Clinical Thyroidology is one of the ATA’s official journals and is published in partnership with Mary Ann Liebert, Inc. This highly valued abstract and commentary publication provides a comprehensive look at clinical thyroid literature. Experts in the field summarize the most innovative, relevant articles and provide insight into the relevance and impact of each article on patient care.

‘I am delighted that Dr. Angell has agreed to take over the reigns as Editor in Chief of Clinical Thyroidology, following the superb job that Dr. Leung has done. I have every confidence that Dr. Angell will continue the clear upward trajectory of the journal,” said Christopher McCabe, American Thyroid Association’s Secretary.

Dr. Angell will succeed Angela M. Leung, MD, who is completing a five-year term as Editor-in-Chief of Clinical Thyroidology. Clinical Thyroidology has seen a growth in readership and downloads during Dr. Leung’s term and the American Thyroid Association is grateful for her strategic and innovative leadership.

“I am thrilled to have the opportunity to be Editor-in-Chief of Clinical Thyroidology following the exceptional tenure of  Dr. Angela Leung. I plan to continue to work with an outstanding editorial board, contributing expertise and thought-leading commentaries, to create this unique and invaluable publication,” said Dr. Angell.

Dr. Angell is an Associate Professor of Clinical Medicine in the Department of Medicine’s division of endocrinology and diabetes at Keck School of Medicine of USC. Dr. Angell is board certified in internal medicine and diabetes, endocrinology, and metabolism. His clinical and research interest is the diagnosis and treatment of thyroid diseases. He is nationally recognized for research and clinical expertise in thyroid nodule evaluation and molecular testing of thyroid nodules.

About the Journal

Clinical Thyroidology® monthly expert commentary provides an expansive look at clinical thyroid literature and summarizes the most innovative, relevant articles that clinicians should know about. Complete tables of content may be viewed on the Clinical Thyroidology website.

About the American Thyroid Association

The  American Thyroid Association® (ATA) is dedicated to transforming thyroid care through clinical excellence, education, scientific discovery, and advocacy in a collaborative community. ATA® is an international professional medical society with more than 1,700 members from 70 countries around the world.

The ATA® promotes thyroid awareness and information through its online Clinical Thyroidology® for the Public (distributed free of charge to over 12,000 patients and public subscribers) and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA® website www.thyroid.org serves as a bonafide clinical resource for patients and the public who look for reliable information on the Internet.

About Mary Ann Liebert
Mary Ann Liebert, Inc., is known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research. A complete list of the firm’s more than 90 journals, books, and newsmagazines is available on its website.

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Today the ATA announced the 2023 award recipients.  The awardees will be recognized during the ATA’s 2023 Annual Meeting & Centennial Celebration on September 27 – October 1, 2023.

“This is a very special time of year for the ATA: a time when we can recognize the varied talents and outstanding contributions of our ATA members,” said Jacqueline Jonklaas, MD, PhD, Secretary of the American Thyroid Association. “The achievements and dedication of these members reminds us of what makes the ATA such a special and valuable society. These individuals are an inspiration to us all.”

This year’s honorees are:

Anne R. Cappola, MD, Sc.M – Valerie Anne Galton Distinguished Lectureship Award
The Valerie Anne Galton Distinguished Lectureship Award recognizes an individual who has been instrumental in collaborative research that has significantly contributed to the advancement of our clinical knowledge of thyroid conditions. Dr. Cappola is Professor of Medicine in the Division of Endocrinology, Diabetes, and Metabolism at the University of Pennsylvania and Director of the Penn Medical Communication Research Institute (PMCRI). Dr. Cappola is recognized for her extensive collaborative research defining thresholds for treatment of thyroid dysfunction.

M. Regina Castro, MD – Distinguished Service Award
The Distinguished Service Award honors a member who has made important and continuing contributions to the American Thyroid Association. Dr. Castro is a is a Professor of Medicine, consultant in endocrinology and Director of the Endocrine Fellowship Program at the Mayo Clinic in Rochester, MN. Dr. Castro is recognized for her longtime service to the ATA, serving on numerous committees, as a member of the Board of Directors, co-chair of the Diversity, Equity & Inclusion Task Force, and as a chair of the ATA’s Women in Thyroidology. Dr. Castro is a mentor and sponsor of many ATA members and endocrine trainees from around the world.

