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Published on: July 22, 2011
Reduced insulin sensitivity in differentiated thyroid cancer patients with suppressed TSH
Thaís Gomes De Melo1, Aglecio Luiz Souza2, Elizabeth Ficher1
1a Division of Endocrinology, Department of Internal Medicine , University of Campinas , Campinas , Brazil.
Objective:
TSH-suppression is a therapy for thyroid cancer management, but it may lead to adverse effects, which should be balanced with its benefits. Previous studies evaluating the consequences of TSH suppression on insulin sensitivity have only been done with indirect techniques, and results were controversial. Therefore, we aimed to assess insulin sensitivity in patients with thyroid cancer and suppressed thyroid-stimulating hormone (TSH) with the most appropriate direct method (hyperinsulinemic-euglycemic clamp) in order to get a more conclusive response about the topic.
Methods:
A group of 20 non-obese and non-diabetic thyroid cancer patients with suppressed TSH underwent a hyperinsulinemic-euglycemic clamp to evaluate insulin sensitivity. Their results were compared to the results of a sex and body mass index (BMI) -paired control group composed of 20 healthy volunteers.
Results:
Patients were all female, aged 36.8 ± 10.2 years-old, with mean TSH 0.1 ± 0.1 μIU/mL and mean BMI 26.2 ± 3.3 kg/m2. Insulin sensitivity, determined by the insulin-stimulated glucose uptake (M-value), was lower in the patients group (4.2 ± 1.6 mg/min*kg versus 5.8 ± 1.7, age-adjusted p-value = 0.0205).
Conclusion:
This study shows for the first time that subclinical thyrotoxicosis in patients with thyroid cancer is associated with insulin resistance, as measured by hyperinsulinemic-euglycemic clamp technique. Such finding may be taken into consideration by clinicians when balancing risks and benefits of TSH-suppression therapy in thyroid cancer patients.
Insights
Thyroid cancer patients on TSH-suppression therapy exhibit insulin resistance. This study used the hyperinsulinemic-euglycemic clamp to directly measure insulin sensitivity, revealing lower levels in patients compared to controls.
Area of Science:
- Endocrinology
- Oncology
- Metabolic Research
Background:
- Thyroid-stimulating hormone (TSH) suppression is a key therapy for thyroid cancer management.
- Previous research on TSH suppression's impact on insulin sensitivity yielded controversial results due to indirect measurement methods.
- Direct assessment of insulin sensitivity in thyroid cancer patients undergoing TSH suppression is needed.
Purpose of the Study:
- To directly assess insulin sensitivity in thyroid cancer patients with suppressed TSH.
- To compare insulin sensitivity in these patients against a healthy control group using a precise method.
- To provide conclusive evidence regarding the relationship between TSH suppression and insulin sensitivity in thyroid cancer.
Main Methods:
- A hyperinsulinemic-euglycemic clamp was performed on 20 non-obese, non-diabetic female thyroid cancer patients with suppressed TSH.
- Insulin sensitivity was evaluated by measuring insulin-stimulated glucose uptake (M-value).
- Patient results were compared to a matched control group of 20 healthy volunteers.
Main Results:
- Thyroid cancer patients (mean age 36.8 years, mean BMI 26.2 kg/m²) had significantly lower insulin sensitivity (M-value 4.2 ± 1.6 mg/min*kg) compared to controls (5.8 ± 1.7 mg/min*kg, p=0.0205).
- The study group consisted exclusively of female patients with a mean TSH level of 0.1 ± 0.1 μIU/mL.
- This indicates subclinical thyrotoxicosis in the study population.
Conclusions:
- Subclinical thyrotoxicosis, induced by TSH suppression in thyroid cancer patients, is directly associated with insulin resistance.
- The hyperinsulinemic-euglycemic clamp is a reliable method for assessing insulin sensitivity in this context.
- Clinicians should consider these findings when weighing the benefits and risks of TSH-suppression therapy for thyroid cancer management.
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