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Higher thyroid hormone levels and cancer.

  • Petranović Ovčariček, Petra1, 2
  • Verburg, Frederik A3, 4
  • Hoffmann, Martha3, 5
  • Iakovou, Ioannis3, 6
  • Mihailovic, Jasna3, 7, 8
  • Vrachimis, Alexis3, 9
  • Luster, Markus3, 10
  • Giovanella, Luca3, 11, 12
  • 1 EANM Thyroid Committee, Vienna, Austria. [email protected] , (Austria)
  • 2 Department of Oncology and Nuclear medicine, University Hospital Center "Sestre milosrdnice", Zagreb, Croatia. [email protected] , (Croatia)
  • 3 EANM Thyroid Committee, Vienna, Austria. , (Austria)
  • 4 Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands. , (Netherlands)
  • 5 Department of Nuclear Medicine, Radiology Centre, Vienna, Austria. , (Austria)
  • 6 Academic Department of Nuclear Medicine, Aristotle University, Thessaloniki, Greece. , (Greece)
  • 7 Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia. , (Serbia)
  • 8 Department of Nuclear Medicine, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia. , (Serbia)
  • 9 Department of Nuclear Medicine, German Oncology Center, University Hospital of the European University, Limassol, Cyprus. , (Cyprus)
  • 10 University Hospital Marburg, Department of Nuclear Medicine, Marburg, Germany. , (Germany)
  • 11 Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland. , (Switzerland)
  • 12 Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland. , (Switzerland)
Published Article
European Journal of Nuclear Medicine
Publication Date
Mar 01, 2021
DOI: 10.1007/s00259-020-05018-z
PMID: 32944783


This narrative review aims to summarize the relationship between hyperthyroidism, upper reference range thyroid hormone (TH) levels, and cancer, and to address the clinical management of hyperthyroidism in cancer patients. A comprehensive search was performed by an independent reviewer through Google Scholar and PubMed Electronic databases. All searches were restricted to English language manuscripts published between 2000 and 2020. Numerous in vitro, in vivo, and population-based studies suggest cancer-stimulating effect of triiodothyronine and thyroxin. THs are presented as mediators for tumor growth, proliferation, and progression. Many population and case-control studies suggest an increased risk of several solid but also hematologic malignancies in relation to hyperthyroidism and upper normal range TH levels. However, results are not unambiguous. In this review, we will summarize population and case-control studies that investigated the relationship between hyperthyroidism, upper reference range TH levels, lower thyrotropin (TSH) levels, lower reference range TSH levels with cancer risk, cancer prognosis, and cancer outcome. The vast majority of evidence suggests an association between clinical and subclinical hyperthyroidism with the risk of developing several types of cancer. Furthermore, hyperthyroidism is also linked with a poorer cancer prognosis. In this review, we will also discuss the diagnosis of hyperthyroidism in patients with pre-existing cancer and cover the management of hyperthyroidism in cancer patients, with special attention on the role of nuclear medicine. It is crucial to emphasize the importance of the rapid establishment of euthyroidism, and consequently, the importance of radioiodine therapy, as the therapy of choice in most cancer patients. We want to show that in this day and age there still is a high relevance for I-131 to achieve a permanent solution and thus likely reduce the risk of adverse influence of hyperthyroidism on the occurrence of new and course of existing cancer cases.

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