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Rising TSH, T4 tied to androgen deprivation therapy
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Androgen deprivation therapy is associated with an increase in thyroid-stimulating hormone and free thyroxine and a reduction in free triiodothyronine in men with nonmetastatic prostate cancer, study data show.
Rudolf Hoermann, MD, PhD, of the department of medicine at the University of Melbourne in Australia, and colleagues evaluated men with nonmetastatic prostate cancer initiating androgen deprivation therapy (case group; n = 34) and age-matched men with prostate cancer (control group; n = 29) to determine whether androgen deprivation is associated with alterations in thyroid function. Follow-up was conducted for 12 months.
After 12 months, the case group had a pronounced increase in TSH, whereas there was no increase in the control group; the mean adjusted difference between the case and control group was 0.69 mIU/L (P < .001). Free T4 rose and free T3 to free T4 ratio was reduced in the case group compared with the control group. Free T3 levels were unchanged.
Leptin was significantly increased in the case group compared with the control group after 12 months. Changes in leptin were correlated with changes in TSH (P < .001).
“Androgen deprivation in men with nonmetastatic prostate cancer is associated with profound changes in body composition and adverse metabolic effects,” the researchers wrote. “The present study extends those findings in a controlled design to the regulation of thyroid function. A rise in TSH in the absence of peripheral hypothyroidism suggests that the set point of the hypothalamic-pituitary-thyroid axis may be reset under [androgen deprivation therapy], in association with changes in body composition, but not directly due to androgen deficiency. Adipokines produced by fat cells, such as leptin, may be directly involved in this adaptive response. It should be noted that despite these moderate alterations none of the patients developed clinical and/or biochemical thyroid dysfunction during follow-up.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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