Influence of thyroid stimulating hormone suppression therapy after differentiated thyroid cancer surgery on serum anti-mullerian hormone level in women of childbearing age

Abstract:

Objective：To investigate the influence of postoperative thyroid stimulating hormone（TSH） suppression on serum anti-mul－lerian hormone（AMH） level in women of childbearing age with differentiated thyroid cancer（DTC），and to observe whether TSH sup－pression therapy has negative interference on ovarian reserve in women of childbearing age. Methods：The DTC subjects were selected from the patients enrolled in the postoperative follow-up pro－gram conducted by China-Japan Union Hospital of Jilin Uni－versity. The female patients，aged 20-48 years，who did not ex－perience menopause and regularly received levothyroxine（LT4） for postoperative TSH suppression for more than 3 years were enrolled，and their general clinical data and menstrual history were recorded. Venous blood samples were collected and serum was separated. Chemiluminescence immunoassay was used to measure the serum levels of TSH，free thyroxine（FT4），free triiodothyronine（FT3），and AMH. After being matched for age，healthy fe－male individuals who underwent physical examination in the Physical Examination Center in The First Affiliated Hospital of China Medical University were enrolled as healthy control group，and their serum samples were collected to measure the levels of TSH，FT4，FT3，and AMH. Results：There was no significant difference in age between postoperative TSH suppression group with 98 patients and healthy control group with 40 individuals. There was also no significant difference in serum AMH level [median（interquartile range）] between the two groups[1.19（0.58-2.21） ng/mL vs. 1.15（0.22-2.72） ng/mL），P=0.89]. The women of childbearing age with DTC were further divided into four subgroups according to the level of TSH suppression，i.e.，TSH<0.1 mIU/L group with 26 patients，0.1 mIU/L ≤TSH<0.4 mIU/L group with 23 patients，0.4 mIU/L≤TSH<2.0 mIU/L group with 36 patients，and TSH≥2.0 mIU/L group with 13 patients；the serum AMH levels in these subgroups were 1.20（0.71-1.62），1.01（0.57-2.22），1.25（0.67-2.83），and 0.92（0.10-2.81） ng/mL，respectively，and there was no significant difference in serum AMH level between these four subgroups and the healthy control group（P=0.58）. In the patients with DTC，serum AMH level was not correlated with TSH，FT4，and FT3 in TSH suppression patients（all P >0.05）. Conclusion：As a good indicator of ovarian reserve，serum AMH level shows no significant difference between women with DTC undergoing postoperative suppression therapy and healthy women of the same age，suggesting that TSH suppression therapy does not affect ovarian reserve，i.e.，reproductive potential，in DTC patients of childbearing age.