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Long-term differentiated thyroid cancer survival linked to diastolic dysfunction
Long-term survivors of pediatric differentiated thyroid cancer are more likely to have diastolic dysfunction, suggesting early cardiac aging, compared with controls who were never exposed to differentiated thyroid cancer, according to a study.
Thera P. Links, MD, PhD, professor in the department of endocrinology at the University of Groningen and the University Medical Center Groningen in the Netherlands, and colleagues evaluated 66 adult survivors of pediatric differentiated thyroid cancer (DTC; median age at diagnosis, 16 years) treated in the Netherlands between 1970 and 2009 to determine the prevalence of cardiac dysfunction and atrial fibrillation.
Early diastolic septal and/or lateral tissue velocity (e’) were used to define diastolic dysfunction.
All participants underwent an echocardiographic evaluation (median age at evaluation, 33 years), and 65 of them also underwent a 24-hour Holter echocardiogram. A group of 66 controls without childhood DTC were evaluated to compare echocardiographic measurements (median age at evaluation, 28 years).
Diastolic dysfunction was present in more survivors than controls during a median follow-up of 21.4 years (21.2% vs. 10.6%; P = .096). Septal (P = .005) and lateral (P = .011) e’ were both decreased in survivors compared with controls. Survivors also had lower early and late mitral valve inflow velocities compared with controls (P < .001 for both).
In survivors, increasing attained age and waist circumference were associated with decreased diastolic function. No differences were observed for the prevalence of diastolic dysfunction in survivors with thyroid-stimulating hormone levels less than 0.4 mU/L during follow-up or survivors with TSH of at least 0.4 mU/L.
Among survivors who underwent the 24-hour Holter echocardiogram evaluations, no atrial fibrillation was observed.
“Although diastolic dysfunction was subclinical, it is clinically relevant as it may be the first manifestation of more overt heart failure,” the researchers wrote. “Therefore, assessment and treatment of cardiovascular risk factors may require additional attention in this patient group as is already the case in other cancer survivors. An echocardiography might be easily accessible in the follow-up of survivors of pediatric DTC if clinically indicated. ... Finally, it should be emphasized that cardiology follow-up together with regular communication between endocrinologists and cardiologists is required and that staging is mandatory before long-term, sometimes lifelong, suppression is implemented.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.