{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:35:02Z","timestamp":1792697702866,"version":"4.5.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Prospective studies have demonstrated the favorable prognosis of differentiated thyroid cancer, primarily due to its low risk of recurrence and mortality. Considering these favorable outcomes, the most recent ATA guidelines recommend individualizing the degree of TSH suppression to balance the risks and benefits of LT4 therapy based on the aggressiveness of the disease. However, no studies have evaluated the cardiovascular risk in disease-free patients receiving long-term replacement doses of LT4 following the 2016 ATA guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>This study aimed to evaluate cardiovascular risk in disease-free athyreotic patients with differentiated thyroid cancer according to the 2021 European Society of Cardiology (ESC) guidelines. Only patients without major CV events prior to DTC diagnosis and treated with long-term LT4 therapy after the 2016 ATA guidelines were included. From a larger cohort, 300 disease-free patients who underwent total thyroidectomy\u2014with or without radioiodine (RAI)\u2014were selected and 102 patients were included in this study. The cardiovascular risk was assessed using the ESC 2021 scoring systems: SCORE2, SCORE2-OP, and SCORE2-Diabetes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 102 patients analyzed in detail, 14 experienced major adverse cardiovascular events (MACE) over a mean follow-up of 12.79 \u00b1 9.13 years post-DTC diagnosis. In patients without MACE, none were classified as having a very high CV risk. A high CV risk was observed in 6% (SCORE2), 38.5% (SCORE2-OP), and 50% (SCORE2-Diabetes) of patients. Moderate CV risk was found in 34% (SCORE2), 38.5% (SCORE2-OP), and 50% (SCORE2-Diabetes), while low risk was recorded in 60% (SCORE2) and 23% (SCORE2-OP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>These findings highlight the need for careful cardiovascular monitoring during long-term follow-up in patients with differentiated thyroid cancer. Specific cardiovascular management guidelines are needed in DTC, similar to those available for other cancer populations, to balance the risks and benefits of LT4 therapy and to identify patients at higher cardiovascular risk who may need closer monitoring.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1659736","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T04:12:58Z","timestamp":1756181578000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Cardiovascular risk after total thyroidectomy in patients with differentiated thyroid carcinoma undergoing levothyroxine replacement monotherapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Martina","family":"Pucci","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilena","family":"Calzolaio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ghezzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Iannotta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Gifuni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Ruberto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Crescenzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Esposito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadette","family":"Biondi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-14-0155","article-title":"Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States","volume":"74","author":"Rahib","year":"2014","journal-title":"Cancer Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1038\/ncpendmet0020","article-title":"Thyroid-hormone therapy and thyroid cancer: a reassessment","volume":"1","author":"Biondi","year":"2005","journal-title":"Nat Clin Pract Endocrinol Metab"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2009.0110","article-title":"Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer","volume":"19","author":"Cooper","year":"2009","journal-title":"Thyroid"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2009.0311","article-title":"Benefits of thyrotropin suppression versus the risks of adverse effects in differentiated thyroid cancer","volume":"20","author":"Biondi","year":"2010","journal-title":"Thyroid"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2018.10.008","article-title":"Thyroid hormone suppression therapy","volume":"48","author":"Biondi","year":"2019","journal-title":"Endocrinol Metab Clin North Am"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab576","article-title":"Cardiovascular outcomes in thyroid cancer patients treated with thyroidectomy: A meta-analysis","volume":"106","author":"Lee","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2024.0232","article-title":"TSH Suppression in Differentiated Thyroid Cancer Patients. 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