Clinical Thyroidology for the Public summarizes selected research studies discussed in the previous month’s issue of Clinical Thyroidology, an official publication of the American Thyroid Association. Editor-in-chief, Alan Farwell, MD, FACE
Volume 17 Issue 12
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Clinical Thyroidology for the Public Volume 17 Issue 12 (PDF file, 2.43 MB)
TABLE OF CONTENTS – Web Format
THYROID CANCER
Levothyroxine dosage and the increased risk of second cancer in thyroid cancer survivors
Because of effective treatments, most thyroid cancer patients live long lives after the diagnosis of thyroid cancer even if the cancer is not completely cured. Some studies suggest that thyroid cancer patients have a higher risk of developing second primary cancers (SPCs) compared to the general population. The goal of this study is to evaluate the relationship between the levothyroxine dose and the risk of developing SPCs in thyroid cancer survivors.
Kim MS, et al. Risk of subsequent primary cancers in thyroid cancer survivors according to the dose of levothyroxine: a nationwide cohort study. Endocrinol Metab (Seoul) 2024;39:288-299; doi: 10.3803/EnM.2023.1815. PMID: 38437824.
THYROID NODULES
Can the behavior of thyroid cancer be predicted by the initial biopsy results?
When a patient has a thyroid biopsy, there are 6 potential categories for the result based on their increasing risk of being cancer (Bethesda scoring system). There are no long-term studies on how cancers in each of these Bethesda categories behave. The aim of the study is to separate cancers into categories based on their initial Bethesda category and monitor how each of the cancer in each category behaves.
Endo M et al. Indolent behavior of malignant Bethesda III nodules compared to Bethesda V/VI nodules. J Clin Endocrinol Metab 2024;109(9):2317-2324; doi: 10.1210/ clinem/dgae108. PMID: 38415340.
THYROID CANCER
Surgery to remove only part of the thyroid for treatment of thyroid cancer is becoming more common: is this a safe option?
In the past, the most common way to treat thyroid cancer was a total thyroidectomy. However, the 2015 ATA thyroid cancer guidelines recommend lobectomy as an option for people undergoing surgery for thyroid cancer. The authors of the study described here further address whether thyroid lobectomy is an acceptable treatment for thyroid cancer by comparing the risk of thyroid cancer recurrence between people undergoing total thyroidectomy and people having a thyroid lobectomy.
Kheng M, et al. Reoperation rates after initial thyroid lobectomy for patients with thyroid cancer: a national cohort study. Thyroid. Epub Jul 25 2024; doi: 10.1089/ thy.2024.0128. PMID: 39049736.
HYPOTHYROIDISM
Use of proton pump inhibitors and levothyroxine
Proton-pump inhibitors (PPIs) lower the amount of acid the stomach makes and are an effective treatment for reflux disease. Because of the decrease in the stomach acid, the levothyroxine pill may not be dissolved completely and the absorption of the levothyroxine may be decreased. In this study, the authors wanted to find out if PPIs also affect the absorption of liquid levothyroxine.
Seng Yue C et al. Proton pump inhibitors do not affect the bioavailability of a novel liquid formulation of levothyroxine. Endocr Pract 2024;30(6):513-520; doi: 10.1016/j. eprac.2024.03.388. PMID: 38554774.
THYROIDITIS
Combination cancer immunotherapy drugs for non-thyroid cancer increase the risk of thyroiditis.
New drugs that use the body’s immune system to attack cancer, called immunotherapy, have been a major breakthrough in treating non-thyroid cancer. These drugs do have a side effect of occasionally attacking the thyroid, causing autoimmune thyroiditis and hypothyroidism. This study examined the frequency, and clinical characteristics of thyroid problems caused by combination therapy cancer immunotherapy drugs.
Kobayashi T et al. Combined use of tyrosine kinase inhibitors with PD-(L)1 blockade increased the risk of thyroid dysfunction in PD-(L)1 blockade: a prospective study. Cancer Immunol Immunother 2024;73(8):146; doi: 10.1007/ s00262-024-03733-2. PMID: 38833157.
GRAVES’ DISEASE
One in six patients with Graves’ disease will develop another autoimmune disease— why knowing about polyautoimmunity is important
Autoimmune diseases often “cluster” in patients, meaning that having one autoimmune disease increases the likelihood of developing another. Thus, patients with Graves’ disease are more likely to develop another autoimmune disease unrelated to the thyroid. This study examined the risk of developing other autoimmune diseases in people who already have Graves’ disease.
Sohn SY, et al. Risk of non-thyroidal autoimmune diseases in patients with Graves’ disease: a nationwide retrospective cohort study. Rheumatology (Oxford). Epub 2024 Jan 5.
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