Current recommendations for levothyroxine treatment of differentiated thyroid cancer patients are not properly implemented in clinical practice

• Published in: Journal of endocrinological investigation Vol. 35; no. 10; pp. 901 - 904
• Main Authors: de Almeida, J. F. Martins, Tsumura, W. Gonçalves, Vaisman, M., Assumpção, L. V. Montalli, Ward, L. S.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.11.2012; Springer Nature B.V
• Subjects: Biomarkers, Tumor - metabolism; Cardiovascular diseases; Cell Differentiation; Choice Behavior; Clinical medicine; Endocrinology; Female; Follow-Up Studies; Fractures; Humans; Male; Medication Adherence - psychology; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Morbidity; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - metabolism; Neoplasm Recurrence, Local - psychology; Original Article; Patients; Practice Guidelines as Topic; Prognosis; Risk assessment; Risk Factors; Thyroglobulin; Thyroglobulin - metabolism; Thyroid cancer; Thyroid Neoplasms - drug therapy; Thyroid Neoplasms - metabolism; Thyroid Neoplasms - psychology; Thyroid-stimulating hormone; Thyrotropin - metabolism; Thyroxine; Thyroxine - therapeutic use; collateral effects; levothyroxine; tumor control; Adequate treatment; adherence
• ISSN: 0391-4097; 1720-8386
• DOI: 10.3275/8369

Background: Levothyroxine (L-T 4 ) treatment aims to minimize the risk of differentiated thyroid cancer (DTC) recurrence and should be tailored to patient risk stratification and potential morbidity from adverse effects. Aim: To evaluate the effectiveness of current recommendations on L-T 4 treatment of DTC patients in clinical practice. Material and methods: We submitted to in-person interviews and revised the charts of 139 low-risk (LR) and 57 not-low-risk (NLR) DTC patients. A second evaluation made 24–60 months after surgery reclassified 131 patients who maintained (thyroglobulin) Tg≤2 ng/dl with no evidence of relapse/recurrence as LR, whereas the remaining 65 cases were considered NLR. Results: Only 27% LR patients were appropriately controlled; 18% were kept suppressed; 49% maintained serum TSH levels between 0.11–0.4 mU/l; 21% had TSH=2.5–4.5 mU/l; and 12% TSH>4.5 mU/l. Among the NLR patients. 24 (37%) of the patients presented serum TSH levels above goal, including 13 (20%) patients with TSH>4.5 mU/l. There were 4 NLR elders whose TSH levels were kept between 0.41 and 4.5 for medical reasons; likewise, 28 NLR patients maintained with low but not undetectable serum TSH levels had cardiovascular and/or bone risk factors, but all the remaining 24 NLR patients were not adequately controlled because of poor treatment compliance. On the other hand, 45% of 152 inappropriately controlled patients presented risks for bone fractures, including 33 patients kept with low serum TSH levels without medical indication. Conclusion: We concluded that guidelines are not adequately applied and alternative strategies aiming to increase adherence are urgently needed for DTC patients.