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Objective <p>Thyroid-stimulating hormone (TSH) suppression therapy with levothyroxine is essential for patients with differentiated thyroid cancer (DTC) after surgery. While it reduces recurrence risk in high-risk patients, its intensity should be tailored according to risk stratification. This study aimed to evaluate physicians’ adherence to recommendations on TSH suppression therapy in patients with DTC after surgery and/or radioiodine therapy.</p> Design <p>This prospective study included patients managed at two specialized centres following total thyroidectomy for DTC.</p> Methods <p>Patients on a stable levothyroxine dose for at least 3&#xa0;months were enrolled. Data collected at the last follow-up included serum TSH, free thyroxine (FT4), free triiodothyronine (FT3), thyroglobulin, and anti-thyroglobulin antibody levels. TSH values were categorized as within target range, below target (over-suppressed), or above target (under-suppressed) according to American Thyroid Association guidelines and recurrence risk (low, intermediate, high).</p> Results <p>Of 365 patients (female/male ratio: 306/59; mean age: 54.7&#xa0;years for females, 56.3&#xa0;years for males), only 136 (37.3%) achieved target TSH levels. TSH was under-suppressed in 86 patients (23.6%) and over-suppressed in 129 patients (35.3%). Over-suppression was most prevalent (62%) in the low-risk group.</p> Conclusions <p>Adherence to guideline-recommended TSH suppression therapy in DTC remains suboptimal, with frequent over-suppression, particularly in low-risk patients. These findings highlight the need for individualized suppression strategies balancing recurrence prevention and the avoidance of iatrogenic complications.</p>

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Adherence to Suppression Therapy Guidelines After Thyroid Cancer Surgery

  • 期刊论文

  • 发表日期：

    2025年10月10日

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  • Petra Nemcikova,
  • Vojtech Kratochvil,
  • Samuel Srobar,
  • Vladimir Musil,
  • Richard Sotornik,
  • Tereza Grimmichova,
  • Ludmila Brunerova

摘要

Objective

Thyroid-stimulating hormone (TSH) suppression therapy with levothyroxine is essential for patients with differentiated thyroid cancer (DTC) after surgery. While it reduces recurrence risk in high-risk patients, its intensity should be tailored according to risk stratification. This study aimed to evaluate physicians’ adherence to recommendations on TSH suppression therapy in patients with DTC after surgery and/or radioiodine therapy.

Design

This prospective study included patients managed at two specialized centres following total thyroidectomy for DTC.

Methods

Patients on a stable levothyroxine dose for at least 3 months were enrolled. Data collected at the last follow-up included serum TSH, free thyroxine (FT4), free triiodothyronine (FT3), thyroglobulin, and anti-thyroglobulin antibody levels. TSH values were categorized as within target range, below target (over-suppressed), or above target (under-suppressed) according to American Thyroid Association guidelines and recurrence risk (low, intermediate, high).

Results

Of 365 patients (female/male ratio: 306/59; mean age: 54.7 years for females, 56.3 years for males), only 136 (37.3%) achieved target TSH levels. TSH was under-suppressed in 86 patients (23.6%) and over-suppressed in 129 patients (35.3%). Over-suppression was most prevalent (62%) in the low-risk group.

Conclusions

Adherence to guideline-recommended TSH suppression therapy in DTC remains suboptimal, with frequent over-suppression, particularly in low-risk patients. These findings highlight the need for individualized suppression strategies balancing recurrence prevention and the avoidance of iatrogenic complications.