In Review | Thryoid Updates 2025 | Oncology

Long-Term Health Consequences in Thyroid Cancer Survivors: Fertility, Bone Health, and Cardiovascular Risk

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This article is a compilation of recent studies published in a number of peer-reviewed publications. It is not intended to represent original research, nor is it intended to replace the original research.  Access the full Disclaimer Information.

 

While thyroid cancer generally has a favourable prognosis, long-term survivors face distinct health challenges that extend beyond remission.
 
New findings presented at the 2024 American Thyroid Association (ATA) Meeting highlighted persistent concerns related to fertility, bone health, and cardiovascular disease (CVD).
 
Below follows a summary of insights presented at the meeting, which underscore the importance of long-term survivorship care plans tailored to individual risk profiles.
 

Fertility in Thyroid Cancer Survivors
 
Although thyroid cancer itself does not appear to reduce fertility, treatment—particularly radioactive iodine (RAI) therapy—may have temporary effects on reproductive health, especially in women.
 
Pregnancy and childbirth rates in thyroid cancer survivors are generally comparable to those in survivors of other cancers like melanoma and non-Hodgkin lymphoma.¹
 
However, RAI is linked to reduced anti-Müllerian hormone levels and menstrual irregularities within the first year post-treatment. Fertility outcomes tend to normalise if conception is delayed for at least six months after therapy.
 
Fertility assessments for women should include pelvic ultrasound, thyroid function tests, and anti-Müllerian hormone levels.
 
For men, thyroid cancer poses no significant long-term fertility risk, though RAI may warrant sperm cryopreservation if conception is planned within 12–18 months post-treatment. Semen analysis and hormone testing are advised for comprehensive evaluation.¹
 
Updated ATA fertility guidelines are anticipated in 2025, aiming to refine recommendations on RAI timing and preservation strategies.


 
Bone Health and Osteoporosis Risk
 
Thyroid cancer survivors are at increased risk for bone loss, primarily due to prolonged TSH suppression therapy, which is a standard part of thyroid cancer management. Suppressed TSH reduces its inhibitory effect on bone resorption and accelerates bone turnover, contributing to osteopenia and osteoporosis.
 
A 2021 cross-sectional study by Jin et al. found the odds ratio (OR) for osteoporosis was significantly elevated in thyroid cancer survivors, particularly among women. However, the fracture risk in these patients did not significantly differ from controls.²   This paradox reflects the complex interplay of demographics, treatment effects, and protective factors.

Ongoing revisions to the ATA’s TSH suppression guidelines are moving toward simplified targets (<0.5 mIU/L), which could ease medication management without compromising safety, especially in older adults and postmenopausal women.
 
Routine bone density screening and lifestyle modifications—such as adequate calcium and vitamin D intake, weight-bearing exercise, and consideration of pharmacologic interventions—are recommended for high-risk survivors.

 
Cardiovascular Risk and Thyroid Cancer
 
In recent years, the relationship between thyroid cancer and cardiovascular disease has been increasingly recognised, but the direct correlation remains complex.
 
A 2023 meta-analysis by Tsai et al. found increased risks for cerebrovascular disease, atrial fibrillation, and coronary artery disease in survivors. Shared risk factors—such as obesity and metabolic syndrome—may predispose survivors to both conditions, further complicating the findings.³

Researchers have cautioned that many studies fail to adjust for key variables such as baseline cardiovascular risk or degree of TSH suppression. This makes it difficult to draw definitive conclusions regarding causality or intervention effects.
 
While routine cardiovascular screening for all thyroid cancer survivors is not yet supported by evidence, individualised risk assessment is essential—particularly for patients with pre-existing cardiovascular conditions or metabolic risk factors.


Conclusion
 
Although thyroid cancer has high survival rates, attention to fertility, bone health, and cardiovascular well-being is essential for long-term quality of life. 
 
Evidence-based survivorship strategies must go beyond disease monitoring to address these emerging concerns. Furthermore more the studies reinforced the need for a multidisciplinary, personalised approach to survivorship care in thyroid cancer. As guidelines evolve, incorporating these insights into routine care can help mitigate long-term risks and support the overall health of thyroid cancer survivors.
 

 

 

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