Skip to main content

Advertisement

SpringerLink
Log in

Thyroid hormone therapy in differentiated thyroid cancer

  • Review
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. L. Lamartina, C. Durante, G. Lucisano, G. Grani, R. Bellantone, C.P. Lombardi, A. Pontecorvi, E. Arvat, F. Felicetti, M.C. Zatelli, R. Rossi, E. Puxeddu, S. Morelli, M. Torlontano, U. Crocetti, T. Montesano, R. Giubbini, F. Orlandi, G. Aimaretti, F. Monzani, M. Attard, C. Francese, A. Antonelli, P. Limone, R. Rossetto, L. Fugazzola, D. Meringolo, R. Bruno, S. Tumino, G. Ceresini, M. Centanni, S. Monti, D. Salvatore, G. Spiazzi, C. Mian, L. Persani, D. Barbaro, A. Nicolucci, S. Filetti, Are evidence-based guidelines reflected in clinical practice? An analysis of prospectively collected data of the Italian Thyroid Cancer Observatory. Thyroid 27(12), 1490–1497 (2017). https://doi.org/10.1089/thy.2017.0299

    Article  PubMed  Google Scholar 

  2. M.C. Zatelli, L. Lamartina, D. Meringolo, E. Arvat, L. Damiani, G. Grani, A. Nervo, C. Durante, L. Giacomelli, Thyroid nodule recurrence following lobo-isthmectomy: incidence, patient’s characteristics, and risk factors. J. Endocrinol. Invest 41(12), 1469–1475 (2018). https://doi.org/10.1007/s40618-018-0946-5

    Article  CAS  PubMed  Google Scholar 

  3. R. Bruno, E. Ferretti, E. Tosi, F. Arturi, P. Giannasio, T. Mattei, A. Scipioni, I. Presta, R. Morisi, A. Gulino, S. Filetti, D. Russo, Modulation of thyroid-specific gene expression in normal and nodular human thyroid tissues from adults: an in vivo effect of thyrotropin. J. Clin. Endocrinol. Metab. 90(10), 5692–5697 (2005). https://doi.org/10.1210/jc.2005-0800

    Article  CAS  PubMed  Google Scholar 

  4. R.R. Cavalieri, Iodine metabolism and thyroid physiology: current concepts. Thyroid 7(2), 177–181 (1997). https://doi.org/10.1089/thy.1997.7.177

    Article  CAS  PubMed  Google Scholar 

  5. B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 26(1), 1–133 (2016). https://doi.org/10.1089/thy.2015.0020

    Article  PubMed  PubMed Central  Google Scholar 

  6. M. Luster, C. Aktolun, I. Amendoeira, M. Barczynski, K.C. Bible, L.H. Duntas, R. Elisei, D. Handkiewicz-Junak, M. Hoffmann, B. Jarzab, L. Leenhardt, T.J. Musholt, K. Newbold, I.J. Nixon, J. Smit, M. Sobrinho-Simoes, J.A. Sosa, R.M. Tuttle, F.A. Verburg, L. Wartofsky, D. Fuhrer, European perspective on 2015 american thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: proceedings of an interactive international symposium. Thyroid 29(1), 7–26 (2019). https://doi.org/10.1089/thy.2017.0129

    Article  PubMed  Google Scholar 

  7. B. Biondi, S. Filetti, M. Schlumberger, Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat. Clin. Pr. Endocrinol. Metab. 1(1), 32–40 (2005). https://doi.org/10.1038/ncpendmet0020

    Article  CAS  Google Scholar 

  8. B. Biondi, D.S. Cooper, Thyroid hormone suppression therapy. Endocrinol. Metab. Clin. North Am. 48(1), 227–237 (2019). https://doi.org/10.1016/j.ecl.2018.10.008

    Article  PubMed  Google Scholar 

  9. S. Filetti, J.M. Bidart, F. Arturi, B. Caillou, D. Russo, M. Schlumberger, Sodium/iodide symporter: a key transport system in thyroid cancer cell metabolism. Eur. J. Endocrinol. 141(5), 443–457 (1999)

