Is Maintaining Thyroid-Stimulating Hormone Effective in Patients Undergoing Thyroid Lobectomy for Low-Risk Differentiated Thyroid Cancer? A Systematic Review and Meta-Analysis
by
, and
Ho-Ryun Won
1,2,†, 
Eonju Jeon
3,†,
Jae Won Chang
1,4,
Yea Eun Kang
5,
Kunho Song
4,
Sun Wook Kim
6,
Dong Mee Lim
7,
Tae Kwun Ha
8,
Ki-Wook Chung
9,
Hyo-Jeong Kim
10,
Young Joo Park
11,* and
Bon Seok Koo
1,4,* 1
Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon 35015, Korea
2
Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Sejong 30099, Korea
3
Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu 42472, Korea
4
Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon 35015, Korea
5
Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
6
Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 16419, Korea
7
Department of Internal Medicine, Konyang University Hospital, Daejeon 35365, Korea
8
Department of Surgery, Inje University Busan Paik Hospital, Busan 47392, Korea
9
Department of Surgery, Ulsan University College of Medicine, Seoul 05505, Korea
10
Department of Internal Medicine, Eulji University College of Medicine, Daejeon 34824, Korea
11
Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2022, 14(6), 1470; https://doi.org/10.3390/cancers14061470
Submission received: 24 January 2022
/
Revised: 24 February 2022
/
Accepted: 11 March 2022
/
Published: 13 March 2022
(This article belongs to the Section Systematic Review or Meta-Analysis in Cancer Research)
Simple Summary
In order to reduce the recurrence rate after surgical treatment of differentiated thyroid cancer (DTC), suppression of thyroid-stimulating hormone (TSH) or maintenance of a certain level after surgery are important. However, the effectiveness of TSH maintenance in the mid to lower reference range (0.5–2 mU/L) in patients undergoing thyroid lobectomy for low-risk DTC is uncertain. In this systematic review and meta-analysis, we compared and analyzed the recurrence rate according to whether TSH maintenance was performed in patients who underwent thyroid lobectomy for low-risk DTC. There was no difference in the recurrence rate with or without TSH control. Therefore, the recommendation to maintain TSH to reduce the recurrence rate after thyroid lobectomy is still controversial.
Abstract
There is no clear evidence that post-operative maintenance of thyroid-stimulating hormone (TSH) in the mid to lower reference range (0.5–2 mU/L) improves prognosis in patients undergoing thyroid lobectomy for low-risk differentiated thyroid cancer (DTC). The purpose of this systematic review and meta-analysis was to compare and analyze the recurrence rate according to whether the serum TSH level was maintained below 2 mU/L in patients who underwent thyroid lobectomy for low-risk DTC. Clinical data and outcomes were collected from MEDLINE, Embase, and the Cochrane Database of Systematic Reviews. The inclusion criteria were related studies on TSH maintenance or serum TSH concentration after surgery for DTC. Seven observational studies with a total of 3974 patients were included in this study. In the patients who received TSH maintenance less than 2 mU/L, the recurrence rate during the follow-up period was 2.3%. A subgroup analysis of five studies showed that the odds ratio for recurrence in patients who received TSH maintenance was 1.45 (p-value = 0.45) compared to patients who did not receive TSH maintenance. In conclusion, the evidence for the effectiveness of post-operative TSH maintenance less than 2 mU/L in patients undergoing thyroid lobectomy for low-risk DTC is insufficient.
