Lipid Metabolic Status in Thyroid Carcinoma
Condition: Thyroid Carcinoma; Dyslipidemias; Risk Reduction Behavior; Hormone Replacement
MeSH terms: Carcinoma; Thyroid Neoplasms; Dyslipidemias; Thyroid Diseases
Study type: Observational

Summary: 
      The continuous increase of the incidence of the thyroid cancer in the last years has taken
      this neoplasia among the first 4 frequent cancers in the cancer registry of the Institute of
      Oncology "Prof.Ion Chiricuţă" from Cluj-Napoca (IOCN), with a total number of over 470 new
      cases per year, added to the other 3700 cases already being in the evidence of the Institute.

      The radical treatment brings for a long term a compensated chronic drug induces mYxoedema
      with it's important side effects. Among these one can find the dislipidemia and the change of
      the high sensitive C reactive protein (hsCRP) serological value. In the last years, many
      epidemiological studies have confirmed the fact that the patients with a high serological
      value of the hsCRP present a higher risk for the coronary disease and heart attack.

      Prospective studies developed in european countries and in USA have provided results that are
      related to the predictive value of the hsCRP determinations over the cardiovascular risk.
      Thus, hsCRP is an indirect risk factor for the coronary disease. The risk for cardiovascular
      disease is 2 to 7 times higher at the people with a high level of hsCRP comparing to ones
      with low levels; the increase of the hsCRP serological value can be determined several years
      before the clinical debut of the coronary disease.

      The screening for this population group with a high risk can introduce in use the prevention
      of the cardiac pathology and change the approach to the monitoring of the patients with
      thyroid cancer. A selection protocol will be elaborated for the patients that will withdraw
      the hormone treatment by using recombinant thyroid stimulating hormone (TSH) or will have
      personalised monitoring algorithm, with a shortening of the hormone treatment withdrawal.
    

Detailed description: 
      Although considered a rare type of cancer with an incidence under 6 cases for 100 000
      persons, the thyroid carcinoma is the most frequent endocrine tumor. The incidence of this
      malignant disease has exponentially increased in the last decade, so that many specially
      centers in the world have focused on a better strategy of diagnosis, of treatment and of
      monitoring. By applying a suitable multimodal treatment, the prognosis of this disease is
      excellent, offering the patients a survival rate of over 90% at 10 years. During the
      monitoring of the disease, the patients are periodically supposed to withdraw the hormone
      treatment; because of this hormone imbalance, there will be important changes of the
      metabolism, especially the lipid one. This is the reason why we are preoccupied to increase
      the quality of life of the patients addicted to a chronic thyroid hormone therapy. The aim of
      this study is to demonstrate the way in which the lipid profile is influenced and to quantify
      the cardiovascular risk for the patients radically treated of thyroid cancer, by total
      thyroidectomy, metabolic irradiation and undergoing a chronic thyroid hormone treatment.
      Nowadays, Romania is one of the countries in which these patients are supposed to be kept in
      a iatrogenous myxoedema, the alternative being the recombinant thyroid stimulating hormone.
      For the patients with the mentioned diagnosis, the lipid profile will be determined and will
      consist of the following: total serologic cholesterol, cholesterol fractions, triglycerides
      and C reactive protein highly sensitive (hsCRP). A score for the cardiovascular accident risk
      will be elaborated. The attempt of classifying in cardiovascular risk groups the patients
      through the present study, would facilitate the selection of the patients and their access to
      therapies and modern monitoring strategies.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        We will prospectively study a group of patients from the evidence of IOCN, with the
        histology of differentiated thyroid cancer, radically treated with total thyroidectomy,
        radioiodine therapy and undergoing chronic substitutive hormone treatment, levothyroxine.
        The evaluation of these patients will be done during the routine oncological control, after
        6-12 months post therapy, while withdrawing the hormone treatment and inducing a short-term
        iatrogenic myxedema. We are estimating a total number of 30 patients with 3 successive
        determinations in 1 year. The ethics committee will evaluate this study and each patient
        will be included voluntarily, following clear information of the patient and an informed
        consent.
      
Keywords: thyroid cancer; dislipidemia; cardiovascular risk