TSH-suppressive treatment in differentiated thyroid cancer. A dogma under review |
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| Authors: | Zafón Carles |
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| Affiliation: | 1. Servicio de Hematología, Hospital Universitario 12 de Octubre, Madrid, España;2. Servicio de Hematología, Hospital Clínico San Carlos, Madrid, España;3. Servicio de Hematología, Hospital Vall d’Hebrón, Barcelona, España;1. Department of Plastic Aesthetic, and Reconstructive Surgery and Burns Center, Vall d’Hebron University Hospital, VHIR-Vall d’Hebron Research Institute, Barcelona, Spain;2. Universitat Autònoma de Barcelona, Bellaterra, Spain;1. Unidad de Transporte Pediátrico, Hospital Universitario Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, España;2. Base SEM-Pediátrico YP01, Sistema de Emergencias Médicas de Catalunya (SEM), Barcelona, España;1. HBP Surgery and Transplant Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain;2. Thoracic Surgery Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain;3. Transplant Coordination Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain;4. Pediatric Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain;1. Neurosurgery department, CHU Timone, Aix-Marseille university, AP–HM, Marseille, France;2. Inserm, MMG, Aix-Marseille university, Marseille, France;3. Endocrinology department, CHU Conception, Aix-Marseille university, AP–HM, Marseille, France;4. EA 3279 CEReSS, Health service research and quality of life center, La Timone Medical Campus, School of medicine, Aix-Marseille university, 27, boulevard, Jean-Moulin cedex 05, 13385 Marseille, France;5. Service d’anatomie pathologique et de neuropathologie, CNRS, INP, Inst. neurophysiopathol, CHU Timone, Aix-Marseille university, AP–HM, Marseille, France |
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| Abstract: | TSH-suppressive therapy (ST) is part of the treatment protocol for differentiated thyroid carcinoma (DTC). There is however little evidence of its clinical effectiveness. On the other side, ST is not free from side effects related to the subclinical hyperthyroidism status induced in patients for a long time period. Because of this, widespread use of ST in all patients has recently been questioned, and individualized treatment based on the characteristics of each particular case has been proposed. Action of thyroid hormones (THs) depends on their binding to specific nuclear receptors. However, a second pathway mediated by a membrane receptor located in integrin α(V)β(3) has recently been established. It has been postulated that the proliferative and angiogenic effects attributed to THs would depend on this second mechanism. It is not known whether the tumorigenic action shown in other neoplasms may have an impact on DTC. The objective of this study was to review the relationship between ST and cancer, particularly as regards tumor evolution and occurrence of second primary neoplasms. One of the future challenges in the field of DTC will be to establish the specific role of TSH and THs in malignant thyroid cells, in order to be able to define more optimized therapeutic schemes. |
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