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Horm Metab Res 2023; 55(06): 379-387
DOI: 10.1055/a-2084-3408
Original Article: Endocrine Care

Cardiovascular Outcomes of Differentiated Thyroid Cancer Patients on Long Term TSH Suppression: A Systematic Review and Meta-Analysis

Jerry Yu
1   Sydney Medical School, The University of Sydney, Sydney, Australia
,
Rajneesh Kaur
1   Sydney Medical School, The University of Sydney, Sydney, Australia
,
Femi Emmanuel Ayeni 
2   Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, Sydney, Australia
,
Guy D. Eslick
1   Sydney Medical School, The University of Sydney, Sydney, Australia
,
Senarath Edirimanne
3   Dept of Surgery, Nepean Hospital, Penrith, Australia
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Abstract

We performed a systematic review and meta-analysis of the literature regarding cardiovascular outcomes of differentiated thyroid cancer (DTC) patients who are on long term thyroid stimulating hormone suppression. Searches were carried out using Prisma guidelines in Medline, Embase, CENTRAL, CINAHL and Scopus databases. Eligible papers were those which investigated discrete cardiovascular clinical outcomes in TSH suppressed patients and meta-analysis of selected studies was performed using Revman 5.4.1. We found a total of 195 879 DTC patients with median length to follow up of 8.6 years (range 5–18.8 years). Analysis showed DTC patients to be at higher risk of atrial fibrillation (HR 1.58, 95% CI 1.40, 1.77), stroke (HR 1.14, 95% CI 1.09, 1.20) and all-cause mortality (HR 2.04, 95% CI 1.02, 4.07). However, there was no difference in risk of heart failure, ischemic heart disease or cardiovascular mortality. These findings suggest that degree of TSH suppression must be titrated to accommodate risk of cancer recurrence and cardiovascular morbidity.

Key words

TSH suppression - cardiovascular disease - thyroid malignancy - heart disease - thyroid cancer

Supplementary Material



Publication History

Received: 25 October 2022

Accepted after revision: 21 April 2023

Article published online:
09 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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