Most adults with thyroid cancer on levothyroxine do not reach target TSH levels
Click Here to Manage Email Alerts
Most patients with differentiated thyroid cancer on levothyroxine suppression therapy do not have a thyroid-stimulating hormone level within the target range, according to study data published in Clinical Endocrinology.
“Only 29.2% of the patients have TSH levels on target,” Dilek Gogas Yavuz, MD, professor and division chief of endocrinology and metabolism at Marmara University School of Medicine, in Istanbul, told Healio. “Half of the differentiated thyroid cancer patients’ TSH suppression was overtreated, and 20.4% were undertreated. Overtreated patients face potential side effects of levothyroxine suppression treatment. A total of 82.9% of patients in this study had good and moderate compliance, but most of the patients were far from TSH target levels; half of the patients were using higher doses of levothyroxine for their needs. Poor compliance rates observed in undertreated patients.”
Researchers conducted a cross-sectional outpatient study of 1,125 adults with differentiated thyroid cancer who were followed up after at least 1 year of levothyroxine suppression treatment at 21 medical centers in Turkey (83.6% women; mean age, 50.7 years). Clinical data, including serum TSH level, were obtained from the most recent medical visit. Daily levothyroxine doses and treatment plans were recorded. ATA guidelines were used to determine each participant’s cancer risk. Each adult’s levothyroxine administration practices were obtained through an interview, and all participants completed the Morisky Medication Adherence Scale to assess levothyroxine compliance. Participants who scored 8 of a possible 8 points had good compliance, those who score 6 or 7 points had moderate compliance, and a score of less than 6 was defined as poor compliance.
The study cohort had a mean levothyroxine daily dose of 132.4 µg. The mean TSH was 2.26 mU/L. Of the study cohort, 29.2% met their TSH target, with 50.4% overtreated and 20.4% undertreated. According to drug ingestion data, 7.6% of participants missed at least one dose in the past week, and 16.4% missed at least one dose in the past month.
According to responses from the medication adherence questionnaire, 50.1% of participants had good compliance with levothyroxine therapy, 32.7% had moderate compliance and 17.1% had poor compliance. Patients with poor compliance had higher levothyroxine dosage (P < .001) and dosage per kilogram (P = .0013) compared with the other adherence groups. Mean TSH was higher for adults with poor compliance (2.74 mU/L) compared with moderate (1.29 mU/L) and good (0.67 mU/L) compliance (P < .001).
Of adults who were undertreated, 38% had good medication compliance, 37.2% had moderate compliance and 24.8% had poor compliance. Of on-target patients, 50.5% had good compliance, 37% had moderate compliance and 12.5% had poor compliance. The percentage of overtreated patients who had good compliance was 54.8%, with 33.7% having moderate compliance and 11.6% poor compliance.
Gogas Yavuz said there are several factors that may be causing the majority of patients to not meet their TSH targets.
“Overtreatment or undertreatment of differentiated thyroid cancer patients in endocrinology clinics in Turkey may be due to the aggressive approach of doctors in suppressing TSH levels, failure to do a risk assessment at follow‐up or the complexity of current guidelines in overcrowded outpatient clinics,” Gogas Yavuz said. “Simplified and clinically applicable guidelines may help prevent this situation. Artificial intelligence-based follow-up methods according to guidelines also need to be investigated.”
For more information:
Dilek Gogas Yavuz, MD, can be reached at dilekyavuz2004@yahoo.com.
Collapse
Read more about
Click Here to Manage Email Alerts