    Article  CAS  Google Scholar 

  10. C. Durante, E. Puxeddu, E. Ferretti, R. Morisi, S. Moretti, R. Bruno, F. Barbi, N. Avenia, A. Scipioni, A. Verrienti, E. Tosi, A. Cavaliere, A. Gulino, S. Filetti, D. Russo, BRAF mutations in papillary thyroid carcinomas inhibit genes involved in iodine metabolism. J. Clin. Endocrinol. Metab. 92(7), 2840–2843 (2007). https://doi.org/10.1210/jc.2006-2707

    Article  CAS  PubMed  Google Scholar 

  11. M. D’Agostino, M. Sponziello, C. Puppin, M. Celano, V. Maggisano, F. Baldan, M. Biffoni, S. Bulotta, C. Durante, S. Filetti, G. Damante, D. Russo, Different expression of TSH receptor and NIS genes in thyroid cancer: role of epigenetics. J. Mol. Endocrinol. 52(2), 121–131 (2014). https://doi.org/10.1530/jme-13-0160

    Article  PubMed  Google Scholar 

  12. M.R. Haymart, D.J. Repplinger, G.E. Leverson, D.F. Elson, R.S. Sippel, J.C. Jaume, H. Chen, Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J. Clin. Endocrinol. Metab. 93(3), 809–814 (2008). https://doi.org/10.1210/jc.2007-2215

    Article  CAS  PubMed  Google Scholar 

  13. H.K. Kim, J.H. Yoon, S.J. Kim, J.S. Cho, S.S. Kweon, H.C. Kang, Higher TSH level is a risk factor for differentiated thyroid cancer. Clin. Endocrinol. (Oxf.) 78(3), 472–477 (2013). https://doi.org/10.1111/cen.12027

    Article  CAS  Google Scholar 

  14. L. Golbert, A.P. de Cristo, C.S. Faccin, M. Farenzena, H. Folgierini, M.S. Graudenz, A.L. Maia, T.S.H. Serum, levels as a predictor of malignancy in thyroid nodules: A prospective study. PLoS One 12(11), e0188123 (2017). https://doi.org/10.1371/journal.pone.0188123

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. A.A. Tam, D. Ozdemir, C. Aydin, N. Bestepe, S. Ulusoy, N. Sungu, R. Ersoy, B. Cakir, Association between preoperative thyrotrophin and clinicopathological and aggressive features of papillary thyroid cancer. Endocrine 59(3), 565–572 (2018). https://doi.org/10.1007/s12020-018-1523-6

    Article  CAS  PubMed  Google Scholar 

  16. I. Sugitani, Y. Fujimoto, Does postoperative thyrotropin suppression therapy truly decrease recurrence in papillary thyroid carcinoma? A randomized controlled trial. J. Clin. Endocrinol. Metab. 95(10), 4576–4583 (2010). https://doi.org/10.1210/jc.2010-0161

    Article  CAS  PubMed  Google Scholar 

  17. J. Jonklaas, N.J. Sarlis, D. Litofsky, K.B. Ain, S.T. Bigos, J.D. Brierley, D.S. Cooper, B.R. Haugen, P.W. Ladenson, J. Magner, J. Robbins, D.S. Ross, M. Skarulis, H.R. Maxon, S.I. Sherman, Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid 16(12), 1229–1242 (2006). https://doi.org/10.1089/thy.2006.16.1229

    Article  PubMed  Google Scholar 

  18. E.L. Mazzaferri, S.M. Jhiang, Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am. J. Med. 97(5), 418–428 (1994)

    Article  CAS  Google Scholar 

  19. N.J. McGriff, G. Csako, L. Gourgiotis, C.G. Lori, F. Pucino, N.J. Sarlis, Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann. Med 34(7-8), 554–564 (2002)

    Article  CAS  Google Scholar 

  20. D.S. Cooper, B. Specker, M. Ho, M. Sperling, P.W. Ladenson, D.S. Ross, K.B. Ain, S.T. Bigos, J.D. Brierley, B.R. Haugen, I. Klein, J. Robbins, S.I. Sherman, T. Taylor, H.R. Maxon 3rd, : Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: results from the National Thyroid Cancer Treatment Cooperative Registry. Thyroid 8(9), 737–744 (1998). https://doi.org/10.1089/thy.1998.8.737