Carole Ann Spencer, PhD – John B. Stanbury Thyroid Pathophysiology Medal
The John B. Stanbury Thyroid Pathophysiology Medal recognizes outstanding research contributions, either conceptual or technical, to the understanding of thyroid physiology or the pathophysiology of thyroid disease, as evidenced by having a major impact on research or clinical practice related to thyroid diseases. Dr. Spencer is Professor of Research Medicine at the Keck School of Medicine at the University of Southern California. Dr. Spencer is recognized for her extensive work on many clinical thyroid assays including the TSH, thyroglobulin, and thyroglobulin antibody assays in the clinical management of differentiated thyroid cancer.  Dr. Spencer has also served as President of the ATA.

Yaron Tomer, MD – Sidney H. Ingbar Distinguished Lectureship Award
The Sidney H. Ingbar Distinguished Lectureship Award recognizes outstanding academic achievements in thyroidology, in keeping with the innovation and vision that epitomized Dr. Ingbar’s brilliant investigative career. The Ingbar award is conferred upon an established investigator who has made major contributions to thyroid-related research over many years. Dr. Tomer is Professor and Chair of the Department of Medicine and Anita and Jack Saltz Chair in Diabetes Research at the Albert Einstein College of Medicine. Dr. Tomer is recognized for his groundbreaking research in thyroid autoimmunity, specifically Graves’ Disease and Hashimoto’s Thyroiditis.

Lisa A. Orloff, MD, FACS, FACE – Women in Thyroidology Woman of the Year
The Women in Thyroidology Woman of the Year Award recognizes an ATA member who is dedicated to the field and the advancement of women in thyroidology. Dr. Orloff is Director of the Endocrine Head & Neck Surgery Program and Professor in the Department of Otolaryngology — Head & Neck Surgery, Division of Head & Neck Surgery, at Stanford University School of Medicine. She is also the Director of the Stanford Thyroid Tumor Program within the Stanford Cancer Center. Dr. Orloff is recognized for her service to the ATA and the field, including serving on the ATA’s surgical affairs committee, development committee, corporate leadership council, and as an editorial board member of Clinical Thyroidology. She is internationally recognized for her work in the management of thyroid nodules and thyroid cancer; holds leadership roles in the American Head and Neck Society, the American Institute of Ultrasound in Medicine, and the American College of Surgeons; and is co-chair of the taskforce for the ATA’s planned update to its thyroid nodules guidelines.

Rosalind Brown, MD – Lewis E. Braverman Distinguished Lectureship Award
The Lewis E. Braverman Distinguished Lectureship Award recognizes an individual who has demonstrated excellence and passion for mentoring fellows, students and junior faculty, has a long history of productive thyroid research, and is devoted to the ATA. Dr. Brown was Associate Professor of Pediatrics at Harvard Medical School and Director of Endocrinology Clinical Trials Research at Boston Children’s Hospital. Dr. Brown is recognized for her pioneering research in pediatric thyroid disease, her mentorship of generations of pediatric trainees, and over 40 years of dedicated service to the ATA.

About the American Thyroid Association

The American Thyroid Association (ATA) is dedicated to transforming thyroid care through clinical excellence, education, scientific discovery and advocacy in a collaborative and diverse community. ATA is an international professional medical society with over 1,700 members from 70 countries around the world. The ATA^® promotes thyroid awareness and information through Clinical Thyroidology^® for the Public, a resource that summarizes research for patients and families, and extensive, authoritative resources on thyroid disease and thyroid cancer in both English and Spanish. The ATA^® website www.thyroid.org serves as a bonafide clinical resource for patients and the public who look for reliable thyroid-related information.

The post 2023 ATA® Award Recipients Announced appeared first on American Thyroid Association.

The consensus statement was drafted by a multidisciplinary, global writing task force led by co-chairs from both societies, including Henry B. Burch, M.D., Program Director, Division of Diabetes, Endocrinology, & Metabolic Diseases, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, and Petros Perros, MD, Honorary Consultant in Endocrinology at Newcastle upon Tyne Hospitals NHS Foundation Trust. The final document integrates feedback from patients and the ophthalmology community, comments from ATA and ETA members, and it underwent formal peer-review in Thyroid and the European Thyroid Journal. Potential conflict of interest was managed, and transparency maintained in formulating the consensus statement.

