High Serum Levels of Thyroid-Stimulating Hormone and Sustained Weight Gain in Patients with Thyroid Cancer Undergoing Radioiodine Therapy
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Objectives: The extent of weight gain and its association with clinical factors in patients undergoing radioiodine therapy for differentiated thyroid cancer remain unclear. We analyzed clinical factors related to sustained weight gain after serum thyroid-stimulating hormone (TSH) stimulation for radioiodine (I-131) therapy. Materials and Methods: The study population included 301 adult patients who underwent total thyroidectomy followed by radioiodine therapy and visited the thyroid clinic regularly. Group 1 received a single radioiodine therapy treatment, while group 2 received multiple radioiodine treatment. Data on transient weight gain, defined as weight gain that resolved (±5%) within 1 year after radioiodine therapy, were collected from medical records. Sustained weight gain was defined as body mass index after treatment (BMIpost) – BMI before treatment (BMIpre) ≥2 kg/m2 more than 1 year following radioiodine therapy. Subjective symptoms were scored by questionnaire. Logistic regression analysis was performed using various clinical and laboratory factors to identify risk factors associated with sustained weight gain. Results: Two hundred and fifty-nine (86%) patients showed transient weight gain and 23 (8%) patients showed sustained weight gain. TSH at therapy and T4-on TSH differed significantly in all patients and in the patients in group 1 with sustained weight gain. The proportion of patients with basal BMI≥25 kg/m2 in group 1 with sustained weight gain also differed significantly. Univariate analysis revealed that high serum levels of TSH at therapy (≥100 μIU/mL) and hypercholesterolemia were associated with sustained weight gain in group 1. Multivariate analysis showed that TSH at therapy levels ≥100 μIU/mL was associated with sustained weight gain in group 1. Of 283 patients remaining after excluding those with insufficient TSH suppression during follow-up, T4-on TSH levels were lower in the sustained weight gain group compared to those without sustained weight gain. TSH at therapy levels ≥100 μIU/mL were significantly associated with sustained weight gain in multivariate analysis. Conclusion: Most patients (86%) had transient weight gain after TSH at therapy, while 8% of patients showed sustained weight gain. Univariate and multivariate analysis revealed relatively high TSH levels (≥100 μIU/mL) to be a risk factor for patients that received a single dose of radioiodine therapy. Insufficient T4 dose was not associated with sustained weight gain.
Abstract
Background and Objectives: The extent of weight gain and its association with clinical factors in patients undergoing radioiodine therapy for differentiated thyroid cancer remain unclear. We analyzed clinical factors related to sustained weight gain after serum thyroid-stimulating hormone (TSH) stimulation for radioiodine (I-131) therapy. Materials and Methods: The study population included 301 adult patients who underwent total thyroidectomy followed by radioiodine therapy and visited the thyroid clinic regularly. Group 1 received a single radioiodine therapy treatment, while group 2 received multiple radioiodine treatment. Data on transient weight gain, defined as weight gain that resolved (±5%) within 1 year after radioiodine therapy, were collected from medical records. Sustained weight gain was defined as body mass index after treatment (BMIpost) – BMI before treatment (BMIpre) ≥2 kg/m2 more than 1 year following radioiodine therapy. Subjective symptoms were scored by questionnaire. Logistic regression analysis was performed using various clinical and laboratory factors to identify risk factors associated with sustained weight gain. Results: Two hundred and fifty-nine (86%) patients showed transient weight gain and 23 (8%) patients showed sustained weight gain. TSH at therapy and T4-on TSH differed significantly in all patients and in the patients in group 1 with sustained weight gain. The proportion of patients with basal BMI≥25 kg/m2 in group 1 with sustained weight gain also differed significantly. Univariate analysis revealed that high serum levels of TSH at therapy (≥100 μIU/mL) and hypercholesterolemia were associated with sustained weight gain in group 1. Multivariate analysis showed that TSH at therapy levels ≥100 μIU/mL was associated with sustained weight gain in group 1. Of 283 patients remaining after excluding those with insufficient TSH suppression during follow-up, T4-on TSH levels were lower in the sustained weight gain group compared to those without sustained weight gain. TSH at therapy levels ≥100 μIU/mL were significantly associated with sustained weight gain in multivariate analysis. Conclusion: Most patients (86%) had transient weight gain after TSH at therapy, while 8% of patients showed sustained weight gain. Univariate and multivariate analysis revealed relatively high TSH levels (≥100 μIU/mL) to be a risk factor for patients that received a single dose of radioiodine therapy. Insufficient T4 dose was not associated with sustained weight gain.
