Risk of incident circulatory disease in patients treated for differentiated thyroid carcinoma with no history of cardiovascular disease

Research output: Contribution to journalArticlepeer-review


  • Konstantinos A Toulis
  • David Viola
  • George Gkoutos
  • Deepiksana Keerthy

External organisations

  • Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece.
  • Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
  • Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.
  • Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
  • MRC Health Data Research UK (HDR UK), London, UK.
  • Institute of Applied Health Research, University of Birmingham, Birmingham, Uk.


CONTEXT: The incidence of differentiated thyroid cancer (DTC) is increasing, yet the prognosis is favourable and long-term survival is expected. Exogenous TSH suppression has been used for many years to prevent DTC recurrence and may be associated with increased risks of circulatory diseases.

DESIGN: Risks of circulatory disease in patients treated for DTC were compared to randomly matched patients without DTC (controls) up to a 1:5 ratio using age, sex, body mass index (BMI) and smoking as the matching parameters in a population-based, open cohort study using The Health Improvement Network.

PATIENTS: A total of 3009 patients treated for DTC with no pre-existing cardiovascular disease were identified and matched to 11 303 controls, followed up to median of 5 years.

RESULTS: A total of 1259 incident circulatory events were recorded during the observation period. No difference in the risk of ischaemic heart disease (IHD) (adjusted hazards ratio [aHR]: 1.04, 95% CI: 0.80-1.36) or heart failure (HF) (aHR: 1.27, 95% CI: 0.89-1.81) was detected. The risk of atrial fibrillation (AF) and stroke was significantly higher in patients with DTC (aHR: 1.71, 95% CI: 1.36-2.15 and aHR: 1.34, 95% CI: 1.05-1.72, respectively). In a sensitivity analysis limited to newly diagnosed patients with DTC, only the risk of AF was consistently elevated (aHR: 1.86, 95% CI: 1.33-2.60).

CONCLUSIONS: The increased risk of AF in patients who have undergone treatment for DTC but without pre-existing CVD may warrant periodic screening for this arrhythmia. Whereas no evidence of increased risk of IHD or HF was observed, the increased risk of stroke/TIA warrants further investigation.

Bibliographic note

© 2019 John Wiley & Sons Ltd.


Original languageEnglish
Pages (from-to)323-330
Number of pages8
JournalClinical Endocrinology
Issue number2
Early online date16 Apr 2019
Publication statusPublished - 1 Aug 2019


  • atrial fibrillation, cardiovascular events, s, differentiated thyroid carcinoma, thyroid cancer