“This carefully crafted statement, written by experts of the two sister societies, provides an up-to-date overview of the management of TED, which can present a challenging clinical problem. Integrating the latest developments, it is an excellent guide for specialists caring for patients with Graves’ disease and emphasizes the need for a multidisciplinary approach for individuals with severe forms of TED,” says Peter A. Kopp, MD, Immediate Past President of the ATA, Professor of Medicine, Division of Endocrinology, Diabetology and Metabolism, University of Lausanne, and Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.

Thyroid Eye Disease (TED) is relatively rare but causes significant morbidity, impaired quality of life, and is associated with excess socioeconomic burden. The publication of the Management of Thyroid Eye Disease: A Consensus Statement by the American Thyroid Association and European Thyroid Association is timely, as novel treatments are rapidly evolving, thus expanding treatment options. The key objective was to create a synopsis to promote delivery of evidence-based care for patients with TED, and those at risk of developing it. The task force considered all treatments including new and emerging therapies, striving to adjudicate inconsistencies and identify gaps in the current literature. The available evidence was translated into practical recommendations for endocrinologists. The consensus statement emphasizes the importance of early diagnosis, appropriate and timely referral to specialty care, joint management by clinical teams with expertise in both endocrinology and ophthalmology, and outlines a roadmap to personalized care. It also highlights important areas of future research.

“This outstanding collaborative effort between the European and American Thyroid Associations includes all the latest evidence and clinical experience from renowned international experts.  The result is a superb clinical guide covering the multidisciplinary care of thyroid eye disease that is practical, timely and highly relevant to specialists all over the world,” says Graham R. Williams FRCP, PhD, FMedSci, President of the ETA, Professor of Endocrinology, Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK.

The consensus statement is expected to be a useful reference tool for practicing endocrinologists globally. The consensus statement does not establish a standard of care and specific outcomes are not guaranteed.  Treatment decisions must be made based on the independent judgment of health care providers and each patient’s individual circumstances. A consensus statement is not intended to take the place of physician judgment in diagnosing and treatment of particular patients.

About the American Thyroid Association®

The American Thyroid Association® (ATA) is dedicated to transforming thyroid care through clinical excellence, education, scientific discovery and advocacy in a collaborative and diverse community. ATA® is an international professional medical society with over 1,800 members from 43 countries around the world. The ATA® promotes thyroid awareness and information through Clinical Thyroidology® for the Public, a resource that summarizes research for patients and families, and extensive, authoritative resources on thyroid disease and thyroid cancer in both English and Spanish. The ATA® website www.thyroid.org serves as a bonafide clinical resource for patients and the public who look for reliable thyroid-related information.

About the European Thyroid Association

The European Thyroid Association is a scientific organization, which aims to promote clinical and basic research, provide clinical practice of excellence in thyroid diseases and raise the public level of awareness about thyroid health. The Association was founded in 1965 and has had its Annual Meeting every year since then, with the exception of the years in which the International Thyroid Congress is held. The ETA has 880 members from almost all the European countries and all the continents. The ETA supports research projects with several Grants and is preparing exchange of junior members in overseas laboratories in collaboration with the ATA. Through eurothyroid.com the ETA provides guidance in thyroid disease management and increases understanding among the general population.

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Register today for the ATA’s 2022 Annual Meeting on October 19-23, 2022 in Montreal, Canada.  View the program and make plans to join us in Montreal.

The post ATA 2022 Annual Meeting Registration appeared first on American Thyroid Association.

Register today for the ATA’s 2022 Annual Meeting on October 19-23, 2022 in Montreal, Canada.  View the program and make plans to join us in Montreal.

The post ATA 2022 Annual Meeting Registration appeared first on American Thyroid Association.

Ulla Feldt-Rasmussen, MD, DMSc
University of Copenhagen
Copenhagen, Denmark

October 18, 2021

Endocrine disruptors are chemical pollutants in the environment that can affect the action of endocrine glands, including the thyroid gland. Some are suspected to influence thyroid function negatively, while a direct causative relationship may not have been scientifically verified. This is especially the case with triclosan, a polychloro phenoxy phenol with hormonal disrupting properties and widespread use in toothpaste and cosmetic and household products.

To appreciate that an influence from triclosan can be detrimental to human health, it is important to understand the significance of intact thyroid function, and how triclosan may impair it. The thyroid gland produces primarily thyroxine (T4), which is paramount for metabolism in every single cell and organ by conversion to the metabolically active triiodothyronine (T3). T4 is thus essential for maintenance of optimal organ function, including the brain, heart, bones, and muscles, and it is vital to fetal neurological and cognitive development.

