Solid cancer mortality with antithyroid drugs, RAI or surgery
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Solid cancer mortality with antithyroid drugs, RAI or surgery In patients with hyperthyroidism, the solid cancer mortality rate does not appear to differ in patients treated with antithyroid drugs (ATD), radioactive iodine (RAI) or surgery after controlling for confounding, according to study results reported in JAMA Network Open, although there is "a dose-dependent association between RAI and solid cancer mortality". The cohort study used data from the Cooperative Thyrotoxicosis Therapy Follow-Up Study (CTTFUS) at centres in the USA (n=25) or UK (n=1). There were 31 363 patients who were treated in 1946–1964 and followed-up to December 2014, with a mean age of 46.9 years; 79.4% of patients were female. Patients received ATDs (n=22 357), RAI (n=19 589) and surgery (n=13 676), alone or in combination. The solid cancer mortality rate was highest for patients treated with ATDs and surgery (18.6%), followed by ATDs only (18.3%), RAI only or ATDs and RAI (each 16.7%), ATDs, RAI and surgery (16.1%), surgery only (15.3%) and surgery and RAI (13.0%). The proportion of deaths during the first five years of follow-up was higher in the ATDs only group (5.2%) than in the other groups (0.8% to 2.1%). Compared with expected rates in the general population, the standardised mortality ratio was significantly higher in the ATDs only group (SMR 1.31; 95% CI 1.11, 1.53), although "excluding patients with prior cancers attenuated these risks", the authors note (SMR 0.90; 0.74, 1.09). The elevated risk was restricted to the first five years of follow-up. No significantly elevated SMRs were observed for the other treatment groups. For RAI recipients, the solid cancer mortality risk increased with total administered activity (hazard ratio 1.08 per 370 MBq; p=0.001 for trend). "Results were stronger among patients receiving only RAI", note the authors. "The elevated solid cancer mortality rate in the drug-only group . . . has been suggested to indicate direct association of ATDs with cancer risk", note the authors; "however, confounding by indication seems to be the more likely explanation". They add that "considering the temporal changes in ATD treatment, more contemporary cohort studies are needed to evaluate the long-term adverse effects of methimazole specifically". Kitahara CM, et al. Association of Radioactive Iodine, Antithyroid Drug, and Surgical Treatments With Solid Cancer Mortality in Patients With Hyperthyroidism. JAMA 803502172 Network Open : 23 Jul 2020. Available from: URL: https://doi.org/10.1001/jamanetworkopen.2020.9660
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Reactions 19 Sep 2020 No. 1822
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