official publication of the American Thyroid Association. Editor-in-chief, Alan Farwell, MD, FACE
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Clinical Thyroidology for the Public Volume 15 Issue 11 (PDF file, 2.88 MB)
TABLE OF CONTENTS – Web Format
Does levothyroxine therapy during the treatment of subclinical hypothyroidism affect bone density?
High levels of thyroid hormone (either from having an overactive thyroid or from taking too much thyroid hormone) cause increased bone turnover leading to bone loss and a decrease in bone density. Thyroid hormone therapy treating overt hypothyroidism that causes suppressed TSH levels has been associated with bone loss and osteoporosis. This study addresses the question of whether treatment with thyroid hormone for subclinical hypothyroidism can also lead to bone loss.
Büchi AE et al. 2022 Bone geometry in older adults with subclinical hypothyroidism upon levothyroxine therapy: A nested study within a randomized placebo controlled trial. Bone 161:116404. PMID: 35381390.
Bone density testing intervals in TSH suppression for thyroid cancer
In patients where thyroid cancer is at high risk for a recurrence, high doses of thyroid hormone are often prescribed to turn off TSH levels (TSH suppression therapy) which may decrease the risk of cancer recurrence. However, the benefit of TSH suppression must be balanced with the risks of doing so, which include a higher risk of osteoporosis. In the present study, the authors evaluate the progression to osteoporosis and the timing of BMD testing in thyroid cancer patients on TSH suppression.
Park H et al 2022. Bone‐density testing interval and transition to osteoporosis in differentiated thyroid carcinoma patients on TSH suppression therapy. Clin Endocrinol 97:130–136.
What influences a patient’s choice in choosing active surveillance in low risk papillary thyroid cancer?
Many small thyroid cancers are at very low risk to spread outside the thyroid or to cause any health risk. Because of this, the option of following the cancer by ultrasound and deferring surgery, called active surveillance, has become increasingly common. This study looks at factors impacting patients’ choice for active surveillance or surgery in low risk papillary thyroid cancer.
Sawka AM et al for the Canadian Active Surveillance Study Group (Greater Toronto Area) 2022 A quantitative analysis examining patients’ choice of active surveillance or surgery for managing low-risk papillary thyroid cancer. Thyroid 32:255–262. PMID: 35019770.
Cost effectiveness of surgery vs active surveillance for low risk thyroid cancer
Low risk papillary thyroid cancer may be treated with a surgical procedure called thyroid lobectomy or by following by ultrasound and deferring surgery, which is called active surveillance. This study looked at the cost effectiveness (cost vs. benefit) of both approaches in the management of the low risk papillary thyroid cancer. The goal of the study was to look at which approach may be more cost effective over the long term.
Youssef MR et al 2022 Thyroid lobectomy as a cost-effective approach in low-risk papillary thyroid cancer versus active surveillance. Surgery 171:190–196. PMID: 34384606.
The need for thyroid hormone replacement predicts poorer quality of life after thyroid surgery
One advantage that lobectomy has over a total thyroidectomy is less need for treatment with thyroid hormone after surgery and, if needed, often lower doses are fine. Some studies suggest that the need for thyroid hormone after surgery affects patient’s quality of life (QOL). This study compared health-related QOL in patients who underwent thyroid lobectomy with those who underwent total thyroidectomy.
Yaniv D et al 2022 Quality of life following lobectomy versus total thyroidectomy is significantly related to hypothyroidism. J Surg Oncol. Epub 2022 Jun 11. PMID: 35689620.
Switching generic-to-generic levothyroxine does not change serum TSH
Levothyroxine is one of the most commonly prescribed medications in the United States, and it is produced by many different manufacturers as generic or brand name products. The investigators in this study compared data from patients who consistently received generic prescriptions from the same manufacturer and data from patients who switched between the three most frequently used generic manufacturers to help understand whether there are significant differences in the stability of thyroid hormone levels between those groups when such a change happens.
Review of: Brito JP et al 2022 Association between genericto- generic levothyroxine switching and thyrotropin levels among US adults. JAMA Intern Med 182:418–425. PMID: 35226058.