Triclosan is structurally similar to T4, and it is therefore possible that it can interfere with the function of T4 at one or more sites of the thyroid function pathways. Triclosan may potentially result in hypothyroidism in the person who has been directly exposed to it, but it can also potentially indirectly compromise neurodevelopment through placental transfer to the fetus.

So, why is triclosan problematic for human health? Triclosan is a broad spectrum antimicrobial used as an antiseptic, disinfectant or preservative in clinical settings and various consumer products including cosmetics, household cleaning products, plastic materials, toys, paints, etc. It was detected in the urine of 97% of young Danish men in 2013, with a decreasing tendency over 8 years, consistent with Denmark’s restriction of the use of triclosan before the official recommendations. Results from The National Health and Nutrition Examination Survey (NHANES) of a nationally annual representative sample of about 5,000 persons from different places within the USA also demonstrated declined concentrations of triclosan, but the NHANESIII 2019 study measured concentrations three to ten times higher in young Americans compared to young Danes.

Both the FDA and the EU introduced regulations with triclosan limits up to 0.3% due to suspicion of skin reactions, cancer development and hormonal disruption in both humans and animals, but it is unknown if these regulations suffice as thyroid protection. It is also unknown if people living in relative iodine deficient areas and people, mainly women, with a low thyroid reserve such as thyroid autoimmunity are more prone to the negative influence on thyroid function.

It is largely unknown if the rest of the world complies with the levels in FDA and EU regulations, but in China and Vietnam for example, triclosan is measured at very high levels in household dust. This is possibly due to slow leakage from its incorporation onto surfaces of medical devices, plastic materials, textiles, kitchen utensils, etc., intended for a long period of biocidal effect in these household products.

The global threat from triclosan as a thyroid disrupter is therefore not solved. As a traveler or online shopper importing potentially affected products, it is therefore important to bear this in mind. It remains necessary to explore the effects of triclosan in human thyroid health in more detail by both clinical and basic research.

References:
1. https://www.thyroid.org/patient-thyroid-information/ct-for-patients/march-2020/vol-13-issue-3-p-11-12/
2. https://ec.europa.eu/health/scientific_committees/opinions_layman/triclosan/en/l-3/2-uses-cosmetics-disinfectant.htm

Disclaimer:
The ideas and opinions expressed on the ATA Blogs do not necessarily reflect those of the ATA. None of the information posted is intended as medical, legal, or business advice, or advice about reimbursement for health care services. The mention of any product, service, company, therapy or physician practice does not constitute an endorsement of any kind by ATA. ATA assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the material contained in, posted on, or linked to this site, or any errors or omissions.

For more information on Thyroid Topics please visit: https://www.thyroid.org/thyroid-information/

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• Giulia Lanzolla, MD, is a Fellow in the Department of Clinical and Experimental Medicine at the University of Pisa. Lanzolla’s research focuses on are the pathogenesis and treatment of Graves’ Orbitopathy which led her to publication of more than 20 peer-reviewed articles in international journals.  Dr. Lanzolla presented a highlighted oral abstract, “Statins for Graves’ Orbitopathy (STAGO): results of a phase II randomized clinical trial”.
• Victoria Casado-Medrano, PhD, is a Postdoctoral Fellow at Children’s Hospital of Philadelphia. Casado-Medrano’s research focuses on understanding the link between the thyroid hormone signaling and breast cancer progression. She is also studying the molecular mechanisms that fusion proteins such as ETV6-NTRK3 or RET/PTC1 contribute to the development and progression of pediatric papillary thyroid cancer. Dr. Casado-Medrano presented an oral abstract, Interplay Between Thyroid Disfunction and Breast Cancer Tumorigenesis.

“The American Thyroid Association is dedicated to supporting our members’ career development and fostering diversity, equity, and inclusion in the field.  The Women Advancing Thyroid Research Award is an important demonstration of this commitment and enables the American Thyroid Association to recognize our members contribution to advancing science and medicine.  Drs. Lanzolla and Casado-Medrano are emerging leaders in the field and we congratulate them on this well-deserved recognition,” said Jacqueline Jonklaas, MD, PhD, ATA’s Secretary. “We wish them continuing success in their careers”.

The American Thyroid Association thanks Mary Ann Liebert, Inc. and the Rosalind Franklin Society, sponsors of this award.

