Age-based factors modulating the required thyroxine dose to achieve thyrotropin suppression in intermediate-and high-risk papillary thyroid cancer

• Published in: Frontiers in endocrinology (Lausanne) 2023-06, Vol.14, p.1126592-1126592
• Main Authors: Zhou, Ruo-Yun, Li, Ning, Tan, Hai-Long, Tang, Neng, Chen, Pei, Liu, Mian, Ou-Yang, Deng-Jie, Qin, Zi-En, Ai, Lei, Wei, Bo, Zhao, Ya-Xin, Chang, Shi, Huang, Peng
• Format: Article
• Language: English
• Subjects: age stratification; Aged; Antineoplastic Agents; Endocrinology; Humans; individualized medication regimens; intermediate-and high-risk differentiated thyroid cancer; Middle Aged; Retrospective Studies; thyroid cancer; Thyroid Cancer, Papillary - surgery; Thyroid Neoplasms - drug therapy; Thyroid Neoplasms - surgery; Thyrotropin; thyrotropin suppression; Thyroxine
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2023.1126592

Guidelines widely recommend thyrotropin suppression to reduce the risk of recurrence in intermediate- and high-risk papillary thyroid cancer (PTC) after total thyroidectomy. However, an insufficient or excessive dosage may result in a number of symptoms/complications especially in older patients. We constructed a retrospective cohort including 551 PTC patient encounters. Using propensity score matching and logistic regression models, we determined the independent risk factors affecting levothyroxine therapy at different ages. Our outcomes included: expected TSH level and an unexpected TSH level, which was based on the initial thyroid-stimulating hormone (TSH) goal< 0.1 mIU/L with usual dosage of L-T4 (1.6 μg/kg/day). From our analysis, more than 70% of patients undergoing total thyroidectomy did not achieve the expected TSH level using an empirical medication regimen, and the effect of the drug was affected by age (odds ratio [OR], 1.063; 95% CI, 1.032-1.094), preoperative TSH level (OR, 0.554; 95% CI, 0.436-0.704) and preoperative fT3 level (OR, 0.820; 95% CI, 0.727-0.925). In patients with age < 55 years old, preoperative TSH level (OR, 0.588; 95% CI, 0.459-0.753), and preoperative fT3 level (OR, 0.859; 95% CI, 0.746-0.990) were two independent protective factors, while, in patients with age ≥ 55 years old, only preoperative TSH level (OR, 0.490; 95% CI, 0.278-0.861) was the independent protective factors to achieve expected TSH level. Our retrospective analysis suggested the following significant risk factors of getting TSH suppression in PTC patients: age (≥55 years), lower preoperative TSH and fT3 levels.