[Hormonal replacement therapy in women after surgery for thyroid cancer treated with suppressive doses of...

Total thyroidectomy followed by 131I ablation and thyroxine suppressive therapy is recommended for the treatment of differentiated thyroid carcinomas. Thyroxine should be given at a dose sufficient to suppress TSH to low or undetectable levels. These patients are categorized as subclinical hyperthyroidism subjects. Some cardiovascular effects of subclinical hyperthyroidism, such as an increase in left ventricular mass and accelerated bone loss, should be taken into consideration. Estrogens reduce the loss of bone mass in thyrotoxic postmenopausal patients and have cardioprotective effects. The relatively high incidence of thyroid carcinoma in women suggests that estrogen and/or progesterone may be important for the development of these neoplasms. Immunohistochemical study has established that steroid receptors are present in thyroid tissue. Many authors suggest that estrogens by itself do not appear to affect the natural history of thyroid cancer. Besides the thyroid, active iodide transports catalysed by the sodium/iodide symporter occurs in the lactating mammary gland. An increased risk of breast carcinoma in women with thyroid carcinoma due to carcinogenicity of radioiodine has been reported by some but not all investigators. Hormone replacement therapy in the thyroxine treated postmenopausal women consists in conventional oral or transdermal estrogen combined with progesterone. In some cases the daily dose of thyroxine should be increased to achieve TSH suppression.