“These impressive researchers highlight the talent and innovation we are proud to support. Worldwide, from bench to bedside, they have already demonstrated their contributions to science and clinical care,” observes Karla Shepard Rubinger, Executive Director of the Rosalind Franklin Society.

 About the American Thyroid Association®
The American Thyroid Association (ATA) is dedicated to transforming thyroid care through clinical excellence, education, scientific discovery and advocacy in a collaborative and diverse community. ATA® is an international professional medical society with over 1,800 members from 43 countries around the world. The ATA® promotes thyroid awareness and information through Clinical Thyroidology® for the Public, a resource that summarizes research for patients and families, and extensive, authoritative resources on thyroid disease and thyroid cancer in both English and Spanish. The ATA® website www.thyroid.org serves as a bonafide clinical resource for patients and the public who look for reliable thyroid-related information.

About Mary Ann Liebert
Mary Ann Liebert, Inc., publishers is known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research. A complete list of the firm’s more than 90 journals, books, and newsmagazines is available on its website.

 About the Rosalind Franklin Society
The Rosalind Franklin Society recognizes and celebrates the contributions of outstanding women in the life sciences and affiliated disciplines, promotes broadened opportunities for women in the sciences, and through its many activities motivates new generations of women to this calling.  The Society honors the achievements of Rosalind Franklin (1920-1958), a British x-ray crystallographer whose extraordinary work, though largely overlooked and under-appreciated at the time, was crucial to the discovery of DNA’s structure by James Watson and Francis Crick.

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Larry A. Fox, MD
Nemours Children’s Health
Jacksonville, Florida

September 22, 2021

Background
Pediatricians and other practitioners are regularly faced with ordering thyroid function tests (TFTs) in children for a variety of clinical reasons. Sometimes it is a child displaying symptoms suggesting hypothyroidism, development of a goiter, or a decline in growth velocity. It is also common for physicians to order TFTs because the patient is obese, and quite often these thyroid labs are abnormal. With the epidemic of childhood obesity, our clinic is seeing an increasing number of referrals for abnormal TFTs in the setting of obesity. It is important for pediatricians to understand how TFTs are affected by obesity, when thyroid function tests should be ordered, and when a referral is necessary.

The relationship between thyroid function tests and obesity
The effect obesity has on thyroid function has been well documented in adults and children. In most studies, TSH is proportional to BMI. TSH results may be within the assay reference range, but are often slightly above. Thus, it is quite common for obese children (and adults) to have elevated TSH (with slightly increased free or total T3 and normal free T4), suggesting compensated hypothyroidism. In fact, TSH levels are above the reference range in up to 25% of obese children, and several population studies suggest TSH reference ranges need to be adjusted for obesity. Changes in TSH are thought to be mediated by increased leptin causing an increased pituitary release of thyrotropin releasing hormone and a rise in TSH. These changes increase resting energy expenditure and thus are adaptive to the obesity. They do not cause the obesity as evidenced by a decline in TSH with weight loss, either with bariatric surgery (in adults) or lifestyle changes in children and adults.

When should thyroid functions tests be done in an obese child?
Under many clinical circumstances checking TFTs (TSH, free T4) in the setting of obesity is reasonable, such as poor growth, goiter, and/or more specific symptoms suggesting hypothyroidism (such as cold intolerance, generalized dry skin, fatigue or constipation). Simply being overweight or obese (BMI >85th or >95th percentile, respectively) are not symptoms of hypothyroidism and ordering TFTs would not be indicated. Obtaining TFTs in overweight or obese patients without clear indications could lead to unnecessary additional testing, treatment, or referrals. Because the TFT changes are adaptive and do not cause the obesity, treatment is thought not to be necessary.

What should one do if the TSH is abnormal?
If the TSH is elevated above the reference range in an obese individual, the practitioner must decide whether further testing, treatment and/or referral is needed. Because autoimmune disorders are more common in obese individuals, it is reasonable to obtain markers of autoimmune (Hashimoto) thyroiditis (i.e., thyroid peroxidase and thyroglobulin antibody titers). If antibody titers are elevated, referral to a thyroid specialist is reasonable. If the child has a goiter or a nodule is palpable, a thyroid ultrasound would also be informative. If the ultrasound reveals a nodule or cyst, the patient should be referred to a thyroid specialist.
Otherwise, mild elevations in TSH without a goiter do not need treatment and a referral would not be necessary. Instead, rechecking TSH and free T4 in 3-6 months to document the trend in TFTs indicated.