    Article  CAS  PubMed  Google Scholar 

  21. S. Diessl, B. Holzberger, U. Mader, I. Grelle, J.W. Smit, A.K. Buck, C. Reiners, F.A. Verburg, Impact of moderate vs stringent TSH suppression on survival in advanced differentiated thyroid carcinoma. Clin. Endocrinol. (Oxf.) 76(4), 586–592 (2012). https://doi.org/10.1111/j.1365-2265.2011.04272.x

    Article  CAS  Google Scholar 

  22. Y. Ito, H. Masuoka, M. Fukushima, H. Inoue, M. Kihara, C. Tomoda, T. Higashiyama, Y. Takamura, K. Kobayashi, A. Miya, A. Miyauchi, Prognosis and prognostic factors of patients with papillary carcinoma showing distant metastasis at surgery (M1 patients) in Japan. Endocr. J. 57(6), 523–531 (2010)

    Article  Google Scholar 

  23. J. Klubo-Gwiezdzinska, S. Auh, M. Gershengorn, B. Daley, A. Bikas, K. Burman, L. Wartofsky, M. Urken, E. Dewey, R. Smallridge, A.M. Chindris, E. Kebebew, Association of thyrotropin suppression with survival outcomes in patients with intermediate- and high-risk differentiated thyroid cancer. JAMA Netw. Open 2(2), e187754 (2019). https://doi.org/10.1001/jamanetworkopen.2018.7754

    Article  PubMed  PubMed Central  Google Scholar 

  24. G.C. Hovens, M.P. Stokkel, J. Kievit, E.P. Corssmit, A.M. Pereira, J.A. Romijn, J.W. Smit, Associations of serum thyrotropin concentrations with recurrence and death in differentiated thyroid cancer. J. Clin. Endocrinol. Metab. 92(7), 2610–2615 (2007). https://doi.org/10.1210/jc.2006-2566

    Article  CAS  PubMed  Google Scholar 

  25. B. Biondi, D.S. Cooper, Benefits of thyrotropin suppression versus the risks of adverse effects in differentiated thyroid cancer. Thyroid 20(2), 135–146 (2010). https://doi.org/10.1089/thy.2009.0311

    Article  CAS  PubMed  Google Scholar 

  26. Q. Xia, S. Dong, P.D. Bian, J. Wang, C.J. Li, Effects of endocrine therapy on the prognosis of elderly patients after surgery for papillary thyroid carcinoma. Eur. Arch. Otorhinolaryngol. 273(4), 1037–1043 (2016). https://doi.org/10.1007/s00405-015-3564-2

    Article  PubMed  Google Scholar 

  27. L.Y. Wang, A.W. Smith, F.L. Palmer, R.M. Tuttle, A. Mahrous, I.J. Nixon, S.G. Patel, I. Ganly, J.A. Fagin, L. Boucai, Thyrotropin suppression increases the risk of osteoporosis without decreasing recurrence in ATA low- and intermediate-risk patients with differentiated thyroid carcinoma. Thyroid 25(3), 300–307 (2015). https://doi.org/10.1089/thy.2014.0287

    Article  CAS  PubMed  Google Scholar 

  28. P. Perros, K. Boelaert, S. Colley, C. Evans, R.M. Evans, G. Gerrard Ba, J. Gilbert, B. Harrison, S.J. Johnson, T.E. Giles, L. Moss, V. Lewington, K. Newbold, J. Taylor, R.V. Thakker, J. Watkinson, G.R. Williams, Guidelines for the management of thyroid cancer. Clin. Endocrinol. (Oxf.) 81(Suppl 1), 1–122 (2014). https://doi.org/10.1111/cen.12515

    Article  CAS  Google Scholar 

  29. L. Lamartina, T. Montesano, R. Falcone, M. Biffoni, G. Grani, M. Maranghi, L. Ciotti, L. Giacomelli, V. Ramundo, C. Lomonaco, C.R. Di Gioia, P. Lucia, G. Ronga, C. Durante, Is it worth suppressing tsh in low- and intermediate-risk papillary thyroid cancer patients before the first disease assessment? Endocr. Pract. 25(2), 165–169 (2019). https://doi.org/10.4158/EP-2018-0393

