Current recommendations for levothyroxine treatment of differentiated thyroid cancer patients are not properly implemented in clinical practice

Background: Levothyroxine (L-T-4) treatment aims to minimize the risk of differentiated thyroid cancer (DTC) recurrence and should be tailored to patient risk stratification and potential morbidity from adverse effects. Aim: To evaluate the effectiveness of current recommendations on L-T-4 treatment of DTC patients in clinical practice. Material and methods: We submitted to in-person interviews and revised the charts of 139 low-risk (LR) and 57 not-low-risk (NLR) DTC patients. A second evaluation made 24-60 months after surgery reclassified 131 patients who maintained (thyroglobulin) Tg <= 2 ng/dl with no evidence of relapse/recurrence as LR, whereas the remaining 65 cases were considered NLR. Results: Only 27% LR patients were appropriately controlled; 18% were kept suppressed; 49% maintained serum TSH levels between 0.11-0.4 mu/l; 21% had TSH=2.5-4.5 mu/l; and 12% TSH>4.5 mu/l. Among the NLR patients, 24 (37%) of the patients presented serum TSH levels above goal, including 13 (20%) patients with TSH>4.5 mu/l. There were 4 NLR elders whose TSH levels were kept between 0.41 and 4.5 for medical reasons; likewise, 28 NLR patients maintained with low but not undetectable serum TSH levels had cardiovascular and/or bone risk factors, but all the remaining 24 NLR patients were not adequately controlled because of poor treatment compliance. On the other hand, 45% of 152 inappropriately controlled patients presented risks for bone fractures, including 33 patients kept with low serum TSH levels without medical indication. Conclusion: We concluded that guidelines are not adequately applied and alternative strategies aiming to increase adherence are urgently needed for DTC patients. (J. Endocrinol. Invest. 35: 901-904, 2012) (C) 2012, Editrice Kurti