Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
Tipotie Health Centre, Social and Health Services, City of Tampere, Tampere, Finland.
Clin Endocrinol (Oxf). 2018 Feb;88(2):303-310. doi: 10.1111/cen.13519. Epub 2017 Dec 14.
Thyroid hormone suppression therapy has been widely used in the treatment of thyroid cancer, but concerns have been raised about the cardiovascular risks of this treatment. The objective of this study was to evaluate long-term cardiovascular morbidity and mortality in patients treated for differentiated thyroid cancer (DTC) and to assess the effect of TSH suppression and radioiodine (RAI) treatment on the cardiovascular outcome.
Retrospective cohort study.
Patients (n = 901) treated for DTC between 1981 and 2002 at 2 Finnish University hospitals were compared with a randomly chosen reference group (n = 4485) matched for age, gender and the place of residence. Kaplan-Meier and Cox regression analyses were used to estimate the risk of morbidity or death due to different cardiovascular diseases (CVD) after the diagnosis of DTC.
Morbidity due to any CVD (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.05-1.28) and due to all arrhythmias (HR 1.25, CI 1.06-1.48) and atrial fibrillation (AF) (HR 1.29, CI 1.06-1.57) was more frequent in the DTC patients than in the controls. The increased cardiovascular morbidity was confined to patients with a mean TSH level below 0.1 mU/L (HR 1.27, CI 1.03-1.58) and to those treated with RAI (HR 1.18, CI 1.05-1.31). Cardiovascular mortality, however, was lower among the patients than the controls (HR 0.73, CI 0.58-0.92), due to a lower mortality from coronary artery disease.
Differentiated thyroid cancer patients have an increased CVD morbidity, which is mostly accountable to AF and to TSH suppression below 0.1 mU/L.
甲状腺激素抑制疗法已广泛应用于甲状腺癌的治疗，但人们对这种治疗方法的心血管风险提出了担忧。本研究的目的是评估分化型甲状腺癌（DTC）患者接受长期治疗后的心血管发病率和死亡率，并评估促甲状腺激素（TSH）抑制和放射性碘（RAI）治疗对心血管结局的影响。
回顾性队列研究。
比较了 1981 年至 2002 年间在芬兰两家大学医院接受 DTC 治疗的 901 名患者（n=901）与随机选择的参考组（n=4485），参考组在年龄、性别和居住地方面相匹配。使用 Kaplan-Meier 和 Cox 回归分析来估计 DTC 诊断后不同心血管疾病（CVD）发病或死亡的风险。
任何 CVD（风险比[HR]1.16，95%置信区间[CI]1.05-1.28）和所有心律失常（HR 1.25，CI 1.06-1.48）以及心房颤动（AF）（HR 1.29，CI 1.06-1.57）的发病率在 DTC 患者中均高于对照组。心血管发病率的增加仅限于 TSH 水平低于 0.1mU/L（HR 1.27，CI 1.03-1.58）的患者和接受 RAI 治疗的患者（HR 1.18，CI 1.05-1.31）。然而，与对照组相比，患者的心血管死亡率较低（HR 0.73，CI 0.58-0.92），这是由于冠心病死亡率降低所致。
分化型甲状腺癌患者的 CVD 发病率增加，这主要归因于 AF 和 TSH 抑制低于 0.1mU/L。
