Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/199971
Type: Artigo de periódico
Title: Current Recommendations For Levothyroxine Treatment Of Differentiated Thyroid Cancer Patients Are Not Properly Implemented In Clinical Practice.
Author: Martins de Almeida, J F
Gonçalves Tsumura, W
Vaisman, M
Montalli Assumpção, L V
Ward, L S
Abstract: Levothyroxine (L-T4) 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. To evaluate the effectiveness of current recommendations on L-T4 treatment of DTC patients in clinical practice. 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. 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. We concluded that guidelines are not adequately applied and alternative strategies aiming to increase adherence are urgently needed for DTC patients.
Subject: Cell Differentiation
Choice Behavior
Female
Follow-up Studies
Humans
Male
Medication Adherence
Middle Aged
Neoplasm Recurrence, Local
Practice Guidelines As Topic
Prognosis
Risk Factors
Thyroglobulin
Thyroid Neoplasms
Thyrotropin
Thyroxine
Tumor Markers, Biological
Rights: fechado
Identifier DOI: 10.3275/8369
Address: http://www.ncbi.nlm.nih.gov/pubmed/22522710
Date Issue: 2012
Appears in Collections:Artigos e Materiais de Revistas Científicas - Unicamp

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.