| アブストラクト | CONTEXT: The incidence of differentiated thyroid cancer (DTC) is increasing, yet the prognosis is favourable and long-term survival is expected. Exogenous TSH suppression has been used for many years to prevent DTC recurrence and may be associated with increased risks of circulatory diseases. DESIGN: Risks of circulatory disease in patients treated for DTC were compared to randomly matched patients without DTC (controls) up to a 1:5 ratio using age, sex, body mass index (BMI) and smoking as the matching parameters in a population-based, open cohort study using The Health Improvement Network. PATIENTS: A total of 3009 patients treated for DTC with no pre-existing cardiovascular disease were identified and matched to 11 303 controls, followed up to median of 5 years. RESULTS: A total of 1259 incident circulatory events were recorded during the observation period. No difference in the risk of ischaemic heart disease (IHD) (adjusted hazards ratio [aHR]: 1.04, 95% CI: 0.80-1.36) or heart failure (HF) (aHR: 1.27, 95% CI: 0.89-1.81) was detected. The risk of atrial fibrillation (AF) and stroke was significantly higher in patients with DTC (aHR: 1.71, 95% CI: 1.36-2.15 and aHR: 1.34, 95% CI: 1.05-1.72, respectively). In a sensitivity analysis limited to newly diagnosed patients with DTC, only the risk of AF was consistently elevated (aHR: 1.86, 95% CI: 1.33-2.60). CONCLUSIONS: The increased risk of AF in patients who have undergone treatment for DTC but without pre-existing CVD may warrant periodic screening for this arrhythmia. Whereas no evidence of increased risk of IHD or HF was observed, the increased risk of stroke/TIA warrants further investigation. |
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| ジャーナル名 | Clinical endocrinology |
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| 投稿日 | 2019/4/18 |
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| 投稿者 | Toulis, Konstantinos A; Viola, David; Gkoutos, George; Keerthy, Deepiksana; Boelaert, Kristien; Nirantharakumar, Krishnarajah |
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| 組織名 | Institute of Applied Health Research, University of Birmingham, Birmingham, UK.;Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece.;Endocrine Unit, Department of Clinical and Experimental Medicine, University of;Pisa, Pisa, Italy.;Centre for Computational Biology, University of Birmingham, Birmingham, UK.;Institute of Metabolism and Systems Research, University of Birmingham,;Birmingham, UK.;Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners,;Health Data Research UK, London, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/30993728/ |
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