Conclusion
TFTs are commonly abnormal in obese patients, with serum TSH concentrations often above the reference range. These laboratory abnormalities are due to changes in leptin and reflect an adaptation to obesity. Most often the abnormal TFTs do not require treatment. In some circumstances, however, a referral to a thyroid specialist is warranted.

References:
1. Popovic V, Duntas LH. Leptin TRH and ghrelin: influence on energy homeostasis at rest and during exercise. Horm Metab Res. 2005;37:533-7.
2. Reinehr T. Obesity and thyroid function. Mol Cell Endocrinol. 2010;316:165-71.
3. Reinehr T. Thyroid function in the nutritionally obese child and adolescent. Curr Opin Pediatr. 2011;23:415-20.
4. Gertig AM, Niechcial E, Skowrońska B. Thyroid axis alterations in childhood obesity. Pediatr Endocrinol Diabetes Metab. 2012;18:116-9.
5. Valdés S, Maldonado-Araque C, Lago-Sampedro A, et al. Reference values for TSH may be inadequate to define hypothyroidism in persons with morbid obesity: Di@bet.es study. Obesity. 2017;25:788-793.
6. Song R-H, Wang B, Yao Q-M, et al. The impact of obesity on thyroid autoimmunity and dysfunction: a systematic review and meta-analysis. Front Immunol. 2019;10:2349.
7. Gyuricsko E. The “slightly” abnormal thyroid test: What is the pediatrician to do? Curr Probl Pediatr Adolesc Health Care. 2020;50:100770.
8. Oron T, Lazar L, Feldhamer I, et al. Pediatric reference values of TSH should be personalized according to BMI and ethnicity. Eur J Endocrinol. 2020;183:419-426.
9. Tsigalou C, Vallianou N, Dalamaga M. Autoantibody production in obesity: Is there evidence for a link between obesity and autoimmunity? Curr Obes Rep. 2020;9:245-254.
10. Gokosmanoglu F, Aksoy E, Onmez A, et al. Thyroid homeostasis after bariatric surgery in obese Cases. Obes Surg. 2020;30:274-278.
11. Mohareb OA, Saqaaby MA, Ekhzaimy A, et al. The relationship between thyroid function and body composition, leptin, adiponectin, and insulin sensitivity in morbidly obese euthyroid subjects compared to non-obese subjects. Clin Med Insights Endocrinol Diabetes. 2021;14:1179551420988523. eCollection 2021.
12. Aykota MR, Atabey M. Effect of sleeve gastrectomy on thyroid-stimulating hormone levels in morbidly obese patients with normal thyroid function. Eur Rev Med Pharmacol Sci. 2021;25:233-240.

Disclaimer:
The ideas and opinions expressed on the ATA Blogs do not necessarily reflect those of the ATA. None of the information posted is intended as medical, legal, or business advice, or advice about reimbursement for health care services. The mention of any product, service, company, therapy or physician practice does not constitute an endorsement of any kind by ATA. ATA assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the material contained in, posted on, or linked to this site, or any errors or omissions.

For more information on Thyroid Topics please visit: https://www.thyroid.org/thyroid-information/

The post Thyroid Health Blog: Obesity and Thyroid Function Tests in Children appeared first on American Thyroid Association.

Kaniksha Desai, MD, FACE
Stanford University
Palo Alto, CA

August 24, 2021

Thyroid hormone replacement is a critical element in the overall management of patients with thyroid cancer. For a long period of time, aggressive TSH suppression with long-term high doses of thyroid hormone was advocated for all thyroid cancer patients to prevent cancer recurrence by reducing the stimulation of cancer cells. Recently, a growing body of evidence has suggested a limited benefit to aggressive TSH suppression in many patients. In addition, there appears to be significant risks of long-term TSH suppression to cardiovascular health, bone health, and mental health including the development of osteoporosis, atrial fibrillation, and mood disorders, which can significantly impact Quality of Life in thyroid cancer patients. Benefits of preventing cancer recurrence should be balanced with risks of excessive thyroid hormone replacement. Therefore, thyroid hormone replacement should be tailored to provide appropriate levels of TSH suppression based on a dynamic risk stratification in thyroid cancer patients.

