4.6 Article

Thyrotropin Suppression for Papillary Thyroid Cancer: A Physician Survey Study

Journal

THYROID
Volume 31, Issue 9, Pages 1383-1390

Publisher

MARY ANN LIEBERT, INC
DOI: 10.1089/thy.2021.0033

Keywords

physician survey; thyroid cancer; TSH suppression

Funding

  1. National Cancer Institute (NCI) [R01 CA201198]
  2. Agency for Healthcare Research and Quality (AHRQ) [R01 HS024512]
  3. National Institute on Aging (NIA) [K08 AG049684]
  4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [T32 DK007245]
  5. California Department of Public Health [103885]
  6. Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries [5NU58DP006344]
  7. NCIs SEER Program [HHSN261201800015I]
  8. NCI [HHSN261201800003I, HHSN26100001]
  9. CDC [5NU58DP003875-04]

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The study revealed that many low-risk thyroid cancer patients continue to be treated with suppressive doses of thyroid hormone, highlighting the need for more high-quality research to guide thyroid cancer management, as well as better understanding of barriers that hinder guideline adoption.
Background: Current guidelines recommend against thyrotropin (TSH) suppression in low-risk differentiated thyroid cancer patients; however, physician practices remain underexplored. Our objective was to understand treating physicians' approach to TSH suppression in patients with papillary thyroid cancer. Methods: Endocrinologists and surgeons identified by thyroid cancer patients from the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles were surveyed in 2018-2019. Physicians were asked to report how likely they were to recommend TSH suppression (i.e., TSH <0.5 mIU/L) in three clinical scenarios: patients with intermediate-risk, low-risk, and very low-risk papillary thyroid cancer. Responses were measured on a 4-point Likert scale (extremely unlikely to extremely likely). Multivariable logistic regressions were performed to determine physician characteristics associated with recommending TSH suppression in each of the aforementioned scenarios. Results: Response rate was 69% (448/654). Overall, 80.4% of physicians were likely/extremely likely to recommend TSH suppression for a patient with an intermediate-risk papillary thyroid cancer, 48.8% for a patient with low-risk papillary thyroid cancer, and 29.7% for a patient with very low-risk papillary thyroid cancer. Surgeons were less likely to recommend TSH suppression for an intermediate-risk papillary thyroid cancer patient (odds ratio [OR] = 0.36 [95% confidence interval, CI, 0.19-0.69]) compared with endocrinologists. Physicians with higher thyroid cancer patient volume were less likely to suppress TSH in low-risk and very low-risk papillary thyroid cancer patients (i.e., >40 patients per year, OR = 0.53 [CI 0.30-0.96]; OR = 0.49 [CI 0.24-0.99], respectively, compared with 0-20 patients per year). Physicians who estimated higher likelihood of recurrence were more likely to suppress TSH in a patient with very low-risk papillary thyroid cancer (OR = 2.34 [CI 1.91-4.59]). Conclusions: Many patients with low-risk thyroid cancer continue to be treated with suppressive doses of thyroid hormone, emphasizing the need for more high-quality research to guide thyroid cancer management, as well as better understanding of barriers that hinder guideline adoption.

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