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Thyroid disease in relation to breast cancer

Schilddrüsenerkrankung in Beziehung zum Brustkrebs

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Zusammenfassung

Literaturberichte über die Beziehung von Schilddrüsenfunktion zum Brustkrebs sind widersprüchlich. Die Hypothyreose ist einerseits als schützend und andererseits als prädisponierend für das Mammakarzinom angesehen worden. Es wurde angenommen, daß es bei Hypothyreosepatientinnen zur Hypersensibilisierung des mammaeren glandulären Epithels gegenüber Prolaktin und Östrogenen kommt, was die Entwicklung von Brustneoplasie begünstigt. Aber auch die Thyreoidhormontherapie wurde mit einem erhöhten Brustkrebsrisiko in Zusammenhang gebracht; die Meinungen darüber sind geteilt. Gegenwärtig wird von der “American Thyroid Association” empfohlen, daß hypothyreoide Patienten mit Schilddrüsenhormonen substituiert werden sollen.

Die Hyperthyreose ist mit einem verminderten Brustkrebsrisiko assoziiert worden. Ebenso soll bei hyperthyreoiden Patientinnen mit inoperablem Brustkrebs der maligne Verlauf verlangsamt sein. Jedoch auch diese Ansichten sind strittig; die Hyperthyreose wurde sogar mit der Brustkrebsentwicklung bei Frauen in der Prämenopause in Verbindung gebracht.

Trotz zahlreicher Publikationen ist gegenwärtig die Rolle von Thyreoidhormonen in der Pathobiologie des Brustkrebses nicht bekannt. Es erscheint, daß die „Thyreoida-Brustkrebs Kontroverse“ nur durch prospektive Untersuchungen geklärt werden kann, wobei vorzugsweise an Frauen in der Postmenopause, Schilddrüsen-, Hypophysen- und Nebennierenrindenfunktionen mit den klinischen Befunden von Thyreoidea und Mamma sowie dem Östrogen-Androgenstatus korreliert werden.

Summary

A controversy exists in regard to thyroid function and breast cancer. Hypothyroidism has been suggested as being either protective from breast cancer or predisposing to the disease. It has been hypothesized that a deficiency in circulating thyroid hormones may hypersensitize the mammary glandular epithelium toward prolactin and estrogens, thus aiding in the development of breast neoplasia. On the other hand, thyroid hormone replacement therapy has been connected with an increased risk of breast cancer, but this has been contested. At this time the American Thyroid Association recommends that, if indicated, hypothyroid patients should take their thyroid hormone medication.

Hyperthyroidism has been associated with a decreased risk of breast cancer. Also, in hyperthyroid patients with inoperable breast cancer, the malignant growth is thought to be slowed. However, this, too has been disputed. Moreover, hyperthyroidism has been connected with the development of breast cancer in premenopausal women.

At present no role of thyroid hormone in the pathobiology of breast cancer can be defined. It seems that the “thyroid-breast cancer controversy” can only be resolved by a prospective study preferably on postmenopausal women correlating thyroid (T3, T4, PBI), pituitary (TSH, TRH, Prolactin), and adrenocortical (androgens) function tests with the clinical examination of thyroid, breast, and genital apparatus and determination of the estrogen status (vaginal smear, plasma estrogens) as well.

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  1. Departments of Obstetrics-Gynecology and of Pharmacology, The University of New Mexico, School of Medicine, 87131, Albuquerque, New Mexico, USA

    H. Vorherr

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Vorherr, H. Thyroid disease in relation to breast cancer. Klin Wochenschr 56, 1139–1145 (1978). https://doi.org/10.1007/BF01476857

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