Active Surveillance Outcomes of Patients with Low-Risk Papillary Thyroid Microcarcinoma According to Levothyroxine Treatment Status
Authors' conclusion
LT4 treatment may be associated with decreased tumor growth during AS of PTMC, but further confirmatory research is needed.
Study context
- Population
- Patients with low-risk papillary thyroid microcarcinoma (PTMC) under active surveillance (AS), 2005–20192,509 included
- Participants
- 2,187 / 1,935 / 252 / 322
- Exposure
- Levothyroxine (LT4) treatment vs no LT4 during active surveillance
- Group In = 2,187reference
- Group IAn = 1,935
- Group IBn = 252
- Group IIn = 322
- Outcome
- Disease progression: tumour enlargement ≥3 mm and/or novel lymph node metastasis
- Follow-up
- 10 years
Main finding
As reported in the abstract
Disease progression rate
Group II vs Group I: P = 0.091 · Group IB vs Group IA and Group II: P < 0.01
Observational data: associations, not effects.
Further findings
Factors associated with disease progression (multivariable)
| OR (CI) | P value | ||
|---|---|---|---|
| Group IB statusMultivariable analysis | 3.42 (2.15–5.44) | P < 0.01 | |
| Age ≥40 and <60 yearsMultivariable analysis | 0.23 (0.14–0.38) | P < 0.01 | |
| Age ≥60 yearsMultivariable analysis | 0.16 (0.10–0.27) | P < 0.01 | |
| 0.10.31310Odds ratio (log scale) |
Per year
| Outcome | Group IA | Group IB | Group II | P value |
|---|---|---|---|---|
| Tumour volume doubling rate before LT4Group IB vs Group IA and Group II · significantly higher with Group IB | −0.0085 | 0.095 | −0.057 | P < 0.01 |
Group IB: time-weighted detailed TSH score, before vs after LT4
- TSH score before vs after LT4 (significantly decreased after, p < 0.01)
- 3.35 vs 3.05
Group IB: Tumor volume doubling rate (TVDR), before vs after LT4
- TVDR decreased (p = 0.08)
- from 0.13 per year to 0.036 per year
Group IB: rapid or moderate growth, before vs after LT4
- Proportion decreased significantly after LT4 (p < 0.01)
- from 26.8% to 12.5%
Original publication
Active Surveillance Outcomes of Patients with Low-Risk Papillary Thyroid Microcarcinoma According to Levothyroxine Treatment Status. Thyroid. Published 5 July 2023. doi:10.
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