Currently best practice for the management of thyroid cancer patients determines individualized thyroid hormone replacement therapy based on risk stratification of cancer recurrence following initial surgery and the patient’s response to subsequent treatment.

After initial surgery, patients are risk-stratified based upon their surgical pathology and extent of tumor metastasis. They are categorized into three groups for their risk of recurrence: low (<5%), intermediate (5-30%) and high (30-50+%). Thyroid hormone replacement is initiated with TSH goals based upon this risk stratification. Low risk patients that have had their cancer completely resected, including lobectomy patients, are given replacement doses to make them euthyroid with a TSH goal of 0.5 to 2.0 mu/L. Intermediate risk patients, often with lymph node involvement, have mild suppression of their TSH with thyroid hormone replacement dosed to a TSH goal of 0.1 to 0.5 mu/L. High risk patients including those who have extensive metastatic disease or incomplete resection are given higher doses of thyroid hormone with a TSH goal of <0.1 mu/L to prevent cancer recurrence.

At subsequent follow up visits, patients are evaluated for their response to overall cancer treatment and are categorized into four groups: 1) excellent response to treatment (no evidence of cancer recurrence), 2) biochemical incomplete response (elevations in thyroglobulin tumor marker levels), 3) structural incomplete response (local or metastatic disease present) or 4) indeterminate response (nonspecific imaging findings or slight elevations in tumor marker levels). Patients with high risk of recurrence, as well as those with structural incomplete response benefit the most from aggressive TSH suppression and are treated accordingly. In patients with excellent response to treatment with no evidence of disease, thyroid hormone treatment can be decreased, even in initially high-risk patients after 5 years. If a patient has a recurrence, then a higher dose of thyroid hormone treatment may be recommended in the future.

In summary, thyroid hormone replacement should be tailored to patients individually based on their initial risk for thyroid cancer recurrence as well as their response to treatment over time to avoid under treatment of high-risk patients and overtreatment of low risk patients. Risk of thyroid cancer growth and recurrence should be balanced with risk of long-term side effects of over-suppression.

References:
1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, 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 Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133.
2. Tarasova VD, Tuttle RM. A Risk-adapted Approach to Follow-up in Differentiated Thyroid Cancer. Rambam Maimonides Med J. 2016 Jan 28;7(1):e0004. doi: 10.5041/RMMJ.10231. PMID: 26886955; PMCID: PMC4737510.
3. Tuttle RM, Alzahrani AS. Risk Stratification in Differentiated Thyroid Cancer: From Detection to Final Follow-up. J Clin Endocrinol Metab. 2019 Mar 15;104(9):4087–100.
4. Grani G, Ramundo V, Verrienti A, Sponziello M, Durante C. Thyroid hormone therapy in differentiated thyroid cancer. Endocrine. 2019 Oct;66(1):43-50.
5. Biondi B, Cooper DS. Thyroid Hormone Suppression Therapy. Endocrinol Metab Clin North Am. 2019 Mar;48(1):227-237.
6. Grani G, Zatelli MC, Alfò M, Montesano T, Torlontano M, Morelli S, Deandrea M, Antonelli A, Francese C, Ceresini G, Orlandi F, Maniglia CA, Bruno R, Monti S, Santaguida MG, Repaci A, Tallini G, Fugazzola L, Monzani F, Giubbini R, Rossetto R, Mian C, Crescenzi A, Tumino D, Pagano L, Pezzullo L, Lombardi CP, Arvat E, Petrone L, Castagna MG, Spiazzi G, Salvatore D, Meringolo D, Solaroli E, Monari F, Magri F, Triggiani V, Castello R, Piazza C, Rossi R, Ferraro Petrillo U, Filetti S, Durante C. Real-World Performance of the American Thyroid Association Risk Estimates in Predicting 1-Year Differentiated Thyroid Cancer Outcomes: A Prospective Multicenter Study of 2000 Patients. Thyroid. 2021 Feb;31(2):264-271.

Disclaimer:
The ideas and opinions expressed on the ATA Blogs do not necessarily reflect those of the ATA. None of the information posted is intended as medical, legal, or business advice, or advice about reimbursement for health care services. The mention of any product, service, company, therapy or physician practice does not constitute an endorsement of any kind by ATA. ATA assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the material contained in, posted on, or linked to this site, or any errors or omissions.

For more information on Thyroid Topics please visit: https://www.thyroid.org/thyroid-information/

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