Abstract
Differentiated thyroid cancer (DTC) represents the most common form of thyroid neoplasms and is becoming increasingly prevalent. Evidence suggests a possible relationship between DTC diagnosis and subsequent atrial fibrillation (AF). If confirmed, this may present an alarming health risk (AF) in an otherwise condition with a relatively good prognosis (DTC). The aim of this systematic review and meta-analysis is to provide for the first time a pooled estimate of AF incidence in DTC patients in comparison to healthy controls. A detailed search in electronic databases, clinical trial registries and grey literature was performed to identify studies reporting the incidence of AF in DTC patients. Newcastle–Ottawa quality assessment scale was used to assess study quality. We used a random effects (RE) generalized linear mixed model (GLMM) in pooling of individual studies and also calculated a prediction interval for the estimate of a new study. Six observational studies met the eligibility criteria, which included totally 187,754 patients with DTC and 199,770 healthy controls. The median follow-up period was 4.3 to 18.8 years; the incidence rate of AF was 4.86 (95% CI, 3.29 to 7.17, I2 = 96%) cases per 1000 person-years, while the incidence rate ratio was 1.54 (95% CI, 1.44 to 1.65, I2 = 0%, 95% PI, 1.33 to 1.78).This is the first meta-analysis to confirm that patients with DTC are at a high risk for developing AF, which may be attributed to a state of iatrogenic hyperthyroidism due to long-term thyrotropin suppression therapy.
Highlights
Differentiated thyroid cancer (DTC), which includes papillary (85%) and follicular (12%) cancer, represents the most common form of malignant thyroid neoplasms
DTC is becoming increasingly prevalent, which is largely attributable to the increased detection of small papillary thyroid carcinomas and might be related to the widespread use of neck ultrasonography and/or cytological analysis of fine-needle aspirations (Davies & Welch 2014, Li et al 2020)
To further quantify the magnitude of difference between patients with DTC and their healthy counterparts, we provided an incidence rate ratio (IRR) approximation, incorporating in parallel variations in the length of follow-up among studies
Summary
Differentiated thyroid cancer (DTC), which includes papillary (85%) and follicular (12%) cancer, represents the most common form of malignant thyroid neoplasms. According to the European and American Thyroid Association, long-term levothyroxine suppression of thyrotropin (THST) is recommended in high- and selected intermediate-risk patients, whereas a low-normal thyroid-stimulating hormone (TSH) is considered to be the optimal therapeutic target for low-risk patients (Perros et al 2014, Haugen et al 2016). The rationale behind this approach is the minimization of potential TSH-mediated stimulation of tumour growth and the prevention of recurrence (Jonklaas et al 2006, Brabant 2008, Goemann et al 2017). We performed a systematic review and meta-analysis to assess for the first time the incidence of AF in DTC patients and collate it in reference to healthy controls
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