Cardiovascular risk after total thyroidectomy in patients with differentiated thyroid carcinoma undergoing levothyroxine replacement monotherapy.

A substantial proportion of disease-free DTC patients experienced major adverse cardiovascular events over long-term follow-up.

• 14 out of 102 analyzed patients experienced major adverse cardiovascular events (MACE)
• Mean follow-up was 12.79 ± 9.13 years post-DTC diagnosis
• Only patients without major CV events prior to DTC diagnosis were included
• Patients were treated with long-term LT4 therapy following the 2016 ATA guidelines

In patients without MACE, none were classified as having a very high cardiovascular risk according to ESC 2021 scoring systems.

• Cardiovascular risk was assessed using ESC 2021 scoring systems: SCORE2, SCORE2-OP, and SCORE2-Diabetes
• No patients without MACE were classified as very high CV risk
• High CV risk was observed in 6% (SCORE2), 38.5% (SCORE2-OP), and 50% (SCORE2-Diabetes) of patients
• Moderate CV risk was found in 34% (SCORE2), 38.5% (SCORE2-OP), and 50% (SCORE2-Diabetes)
• Low CV risk was recorded in 60% (SCORE2) and 23% (SCORE2-OP)

A selected cohort of 102 patients was identified from a larger group of 300 disease-free athyreotic DTC patients.

• From a larger cohort, 300 disease-free patients who underwent total thyroidectomy—with or without radioiodine (RAI)—were selected
• 102 patients met inclusion criteria and were included in the detailed analysis
• Only patients without major CV events prior to DTC diagnosis were included
• Patients were required to have been treated with long-term LT4 therapy after the 2016 ATA guidelines

The 2016 ATA guidelines recommend individualizing TSH suppression based on disease aggressiveness, reflecting the favorable prognosis of differentiated thyroid cancer.

• Differentiated thyroid cancer has a favorable prognosis primarily due to its low risk of recurrence and mortality
• The most recent ATA guidelines recommend individualizing the degree of TSH suppression to balance the risks and benefits of LT4 therapy
• No prior studies had evaluated cardiovascular risk in disease-free patients receiving long-term replacement doses of LT4 following the 2016 ATA guidelines

The authors concluded that specific cardiovascular management guidelines are needed for DTC patients, similar to those available for other cancer populations.

• The findings highlight the need for careful cardiovascular monitoring during long-term follow-up in patients with differentiated thyroid cancer
• Specific cardiovascular management guidelines are needed in DTC to balance the risks and benefits of LT4 therapy
• Such guidelines would help identify patients at higher cardiovascular risk who may need closer monitoring
• The authors draw a parallel to cardiovascular management guidelines already available for other cancer populations