![]() ![]() Hypothyroidism can be controlled with levothyroxine substitution therapy. Hypothyroidism is characterized biochemically by elevated thyroid-stimulating hormone and normal or low free T 4 levels in the serum. If left untreated, hypothyroidism has a substantial negative impact on patient wellbeing and is associated with symptoms like tiredness, weakness, weight gain, and mental changes. The prevalence of hypothyroidism is higher in women and risk increases with age. ![]() Hypothyroidism affects approximately 3% of the European population. Therefore, it is critical to identify harmful late effects of cancer treatment, such as hypothyroidism. Today, almost 90% of patients with early-stage breast cancer receive (neo) adjuvant treatment 10-year life expectancy after diagnosis is about 75%. Over the past 30 years, breast cancer survival has improved substantially due to earlier detection and improved adjuvant therapies. BCS and those working in cancer survivorship settings ought to be aware that this risk is highest in women treated with radiation therapy to the lymph nodes and chemotherapy. ConclusionsīCS have an excess risk of hypothyroidism compared with age-matched controls. BCS who received RTn with chemotherapy (HR = 1.74, 95%CI = 1.50–2.02) or without chemotherapy (HR = 1.31, 95%CI = 1.14–1.51) had an elevated risk of hypothyroidism compared with matched controls and compared with BCS who underwent surgery alone. BCS had a slightly higher incidence of hypothyroidism than controls. We included 44,574 BCS and 203,306 matched controls with 2,631,488 person-years of follow-up. ![]() We calculated the cumulative incidence, incidence rates (IR) per 1000 person-years, and used Cox regression to estimate hazard ratios (HR) and associated 95% confidence intervals (CIs) of hypothyroidism, adjusting for comorbidities. We identified hypothyroidism using diagnostic codes, and/or levothyroxine prescriptions. Cancer treatment was chemotherapy with or without radiotherapy (RT) targeting the breast/chest wall only, or also the lymph nodes (RTn). We excluded women with prevalent thyroid disease. We matched up to five cancer-free women (controls) for each BCS. Using nationwide registries, we identified all Danish women aged ≥ 35 years diagnosed with non-metastatic breast cancer (1996–2009). We estimated the incidence of hypothyroidism in women with breast cancer, and according to cancer treatment. These categories are (i) children and infants, (ii) patients in whom it is difficult to render and maintain a euthyroid state, (iii) pregnancy, (iv) women planning conception, (v) cardiac disease, (vi) presence of goiter, nodule, or other structural changes in the thyroid gland, (vii) presence of other endocrine disease such as adrenal and pituitary disorders, (viii) unusual constellation of thyroid function test results and (ix) unusual causes of hypothyroidism such as those induced by agents that interfere with absorption of L-thyroxine impact thyroid gland hormone production or secretion, affect the hypothalamic-pituitary-thyroid axis (directly or indirectly), increase clearance, or peripherally impact metabolism.Breast cancer survivors (BCS) may have increased risk of hypothyroidism, but risk according to treatment modality is unclear. However, patients with hypothyroidism who fall into the following categories should be seen in consultation with an endocrinologist. Physicians who are not endocrinologists, but who are familiar with the diagnosis and treatment of hypothyroidism should be able to care for most patients with primary hypothyroidism.
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