[Clinical endocrinologists' perception of the deleterious effects of TSH suppressive therapy in patients with differentiated thyroid carcinoma].
OBJECTIVE
To explore the opinion of clinical endocrinologists as to the deleterious effects of thyrotropin (TSH) suppressive therapy in patients with differentiated thyroid carcinoma (DTC).


METHODS
A self-administered survey was sent by e-mail to a group of endocrinologists with expertise in the treatment of patients with differentiated thyroid carcinoma. The questionnaire consisted of three questions related to: 1) the possible adverse effects of this therapy on different organ systems, 2) the clinical significance of these effects and 3) the usefulness of treatment guidelines for DTC.


RESULTS
A total of 91 endocrinologists responded with a wide divergence of opinions. No question had more than 80% of answers in a particular option. Of the possible side effects of suppressive therapy, a high degree of ignorance to three of them (increased left ventricular mass, reentrant tachycardia and diastolic dysfunction). Most respondents felt that the seven items, dementia and Alzheimer, decreased quality of life, decreased bone mineral density (BMD) in premenopausal women and men, thromboembolic disease, signs and symptoms of hyperthyroidism and increased risk of fractures were not affected by suppressive therapy, while most responded positively to two items (increased heart rate and decreased BMD in postmenopausal women). Eighty percent of the respondents felt that in any case these effects were not clinically significant and 33% considered that treatment guidelines should be reviewed.


CONCLUSIONS
Clinical endocrinologists seem to have a very heterogeneous opinion regarding the potential harmful effects of TSH-suppressive therapy for DTC.
Reverter
Jordi L
JL
Servei d'Endocrinologia i Nutrició, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España. reverter.germanstrias@gencat.cat
Colomé
Eulàlia
E
Puig Domingo
Manuel
M
Julián
Teresa
T
Halperin
Irene
I
Sanmartí
Anna
A
D000328:Adult; D001291:Attitude of Health Personnel; D002277:Carcinoma / Q000188:drug therapy*; D003072:Cognition Disorders / Q000139:chemically induced; D003430:Cross-Sectional Studies; D003625:Data Collection; D004704:Endocrinology; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced; D006801:Humans; D006980:Hyperthyroidism / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D019851:Thrombophilia / Q000139:chemically induced; D013964:Thyroid Neoplasms / Q000188:drug therapy*; D013972:Thyrotropin / Q000037:antagonists & inhibitors* / Q000378:metabolism; D013974:Thyroxine / Q000009:adverse effects* / Q000627:therapeutic use
D013972:Thyrotropin; D013974:Thyroxine