Perspective from Maria Papaleontiou, MD
Disclosures: The authors report no relevant financial disclosures.
September 02, 2021
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Thyroidectomy tied to CV complications after cancer diagnosis

Perspective from Maria Papaleontiou, MD
Disclosures: The authors report no relevant financial disclosures.
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Adults with differentiated thyroid cancer who undergo thyroidectomy are at increased risks for atrial fibrillation, cardiovascular disease, increased heart rate and left ventricular mass development, data from a review show.

“Once differentiated thyroid cancer is diagnosed, the patient undergoes thyroidectomy, followed by thyroid-stimulating hormone suppression therapy and/or radioactive iodine therapy, depending on the risk stratification,” Eun-Kyung Lee, MD, PhD, specialist in the division of endocrinology and metabolism at the National Cancer Center Korea, and colleagues wrote in the study background. “TSH suppression by exogenous thyroid hormone replacement is widely recommended to prevent cancer recurrence in patients with high-risk differentiated thyroid cancer, despite the risk of TSH suppression on CVD. An increased risk of atrial fibrillation in patients with differentiated thyroid cancer was suggested by a recently published meta-analysis. However, the risk of thyroid hormone supplementation in patients with differentiated thyroid cancer for CVD other than atrial fibrillation has not been established yet.”

Adults with differentiated thyroid cancer who undergo a thyroidectomy have an increased risk for atrial fibrillation, coronary artery disease, cerebrovascular accident and all-cause mortality compared with healthy controls. Data were derived from Lee EK, et al. J Clin Endocrinol Metab. 2021;doi:10.1210clinem/dgab576. 

In a meta-analysis, researchers analyzed data from 18 observational studies assessing associations between differentiated thyroid cancer (DTC) and CV outcomes, excluding those that evaluated CVD as a comorbidity before any DTC diagnosis and those that used active surveillance without thyroidectomy or TSH suppression therapy as an intervention (193,320 cases and 225,575 healthy controls). Risk estimates were pooled using random- and fixed-effects models when three or more studies reported on the outcome of interest. Echocardiographic and hemodynamic parameters were examined.

Researchers found that thyroidectomy after DTC was associated with an increased risk for atrial fibrillation, with a pooled RR of 1.55 (95% CI, 1.3-1.84), coronary artery disease (RR = 1.1; 95% CI, 1-1.21), cerebrovascular accidents (RR = 1.15; 95% CI, 1.09-1.2), and all-cause mortality (RR = 1.95; 95% CI, 1.03-3.69).

Thyroidectomy after DTC was also associated with higher diastolic blood pressure, with a standardized mean difference (SMD) of 0.22 (95% CI, 0.01-0.42), heart rate (SMD = 0.37; 95 CI, 0.17-0.57), left ventricular mass index (SMD = 0.66; 95% CI, 0.45-0.88), interventricular septal thickness (SMD = 0.91; 95% CI, 0.33-1.49) and lower early to late ventricular filling velocities (SMD = –0.42; 95 CI, –0.79 to –0.05). Thyroidectomy after DTC was not associated with ejection fraction.

“In this study, patients with DTC had a higher risk of developing atrial fibrillation than the general population and a faster heart rate, consistent with the previous studies,” the researchers wrote. “Interestingly, there was also an increased risk of CAD and cerebrovascular accidents in patients with DTC. However, hypothyroidism is also a risk factor for CAD or cerebrovascular accidents due to atherosclerosis. One possible explanation is the imbalance between thyroxine ... and triiodothyronine ... due to altered deiodinase activity in athyreotic patients.”

The researchers cautioned that the data were retrospective; prospective studies with long-term follow-up are needed to assess CV outcomes and mortality rates.