분화갑상선암 수술 후 갑상선자극호르몬 억제요법과 골다공증
TSH Suppression after Differentiated Thyroid Cancer Surgery and Osteoporosis
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초록
Thyroid stimulating hormone (TSH) suppression therapy has been known to play an important role in lowering the risk of recurrence after surgery for differentiated thyroid carcinoma. Osteoporosis is a major complication of TSH suppression. The purpose of this study is to review the current thyroid stimulating hormone suppression therapy and osteoporosis risk and examine the proper TSH suppression after surgery for patients with differentiated thyroid cancer. Previous studies and current guidelines on TSH suppression and osteoporosis were collected from databases in Korea and other countries and reviewed. According to the recommendations of the Korean Thyroid Association in 2010, initial TSH suppression to below 0.1 mU/L is recommended for high-risk and intermediate-risk thyroid cancer patients, while TSH level at or slightly below the lower limit of normal (0.1∼0.5 mU/L) is appropriate for low-risk patients. During follow-up, in patients with persistent disease, the serum TSH should be maintained below 0.1 mU/L indefinitely in the absence of specific contraindications, while in patients free of disease, especially those at low risk for recurrence, the serum TSH may be kept within the low normal range (0.3∼2 mU/L). In 2015, the American Thyroid Association recommended revised guidelines considering the initial ATA risk classification, Tg level, Tg trend over time, and risk of TSH suppression during the long term follow-up period. Appropriate recommendations considering the risk stratification of thyroid cancer and adverse effects of TSH suppression are required to improve the survival of differentiated thyroid cancer patients and minimize the adverse effects of long-term therapy.
Abstract
Thyroid stimulating hormone (TSH) suppression therapy has been known to play an important role in lowering the risk of recurrence after surgery for differentiated thyroid carcinoma. Osteoporosis is a major complication of TSH suppression. The purpose of this study is to review the current thyroid stimulating hormone suppression therapy and osteoporosis risk and examine the proper TSH suppression after surgery for patients with differentiated thyroid cancer. Previous studies and current guidelines on TSH suppression and osteoporosis were collected from databases in Korea and other countries and reviewed. According to the recommendations of the Korean Thyroid Association in 2010, initial TSH suppression to below 0.1 mU/L is recommended for high-risk and intermediate-risk thyroid cancer patients, while TSH level at or slightly below the lower limit of normal (0.1∼0.5 mU/L) is appropriate for low-risk patients. During follow-up, in patients with persistent disease, the serum TSH should be maintained below 0.1 mU/L indefinitely in the absence of specific contraindications, while in patients free of disease, especially those at low risk for recurrence, the serum TSH may be kept within the low normal range (0.3∼2 mU/L). In 2015, the American Thyroid Association recommended revised guidelines considering the initial ATA risk classification, Tg level, Tg trend over time, and risk of TSH suppression during the long term follow-up period. Appropriate recommendations considering the risk stratification of thyroid cancer and adverse effects of TSH suppression are required to improve the survival of differentiated thyroid cancer patients and minimize the adverse effects of long-term therapy.
