Menopause-Related Health Outcomes in Women with Differentiated Thyroid Carcinoma Receiving Long-Term TSH Suppression after Total Thyroidectomy

Abstract

Background:

There is uncertainty regarding whether thyroid-stimulating hormone (TSH) suppression therapy in postmenopausal women with differentiated thyroid cancer (DTC) is associated with menopause-specific health concerns. This study aimed to determine whether prolonged TSH suppression confers an additional burden on postmenopausal health by comprehensively evaluating cardiovascular health (CVH), quality of life (QoL), muscle mass, and bone health using menopause-specific assessment tools.

Methods:

A cross-sectional study was conducted involving three groups of postmenopausal women 107 patients with DTC receiving TSH suppression therapy following total thyroidectomy for ≥3 years, 80 women receiving levothyroxine (LT4) replacement for primary hypothyroidism, and 97 euthyroid controls. Women with cognitive impairment, a history of osteoporosis, or cardiovascular disease were excluded. CVH was assessed using Life’s Essential 8 (LE8) score, carotid intima-media thickness (cIMT), and electrocardiography. QoL was assessed using the Utian QoL (UQoL) Scale, cognition by the Mini-Mental State Examination, body composition by bioelectrical impedance analysis, and bone density by dual-energy X-ray absorptiometry.

Results:

Women with DTC demonstrated significantly lower LE8 scores, lower UQoL scores, higher cIMT values, higher prevalence of osteoporosis, and reduced muscle mass than those in the other two groups (p < 0.001, p < 0.001, p < 0.001, p = 0.003, and p = 0.017, respectively). Multivariable regression analysis revealed that cumulative LT4 dose was independently associated with lower LE8 and UQoL scores (β = −0.354, p < 0.001; and β = −0.396, p < 0.001, respectively), while higher serum TSH levels were positively associated with both LE8 and UQoL scores (β = 0.271, p = 0.002; and β = 0.487, p < 0.001, respectively).

Conclusions:

Prolonged TSH suppression may adversely affect postmenopausal health, particularly in low-risk, disease-free women with DTC. The primary clinical implication of these findings is the need to avoid unnecessary long-term TSH suppression. Menopause-specific assessment tools may have a complementary role in selected patients in whom TSH suppression remains clinically indicated.