Thyrotropin Suppression and Disease Progression in Patients with Differentiated Thyroid Cancer: Results from the National Thyroid Cancer Treatment Cooperative Registry

作者：David S. Cooper, BONNY L SPECKER, Mona L. Ho, Matthew I. Sperling, Paul W. Ladenson, Douglas S. Ross, Kenneth B. Ain, S. Thomas Bigos, James D. Brierley, Bryan R. Haugen, Irwin L. Klein, JACOB JOHN ROBBINS, Steven I. Sherman, Terry W. Taylor, Harry R. Maxon · 发表于：Thyroid · 年份：1998 · DOI：10.1089/thy.1998.8.737 · 被引用次数：354 · 研究领域：Thyroid Cancer Diagnosis and Treatment、Thyroid Disorders and Treatments、Pituitary Gland Disorders and Treatments

The ideal therapy for differentiated thyroid cancer is uncertain. Although thyroid hormone treatment is pivotal, the degree of thyrotropin (TSH) suppression that is required to prevent recurrences has not been studied in detail. We have examined the relation of TSH suppression to baseline disease characteristics and to the likelihood of disease progression in a cohort of thyroid cancer patients who have been followed in a multicenter thyroid cancer registry that was established in 1986. The present study describes 617 patients with papillary and 66 patients with follicular thyroid cancer followed annually for a median of 4.5 years (range 1-8.6 years). Cancer staging was assessed using a staging scheme developed and validated by the registry. Cancer status was defined as no residual disease; progressive disease at any follow-up time; or death from thyroid cancer. A mean TSH score was calculated for each patient by averaging all available TSH determinations, where 1 = undetectable TSH; 2 = subnormal TSH; 3 = normal TSH; and 4 = elevated TSH. Patients were also grouped by their TSH scores: group 1: mean TSH score 1.0-1.99; group 2: mean TSH score 2.0-2.99; group 3: mean TSH score 3.0-4.0. The degree of TSH suppression did not differ between papillary and follicular thyroid cancer patients. However, TSH suppression was greater in papillary cancer patients who were initially classified as being at higher risk for recurrence. This was not the case for follicular cancer patients, wh...