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Thyroid Hormone Therapy and Thyrotropin Suppression

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Thyroid Cancer

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Abstract

Levothyroxine (L-T4) is arguably the most prescribed medication in the United States, with its most common therapeutic indication being for hypothyroidism due to chronic thyroiditis or Hashimoto’s disease. Such patients are candidates for so-called replacement dosage, with the administered dosage of L-T4 titrated to a target thyrotropin (TSH) level within the normal reference range of 0.4–3.0 mU/L. Patients with thyroid cancer who have had near-total to total thyroidectomy and have suspected residual disease are usually candidates for suppressive levothyroxine dosage, which is so-called because the aim of therapy is to give a slightly supraphysiologic dosage of thyroxine to suppress TSH. The rationale for suppressive therapy is based on studies indicating that TSH stimulation enhances tumor growth, TSH serving as a growth factor or mitogen for thyroid malignancies with observations of more rapid tumor growth seen clinically after thyroxine withdrawal. The growth-promoting property of TSH is presumed to be from the presence of TSH receptors on thyroid cancer cells; however, non-TSH receptor-mediated growth is certainly a property of undifferentiated thyroid cancers. In patients presenting with a thyroid nodule, the likelihood that the nodule may be malignant correlates directly to the level of serum TSH, and thyroid cancer patients with elevated TSH levels may be more likely to have more advanced disease or evidence of extrathyroidal extension at time of presentation.

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  1. Department of Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street, N.W., Washington, DC, 20010-2975, USA

    Leonard Wartofsky MD, MACP

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Correspondence to Leonard Wartofsky MD, MACP .

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  1. Department of Medicine, MedStar Washington Hospital Center Georgetown University School of Medicine, Washington, DC, USA

    Leonard Wartofsky

  2. Nuclear Medicine Research MedStar Research Institute and Washington Hospital Center, Georgetown University School of Medicine Washington Hospital Center, Washington, DC, USA

    Douglas Van Nostrand

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Wartofsky, L. (2016). Thyroid Hormone Therapy and Thyrotropin Suppression. In: Wartofsky, L., Van Nostrand, D. (eds) Thyroid Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-3314-3_36

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