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This version published online on April 10, 2007
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-2566
A more recent version of this article appeared on July 1, 2007
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Submitted on November 22, 2006
Accepted on April 2, 2007

Associations of Serum Thyrotropin Concentrations with Recurrence and Death in Differentiated Thyroid Cancer

Guido C. Hovens, Marcel P. Stokkel, Job Kievit, Eleonora P. Corssmit, Alberto M. Pereira, Johannes A. Romijn, and Johannes W.A. Smit*

Departments of Endocrinology and Metabolic Diseases, Nuclear Medicineand Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands

* To whom correspondence should be addressed. E-mail: jwasmit{at}lumc.nl.

Objective: The relation between serum TSH levels and risk for recurrence or thyroid carcinoma related death in patients with differentiated thyroid carcinoma (DTC) has only been studied to a limited extent.

Design: Single-centre observational study in 366 consecutive patients with DTC, who had all been treated according to the same protocol for initial therapy and follow-up. Median duration of follow-up was 8.85 years.

Methods: The relation between summarizing variables of unstimulated serum TSH concentrations (25th, 50th 75th percentiles, the percentage of suppressed and unsuppressed TSH values) and risk for recurrence or thyroid carcinoma related death was analyzed by Cox survival analyses in patients with at least 4 TSH measurements.

Results: In Cox-regression analysis, we found a positive association between serum TSH concentrations and risk for thyroid carcinoma related death and relapse, even in initially cured patients. The median of the individual TSH concentrations was the best indicator for thyroid carcinoma related death (hazard ratio (HR): 2.03 (confidence interval (CI): 1.22 - 3.37) and relapse 1.41 (C.I. 1.03 - 1.95). A threshold of 2 mU/L differentiated best between relapse free survival and thyroid carcinoma related death or relapse.

Conclusion: Our study supports current guidelines, which advise to aim at TSH levels in the low normal range in cured low risk patients, whereas TSH levels should be suppressed in non-cured or high-risk patients.




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