Objectives: Thyroid cancer long-term treatment requires suppression of thyroid stimulating hormone (TSH) levels to below normal range based on risk stratification of the patient at time of diagnosis. This audit aimed to assess the practicality of implementation of the guideline recommendations of the American Thyroid Association (ATA) for target TSH levels in high, intermediate and low risk thyroid cancer patients. It also aimed to identify whether lack of implementation of the guidelines will affect patient outcomes in form of increased thyroglobulin levels.
Methods: Health records of 100 adult patients with a diagnosis of thyroid cancer were reviewed by selecting patients who visited the Thyroid Clinic at Dubai Hospital in 20172018. Baseline characteristics were recorded as well as the last 3 TSH values of each patient as a mean TSH per patient. We also recorded the most recent thyroglobulin level. Risk stratification was documented from medical notes and histopathology reviews. TSH targets were below 0.1uiu/ml in high-risk thyroid cancer patients, below 0.5 uiu/ml in intermediate-risk patients and TSH of 0.52 uiu/ml in low-risk thyroid cancer patients.
Results: A total of 100 patients were included in the study. 87% female and 45% UAE nationals. The mean age was 47.35 years. Low-risk and intermediate-risk patients achieved target TSH values, with a mean TSH of 0.66ng/ml in the former and a mean TSH of 0.26 ng/ml in the latter. Thyroglobulin levels in both groups was acceptable (target <1 ng/ml) at 0.3 and 0.5 ng/ml, respectively. High-risk thyroid cancer patients did not achieve target TSH. The mean level was 0.4 uiu/ml. The mean thyroglobulin level was significantly elevated in this group at 13.95 ng/ml. Half of the patients included did not have any written data available in their electronic records to accurately classify them into an appropriate risk category. This does not facilitate in the selection of appropriate therapeutic targets. Despite this issue, patients in this group have reasonable control with a mean TSH value of 0.80 uiu/ml and a thyroglobulin level of 0.68 ng/ml.
Conclusion: We report difficulties in applying the 2015 ATA Guidelines in risk stratification of thyroid cancer patients, as accurate classification relies on clear documentation of the history, including type of surgery and histopathology, which is not always readily available in follow up patients. Target TSH value ranges cannot be determined in these patients. We also note that high-risk thyroid cancer patients are not achieving target TSH or thyroglobulin levels, possibly due to a heavy burden of disease.
18 - 21 May 2019
European Society of Endocrinology