Further Debate on T3 + T4 Combination Therapy at ATA Meeting

Nancy A. Melville

October 30, 2019

CHICAGO — The 89th American Thyroid Association (ATA) Annual Meeting gets underway this week, offering a 5-day dive into all things thyroid, ranging from a broad selection of debates to plenary sessions covering some of the most pressing and controversial issues facing the field, as well as a first-of-its-kind joint session with leading European thyroid groups.

The latter will cover the ongoing debate regarding combination therapy with levothyroxine [T4] and triiodothyronine [T3] for hypothyroid patients.

"The ATA meeting continues to grow: this year we have set a new abstract submission record, with 560 scheduled presentations from 39 countries," Program Committee Cochair Antonio Di Cristofano, PhD, told Medscape Medical News.

Cristofano is a professor in the Department of Developmental and Molecular Biology at the Albert Einstein Cancer Center in New York City.

The highlighted oral abstract session will feature research selected by the program committee as being the most important and will feature topics including CTNNB 1, which "Inhibits Progression of BrafV600E-Induced Papillary Thyroid Cancer and Promotes Re-Differentiation and Iodine Uptake"; clinical trial results on the "Efficacy of Teprotumumab, an Insulin-Like Growth Factor-1 Receptor Antagonist Antibody, in Patients with Active Thyroid Eye Disease"; and "Heat-Inducible Mesenchymal Stem Cell (MSC)-Mediated Sodium Iodide Symporter (NIS) Gene Therapy."

And on Saturday afternoon, the ATA will pay tribute to Leslie De Groot, MD, praised as a leader in the field of thyroid medicine, who recently passed away. The session will focus on De Groot's many contributions to thyroidology.

Women in Thyroid Medicine; CAR T-Cell Therapy and Pregnancy

The work of two prominent women will be profiled during the Clark T. Sawin Historical Vignette Women in Thyroidology plenary session on paradigm-shifting scientific contributions.

"I am very excited that we will be announcing at that session the creation of the first ATA lectureship to be named after a woman thyroidologist," ATA president Elizabeth Pearce, MD, told Medscape Medical News.

Other plenary sessions will include a lecture by Terry Fry, MD, during which he will discuss the hot topic of "CAR T-Cell Therapy in Blood Malignancies."

Fry, a professor of pediatrics, hematology, and immunology at Children's Hospital Colorado, in Denver, specializes in cell-based immunotherapy for pediatric leukemia.

And in another plenary lecture, Gil Mor, MD, will talk about "Pregnancy — A Unique Immunological and Microbial Condition."

Mor is the John M. Malone Jr, MD, endowed professor, Department of Obstetrics and Gynecology at Wayne State University School of Medicine, Detroit, Michigan.

Combination Therapy Tackled in International Joint Symposium

The meeting will also feature a first-of-its-kind joint symposium by the ATA, European Thyroid Association (ETA), and British Thyroid Association (BTA) that will link experts in Chicago and London by video to take on "Evidence Based Use of T3 + T4 Combinations," a topic of ongoing debate.

"The goal for this session is to explore the current evidence for benefit of combination therapy with both levothyroxine and T3 [triiodothyronine] for hypothyroid patients, an area of considerable controversy, and then to define the optimal parameters for a clinical trial to determine whether combination therapy is superior to levothyroxine alone in some or all hypothyroid patients," Pearce explained.

"I am very excited about the first joint ETA/BTA/ATA symposium," added Program Committee Cochair Mona M. Sabra, MD.

"This is obviously a very hot topic that will discuss optimal thyroid replacement strategies in the setting of renewed interest in combination T4 and T3 therapy, new research efforts, and data," she told Medscape Medical News.

"And a new formulation for this combination therapy...is apparently now available or soon to be available in the European market," said Sabra, a professor of clinical medicine, Endocrine Service, Department of Medicine, Memorial Sloan Kettering and Weill Cornell School of Medicine, New York City.

Anaplastic Thyroid Cancer Update, Other Thyroid Cancer Developments

Pearce noted that among the most anticipated sessions at the meeting is the Arthur Bauman Clinical Symposium, which will feature a preview of new anaplastic thyroid cancer guidelines, including talks on ethical, surgical, and medical considerations in the management and treatment of this rare but aggressive cancer.

"Newly updated anaplastic thyroid cancer guidelines will be issued in late 2019 or early 2020. This session will provide an overview of the new guidelines," Pearce said.

Meanwhile, other symposia will address a number of important issues in the management of other thyroid cancers.

An Early Riser symposium on Friday, entitled "Cutting Edge Concepts in the Surgical Management of Thyroid Disease: The Future Is Here," will tackle topics including "Transoral Thyroid Surgery: State of Affairs 2019," "Radiofrequency Ablation (RFA) for Thyroid Nodules and Thyroid Cancer: Pipedream or Disruptive Technology?" and "Nerve Monitoring in Remote Access Surgery: Why It's an Imperative."

Another clinical symposium focusing on thyroid cancer will feature talks on "Low Risk Differentiated Thyroid Cancer (DTC) Patients: Who to Treat and Who to Watch," "Local Therapy (Laser, RF, MW, ETOH) for Recurrent Nodal DTC," and "TVDT as a Predictor of Prognosis and Treatment Response in Metastatic DTC."

And a symposium on the "Surgical Management of Difficult Multinodular Goiters: International Perspectives" will cover challenges and recommendations in their treatment.

There will also be a talk on the compelling scenario of "Thyroid Surgery By Flashlight: Situations in Low-Resource Environments."

Other sessions include "Thoracotomy in Substernal Goiter Always Necessary? Fact or Fiction?" "Minimizing Nervousness About the Nerve: Preservation and Monitoring in Goiter Surgery," and "There Are No Difficult Patients — Only Difficult Patient Interactions."

Thyroid Disease in Children

Taking on the pressing issue of thyroid disease in children will be the "Pediatric Thyroid Forum Satellite Symposium 2019: Update on Pediatric Thyroid Disease." The hottest topics — and controversies facing the thyroid field — will be hashed out in a variety of debates, including "Controversies in Identifying RAI Refractory Thyroid Cancer" and "Remote Access Thyroid Surgery Update 2019: When? Why? How?"

Throughout the meeting, attendees can expect to network with as many, if not more, colleagues than ever, Cristofano said.

Although the finally tally is not in, "We are close to matching (or breaking) the all-time attendance record set last year in Washington, DC," he said.

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