    Article  PubMed  Google Scholar 

  30. T. Tian, R. Huang, B. Liu, Is TSH suppression still necessary in intermediate- and high-risk papillary thyroid cancer patients with pre-ablation stimulated thyroglobulin <1 ng/mL before the first disease assessment? Endocrine (2019). https://doi.org/10.1007/s12020-019-01914-z

  31. M.C. Lee, M.J. Kim, H.S. Choi, S.W. Cho, G.H. Lee, Y.J. Park, D.J. Park, Postoperative thyroid-stimulating hormone levels did not affect recurrence after thyroid lobectomy in patients with papillary thyroid cancer. Endocrinol Metab (Seoul) 34(2), 150–157 (2019). https://doi.org/10.3803/EnM.2019.34.2.150

    Article  Google Scholar 

  32. S. Park, W.G. Kim, M. Han, M.J. Jeon, H. Kwon, M. Kim, T.Y. Sung, T.Y. Kim, W.B. Kim, S.J. Hong, Y.K. Shong, Thyrotropin suppressive therapy for low-risk small thyroid cancer: a propensity score-matched cohort study. Thyroid 27(9), 1164–1170 (2017). https://doi.org/10.1089/thy.2017.0177

    Article  CAS  PubMed  Google Scholar 

  33. G. Grani, L. Lamartina, C. Durante, S. Filetti, D.S. Cooper, Follicular thyroid cancer and Hurthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes &. Endocrinology 6(6), 500–514 (2018). https://doi.org/10.1016/S2213-8587(17)30325-X

    Article  Google Scholar 

  34. Y.M. Lee, Y.H. Lee, D.E. Song, W.B. Kim, T.Y. Sung, J.H. Yoon, K.W. Chung, S.J. Hong, Prognostic impact of further treatments on distant metastasis in patients with minimally invasive follicular thyroid carcinoma: verification using inverse probability of treatment weighting. World J. Surg. 41(1), 138–145 (2017). https://doi.org/10.1007/s00268-016-3608-9

    Article  PubMed  Google Scholar 

  35. R. Petric, B. Gazic, N. Besic, Prognostic factors for disease-specific survival in 108 patients with Hurthle cell thyroid carcinoma: a single-institution experience. BMC cancer 14, 777 (2014). https://doi.org/10.1186/1471-2407-14-777

    Article  PubMed  PubMed Central  Google Scholar 

  36. T.G. de Melo, D.E. Zantut-Wittmann, E. Ficher, L.V. da Assumpcao, Factors related to mortality in patients with papillary and follicular thyroid cancer in long-term follow-up. J. Endocrinol. Invest 37(12), 1195–1200 (2014). https://doi.org/10.1007/s40618-014-0131-4

    Article  CAS  PubMed  Google Scholar 

  37. A. Pisanu, D. Deplano, M. Pili, A. Uccheddu, Larger tumor size predicts nodal involvement in patients with follicular thyroid carcinoma. Tumori 97(3), 296–303 (2011). https://doi.org/10.1700/912.10025

    Article  PubMed  Google Scholar 

  38. F.A. Verburg, M.P. Stokkel, C. Duren, R.B. Verkooijen, U. Mader, J.W. van Isselt, R.J. Marlowe, J.W. Smit, C. Reiners, M. Luster, No survival difference after successful (131)I ablation between patients with initially low-risk and high-risk differentiated thyroid cancer. Eur. J. Nucl. Med. Mol. imaging 37(2), 276–283 (2010). https://doi.org/10.1007/s00259-009-1315-6

    Article  PubMed  Google Scholar 

  39. M.A. Gulcelik, N.E. Gulcelik, B. Kuru, M. Camlibel, H. Alagol, Prognostic factors determining survival in differentiated thyroid cancer. J. Surg. Oncol. 96(7), 598–604 (2007). https://doi.org/10.1002/jso.20845