참고문헌 (32)
- Wartofsky L, "Radioiodine treatment of well-differentiated thyroid cancer", Endocrine, 42(3), pp.506~513 (2012)
- Handkiewicz-Junak D, "Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer", J Nucl Med, 48(6), pp.879~888 (2007)
- Sohn SY, "Weight changes in patients with differentiated thyroid carcinoma during postoperative long-term follow-up under thyroid stimulating hormone suppression", Endocrinol Metab (Seoul), 30(3), pp.343~351 (2015)
- Ik Dong Yoo, "The Success Rate of Initial 131I Ablation in Differentiated Thyroid Cancer: Comparison Between Less Strict and Very Strict Low Iodine Diets", Nuclear Medicine and Molecular Imaging, 46(1), pp.34~40 (2012), 대한핵의학회
- Goh VH, "Are BMI and other anthropometric measures appropriate as indices for obesity? A study in an Asian population", J Lipid Res, 45(10), pp.1892~1898 (2004)
- Virdis A, "Microvascular endothelial dysfunction in obesity and hypertension", Curr Pharm Des, 19(13), pp.2382~2389 (2013)
- Forte V, "Obesity, diabetes, the cardiorenal syndrome, and risk for cancer", Cardiorenal Med, 2(2), pp.143~162 (2012)
- Jee SH, "Body mass index and cancer risk in Korean men and women", Int J Cancer, 123(8), pp.1892~1896 (2008)
- Wang YC, "Health and economic burden of the projected obesity trends in the USA and the UK", Lancet, 378(9793), pp.815~825 (2011)
- Fagour C, "Low physical activity in patients with type 2 diabetes: the role of obesity", Diabetes Metab, 39(1), pp.85~87 (2013)
- Haslam DW, "Obesity", Lancet, 366(9492), pp.1197~1209 (2005)
- Rathi MS, "Weight gain during the treatment of thyrotoxicosis using conventional thyrostatic treatment", J Endocrinol Invest, 31(6), pp.505~508 (2008)
- Brunova J, "Weight gain in patients after therapy for hyperthyroidism", S Afr Med J, 93(7), pp.529~531 (2003)
- Pears J, "Long-term weight changes in treated hyperthyroid and hypothyroid patients", Scott Med J, 35(6), pp.180~182 (1990)
- Watts MR, "Weight gain and treatment for thyrotoxicosis", QJM, 95(1), pp.57~58 (2002)
- Jonklaas J, "Weight changes in euthyroid patients undergoing thyroidectomy", Thyroid, 21(12), pp.1343~1351 (2011)
- Giuffrida FM, "Heterogeneous behavior of lipids according to HbA1c levels undermines the plausibility of metabolic syndrome in type 1 diabetes: data from a nationwide multicenter survey", Cardiovasc Diabetol, 11, pp.156~ (2012)
- Sorisky A, "TSH receptor in adipose cells", Horm Metab Res, 32(11-12), pp.468~474 (2000)
- Bell A, "Functional TSH receptor in human abdominal preadipocytes and orbital fibroblasts", Am J Physiol Cell Physiol, 279(2), pp.C335~C340 (2000)
- Murakami M, "Thyrotropin receptors in brown adipose tissue: thyrotropin stimulates type II iodothyronine deiodinase and uncoupling protein-1 in brown adipocytes", Endocrinology, 142(3), pp.1195~1201 (2001)
- Davies T, "The TSH receptor reveals itself", J Clin Invest, 110(2), pp.161~164 (2002)
- Lu S, "Role of extrathyroidal TSHR expression in adipocyte differentiation and its association with obesity", Lipids Health Dis, 11, pp.17~ (2012)
- Ambrosi B, "Relationship of thyroid function with body mass index and insulin-resistance in euthyroid obese subjects", J Endocrinol Invest, 33(9), pp.640~643 (2010)
- de Lloyd A, "TSH receptor activation and body composition", J Endocrinol, 204(1), pp.13~20 (2010)
- Valyasevi RW, "Differentiation of human orbital preadipocyte fibroblasts induces expression of functional thyrotropin receptor", J Clin Endocrinol Metab, 84(7), pp.2557~2562 (1999)
- Crisp M, "Adipogenesis in thyroid eye disease", Invest Ophthalmol Vis Sci, 41(11), pp.3249~3255 (2000)
- Starkey KJ, "Adipose thyrotrophin receptor expression is elevated in Graves' and thyroid eye diseases ex vivo and indicates adipogenesis in progress in vivo", J Mol Endocrinol, 30(3), pp.369~380 (2003)
- Arora S, Anubhuti, "Role of neuropeptides in appetite regulation and obesity--a review", Neuropeptides, 40(6), pp.375~401 (2006)
- Valcavi R, "Influence of thyroid status on serum immunoreactive leptin levels", J Clin Endocrinol Metab, 82(5), pp.1632~1634 (1997)
- Kapadia KB, "Association between altered thyroid state and insulin resistance", J Pharmacol Pharmacother, 3(2), pp.156~160 (2012)
- Sun Y, "Ghrelin stimulation of growth hormone release and appetite is mediated through the growth hormone secretagogue receptor", Proc Natl Acad Sci U S A, 101(13), pp.4679~4684 (2004)
- Gimenez-Palop O, "Circulating ghrelin in thyroid dysfunction is related to insulin resistance and not to hunger, food intake or anthropometric changes", Eur J Endocrinol, 153(1), pp.73~79 (2005)