Abstract

Context

Thyroid dysfunction is associated with an increased risk of cardiovascular disease (CVD) in the general population; however, it remains controversial whether differentiated thyroid cancer (DTC) treatment, including thyroidectomy and thyroid-stimulating hormone suppression, further increases the risk of CVD. This study aimed to evaluate the risk of CVD in patients with DTC.

Evidence acquisition

We performed a review of observational studies on associations between DTC and cardiovascular outcomes, indexed in MEDLINE, EMBASE, and Web of Science. We excluded studies that evaluated CVD as comorbidity before DTC diagnosis and those that used active surveillance without thyroidectomy as an intervention. Risk estimates were pooled using random- and fixed-effects models when three or more studies reported on the outcome of interest. Echocardiographic and hemodynamic parameters were examined.

Evidence synthesis

Eighteen studies were included in the quantitative analysis (193,320 cases with DTC and 225,575 healthy controls). DTC was associated with an increased risk of atrial fibrillation (pooled risk ratio [RR]=1.55 [95% confidence interval: 1.30‒1.84]), coronary artery disease (RR=1.10 [1.00‒1.21]), cerebrovascular accidents (RR=1.15 [1.09‒1.20]), and all-cause mortality (RR=1.95 [1.03‒3.69]). DTC was associated with higher diastolic blood pressure (standardized mean difference [SMD], 0.22 [0.01‒0.42]), heart rate (0.37 [0.17‒0.57]), left ventricular mass index (0.66 [0.45‒0.88]), and interventricular septal thickness (0.91 [0.33‒1.49]) and lower early to late ventricular filling velocities (-0.42 [-0.79‒(-0.05)]), but not with ejection fraction.

Conclusions

Patients with DTC are at an increased risk of atrial fibrillation, CVD, increased heart rate, and left ventricular mass development.

中文翻译：

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甲状腺癌患者接受甲状腺切除术治疗的心血管结局：一项荟萃分析

摘要

语境

在一般人群中，甲状腺功能障碍与心血管疾病 (CVD) 风险增加有关；然而，分化型甲状腺癌 (DTC) 治疗，包括甲状腺切除术和促甲状腺激素抑制，是否会进一步增加 CVD 风险仍存在争议。本研究旨在评估 DTC 患者发生 CVD 的风险。

取证

我们对 DTC 与心血管结果之间关联的观察性研究进行了回顾，这些研究在 MEDLINE、EMBASE 和 Web of Science 中编入索引。我们排除了在 DTC 诊断前将 CVD 评估为合并症的研究，以及那些使用主动监测而不用甲状腺切除术作为干预的研究。当三项或更多研究报告了感兴趣的结果时，使用随机和固定效应模型合并风险估计。检查了超声心动图和血液动力学参数。

证据综合

18 项研究被纳入定量分析（193,320 例 DTC 病例和 225,575 例健康对照）。DTC 与房颤（合并风险比 [RR]=1.55 [95% 置信区间：1.30-1.84]）、冠状动脉疾病（RR=1.10 [1.00-1.21]）、脑血管意外（RR= 1.15 [1.09-1.20]）和全因死亡率（RR=1.95 [1.03-3.69]）。DTC 与较高的舒张压（标准化平均差 [S​​MD]，0.22 [0.01-0.42]）、心率（0.37 [0.17-0.57]）、左心室质量指数（0.66 [0.45-0.88]）和室间室间隔厚度 (0.91 [0.33-1.49]) 和早期至晚期心室充盈速度降低 (-0.42 [-0.79-(-0.05)])，但与射血分数无关。

结论

DTC 患者发生心房颤动、心血管疾病、心率增加和左心室肿块发展的风险增加。