    Article  PubMed  Google Scholar 

  40. M. Haq, C. Harmer, Differentiated thyroid carcinoma with distant metastases at presentation: prognostic factors and outcome. Clin. Endocrinol. (Oxf.) 63(1), 87–93 (2005). https://doi.org/10.1111/j.1365-2265.2005.02304.x

    Article  CAS  Google Scholar 

  41. Y. Ito, A. Miyauchi, H. Inoue, M. Fukushima, M. Kihara, T. Higashiyama, C. Tomoda, Y. Takamura, K. Kobayashi, A. Miya, An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J. Surg. 34(1), 28–35 (2010). https://doi.org/10.1007/s00268-009-0303-0

    Article  PubMed  Google Scholar 

  42. Y. Ito, T. Uruno, K. Nakano, Y. Takamura, A. Miya, K. Kobayashi, T. Yokozawa, F. Matsuzuka, S. Kuma, K. Kuma, A. Miyauchi, An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 13(4), 381–387 (2003). https://doi.org/10.1089/105072503321669875

    Article  PubMed  Google Scholar 

  43. R.M. Tuttle, J.A. Fagin, G. Minkowitz, R.J. Wong, B. Roman, S. Patel, B. Untch, I. Ganly, A.R. Shaha, J.P. Shah, M. Pace, D. Li, A. Bach, O. Lin, A. Whiting, R. Ghossein, I. Landa, M. Sabra, L. Boucai, S. Fish, L.G.T. Morris, Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance. JAMA Otolaryngol. Head. Neck Surg. 143(10), 1015–1020 (2017). https://doi.org/10.1001/jamaoto.2017.1442

    Article  PubMed  PubMed Central  Google Scholar 

  44. H.I. Kim, H.W. Jang, H.S. Ahn, S. Ahn, S.Y. Park, Y.L. Oh, S.Y. Hahn, J.H. Shin, J.H. Kim, J.S. Kim, J.H. Chung, T.H. Kim, S.W. Kim, High serum TSH level is associated with progression of papillary thyroid microcarcinoma during active surveillance. J. Clin. Endocrinol. Metab. 103(2), 446–451 (2018). https://doi.org/10.1210/jc.2017-01775

    Article  PubMed  Google Scholar 

  45. I. Sugitani, Y. Fujimoto, K. Yamada, Association between serum thyrotropin concentration and growth of asymptomatic papillary thyroid microcarcinoma. World J. Surg. 38(3), 673–678 (2014). https://doi.org/10.1007/s00268-013-2335-8

    Article  PubMed  Google Scholar 

  46. C. Do Cao, J.L. Wemeau, Risk-benefit ratio for TSH- suppressive Levothyroxine therapy in differentiated thyroid cancer. Ann. Endocrinol. (Paris) 76(1 Suppl 1), 1s47–52s47 (2015). https://doi.org/10.1016/s0003-4266(16)30014-2

    Article  Google Scholar 

  47. B. Biondi, S. Fazio, A. Cuocolo, D. Sabatini, E. Nicolai, G. Lombardi, M. Salvatore, L. Sacca, Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine. J. Clin. Endocrinol. Metab. 81(12), 4224–4228 (1996). https://doi.org/10.1210/jcem.81.12.8954019

    Article  CAS  PubMed  Google Scholar 

  48. N. Pajamaki, S. Metso, T. Hakala, T. Ebeling, H. Huhtala, E. Ryodi, J. Sand, A. Jukkola-Vuorinen, P.L. Kellokumpu-Lehtinen, P. Jaatinen, Long-term cardiovascular morbidity and mortality in patients treated for differentiated thyroid cancer. Clin. Endocrinol. (Oxf.) 88(2), 303–310 (2018). https://doi.org/10.1111/cen.13519

    Article  CAS  Google Scholar 

  49. J. Park, B.E. Blackburn, P.A. Ganz, K. Rowe, J. Snyder, Y. Wan, V. Deshmukh, M. Newman, A. Fraser, K. Smith, K. Herget, A.C. Kirchhoff, D. Abraham, J. Kim, M. Monroe, M. Hashibe, Risk factors for cardiovascular disease among thyroid cancer survivors: findings from the Utah Cancer Survivors Study. J. Clin. Endocrinol. Metab. 103(7), 2468–2477 (2018). https://doi.org/10.1210/jc.2017-02629

