Thyroid hormone therapy in differentiated thyroid cancer

Surgery—with or without postoperative radioiodine—is the standard of care for most patients with differentiated thyroid carcinoma (DTC). Thyroid hormone replacement therapy is the mainstay of long-term medical management. Patients treated with total thyroidectomy and some who undergo lobectomy alone...

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Bibliographic Details
Published in:Endocrine 2019-10, Vol.66 (1), p.43-50
Main Authors: Grani, Giorgio, Ramundo, Valeria, Verrienti, Antonella, Sponziello, Marialuisa, Durante, Cosimo
Format: Article
Language:English
Subjects:
Carcinoma - rehabilitation
Diabetes
Endocrinology
Health risk assessment
Hormone Replacement Therapy
Humanities and Social Sciences
Humans
Internal Medicine
Medicine
Medicine & Public Health
Menopause
multidisciplinary
Patients
Quality of life
Review
Science
Secretion
Surgery
Thyroid cancer
Thyroid carcinoma
Thyroid Hormones - administration & dosage
Thyroid Neoplasms - rehabilitation
Thyroid-stimulating hormone
Thyroidectomy
Thyrotropin - blood
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Summary:Surgery—with or without postoperative radioiodine—is the standard of care for most patients with differentiated thyroid carcinoma (DTC). Thyroid hormone replacement therapy is the mainstay of long-term medical management. Patients treated with total thyroidectomy and some who undergo lobectomy alone require thyroid hormone therapy to restore euthyroidism with normal serum thyroid-stimulating hormone (TSH) levels. Because TSH acts as a growth factor for thyroid follicular cells (including those that are neoplastic), it can potentially affect the onset and/or progression of follicular-cell derived thyroid cancer. For this reason, some patients are placed on thyroid hormone therapy at doses that suppress secretion of TSH (suppression therapy). This mini-review looks at the potential benefits and risks of this practice in patients diagnosed with DTC. Aggressive TSH-suppressive therapy is of little or no benefit to the vast majority of patients with DTC. Practice guidelines, therefore, recommend a graded algorithm in which the potential benefits of suppression are weighed against the associated cardiovascular and skeletal risks. Large randomized controlled studies are needed to confirm the presumed oncological benefits of TSH-suppression and its causal role in adverse cardiac, skeletal, and quality of life effects and to assess the efficacy of TSH normalization in reversing or reducing these effects.
ISSN:1355-008X
1559-0100
DOI:10.1007/s12020-019-02051-3