참고문헌 (32)
- Yi KH, "Revised Korean thyroid association management guidelines for patients with thyroid nodules and thyroid cancer", Korean J Otorhinolaryngol-Head Neck Surg, 54, pp.8~36 (2011)
- American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 19, pp.1167~1214 (2009)
- Haugen BR, "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, 26, pp.1~133 (2016)
- Cooper DS, "Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: results from the National Thyroid Cancer Treatment Cooperative Registry", Thyroid, 8, pp.737~744 (1998)
- McGriff NJ, "Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer", Ann Med, 34, pp.554~564 (2002)
- Pujol P, "Degree of thyrotropin suppression as a prognostic determinant in differentiated thyroid cancer", J Clin Endocrinol Metab, 81, pp.4318~4323 (1996)
- Toft AD, "Clinical practice. Subclinical hyperthyroidism", N Engl J Med, 345, pp.512~516 (2001)
- Vestergaard P, "Fracture risk in patients treated for hyperthyroidism", Thyroid, 10, pp.341~348 (2000)
- Kalra S, "Subclinical thyroid dysfunction does not affect one-year mortality in elderly patients after hip fracture: a prospective longitudinal study", Injury, 41, pp.385~387 (2010)
- Heijckmann AC, "Hip bone mineral density, bone turnover and risk of fracture in patients on long-term suppressive L-thyroxine therapy for differentiated thyroid carcinoma", Eur J Endocrinol, 153, pp.23~29 (2005)
- Franklyn JA, "Mortality after the treatment of hyperthyroidism with radioactive iodine", N Engl J Med, 338, pp.712~718 (1998)
- Ross DS, "Hyperthyroidism, thyroid hormone therapy, and bone", Thyroid, 4, pp.319~326 (1994)
- Mosekilde L, "Effects of thyroid hormones on bone and mineral metabolism", Endocrinol Metab Clin North Am, 19, pp.35~63 (1990)
- Solomon BL, "Prevalence of fractures in postmenopausal women with thyroid disease", Thyroid, 3, pp.17~23 (1993)
- Ongphiphadhanakul B, "Excessive L-thyroxine therapy decreases femoral bone mineral densities in the male rat: effect of hypogonadism and calcitonin", J Bone Miner Res, 7, pp.1227~1231 (1992)
- Abe E, "TSH is a negative regulator of skeletal remodeling", Cell, 115, pp.151~162 (2003)
- Bassett JH, "Thyroid hormone excess rather than thyrotropin deficiency induces osteoporosis in hyperthyroidism", Mol Endocrinol, 21, pp.1095~1107 (2007)
- 이미영, "Bone mineral density and bone turnover markers in patients on long-term suppressive levothyroxine therapy for differentiated thyroid cancer", 대한외과학회지, 86(2), pp.55~60 (2014), 대한외과학회
- Larijani B, "Effects of levothyroxine suppressive therapy on bone mineral density in premenopausal women", J Clin Pharm Ther, 29, pp.1~5 (2004)
- Reverter JL, "Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma", Endocr Relat Cancer, 12, pp.973~981 (2005)
- Marcocci C, "Carefully monitored levothyroxine suppressive therapy is not associated with bone loss in premenopausal women", J Clin Endocrinol Metab, 78, pp.818~823 (1994)
- Jódar E, "Bone changes in pre- and postmenopausal women with thyroid cancer on levothyroxine therapy: evolution of axial and appendicular bone mass", Osteoporos Int, 8, pp.311~316 (1998)
- Kung AW, "Prevention of bone loss induced by thyroxine suppressive therapy in postmenopausal women: the effect of calcium and calcitonin.", J Clin Endocrinol Metab, 81, pp.1232~1236 (1996)
- Kim MK, "The effects of thyrotropin-suppressing therapy on bone metabolism in patients with well-differentiated thyroid carcinoma", Bone, 71, pp.101~105 (2015)
- Mazokopakis EE, "Changes of bone mineral density in pre-menopausal women with differentiated thyroid cancer receiving L-thyroxine suppressive therapy", Curr Med Res Opin, 22, pp.1369~1373 (2006)
- Mohammadi B, "Modeling the effect of levothyroxine therapy on bone mass density in postmenopausal women: a different approach leads to new inference", Theor Biol Med Model, 4, pp.23~ (2007)
- 김채원, "Change of Bone Mineral Density and Biochemical Markers of Bone Turnover in Patients on Suppressive Levothyroxine Therapy for Differentiated Thyroid Carcinoma", 대한골대사학회지, 22(3), pp.135~141 (2015), 대한골대사학회[DOI]
- Heemstra KA, "The effects of thyrotropin-suppressive therapy on bone metabolism in patients with well-differentiated thyroid carcinoma", Thyroid, 16, pp.583~591 (2006)
- Flynn RW, "Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy", J Clin Endocrinol Metab, 95, pp.186~193 (2010)
- Bauer DC, "Risk for fracture in women with low serum levels of thyroid-stimulating hormone", Ann Intern Med, 134, pp.561~568 (2001)
- 고영진, "Levothyroxine Dose and Fracture Risk According to the Osteoporosis Status in Elderly Women", 예방의학회지, 47(1), pp.36~46 (2014), 대한예방의학회
- Biondi B, "Benefits of thyrotropin suppression versus the risks of adverse effects in differentiated thyroid cancer", Thyroid, 20, pp.135~146 (2010)