    Article  PubMed  Google Scholar 

  50. E.H. Kim, Y.K. Jeon, K. Pak, I.J. Kim, S.J. Kim, S. Shin, B.H. Kim, S.S. Kim, B.J. Lee, J.G. Lee, T.S. Goh, K. Kim, Effects of thyrotropin suppression on bone health in menopausal women with total thyroidectomy. J. Bone Metab. 26(1), 31–38 (2019). https://doi.org/10.11005/jbm.2019.26.1.31

    Article  PubMed  PubMed Central  Google Scholar 

  51. M.L. Quan, J.L. Pasieka, O. Rorstad, Bone mineral density in well-differentiated thyroid cancer patients treated with suppressive thyroxine: a systematic overview of the literature. J. Surg. Oncol. 79(1), 62–69 (2002). discussion 69-70

    Article  CAS  Google Scholar 

  52. K.A. Heemstra, N.A. Hamdy, J.A. Romijn, J.W. Smit, The effects of thyrotropin-suppressive therapy on bone metabolism in patients with well-differentiated thyroid carcinoma. Thyroid 16(6), 583–591 (2006). https://doi.org/10.1089/thy.2006.16.583

    Article  CAS  PubMed  Google Scholar 

  53. B. Biondi, D.S. Cooper, Subclinical hyperthyroidism. N. Engl. J. Med 379(15), 1485–1486 (2018). https://doi.org/10.1056/NEJMc1809627

    Article  PubMed  Google Scholar 

  54. B.H. Yoon, Y. Lee, H.J. Oh, S.H. Kim, Y.K. Lee, Influence of thyroid-stimulating hormone suppression therapy on bone mineral density in patients with differentiated thyroid cancer: a meta-analysis. J. Bone Metab. 26(1), 51–60 (2019). https://doi.org/10.11005/jbm.2019.26.1.51

    Article  PubMed  PubMed Central  Google Scholar 

  55. S. Tagay, S. Herpertz, M. Langkafel, Y. Erim, L. Freudenberg, N. Schopper, A. Bockisch, W. Senf, R. Gorges, Health-related quality of life, anxiety and depression in thyroid cancer patients under short-term hypothyroidism and TSH-suppressive levothyroxine treatment. Eur. J. Endocrinol. 153(6), 755–763 (2005). https://doi.org/10.1530/eje.1.02047

    Article  CAS  PubMed  Google Scholar 

  56. G. Grani, D. Tumino, V. Ramundo, L. Ciotti,C. Lomonaco, M. Armillotta, R. Falcone, P. Lucia, M. Maranghi, S. Filetti, C. Durante, Changes in TSH levels in athyreotic patients with differentiated thyroid cancer during levothyroxine therapy: influence on dose adjustments. J Endocrinol Invest (2019). https://doi.org/10.1007/s40618-019-01074-x

Download references

Acknowledgements

VR contributed to this paper as part of her PhD studies in Biotechnologies and Clinical Medicine at the University of Rome, Sapienza.

Author information

Author notes

  1. These authors contributed equally: Giorgio Grani, Valeria Ramundo

Authors and Affiliations

  1. Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

    Giorgio Grani, Valeria Ramundo, Antonella Verrienti, Marialuisa Sponziello & Cosimo Durante

Authors
  1. Giorgio Grani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valeria Ramundo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonella Verrienti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marialuisa Sponziello
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cosimo Durante
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cosimo Durante.

Ethics declarations

Conflict of interest

Author Cosimo Durante declares that he has received a speaker honorarium from Eisai Europe Limited. The remaining authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grani, G., Ramundo, V., Verrienti, A. et al. Thyroid hormone therapy in differentiated thyroid cancer. Endocrine 66, 43–50 (2019). https://doi.org/10.1007/s12020-019-02051-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-019-02051-3

Keywords

Search

Navigation