Thyrotropin Suppressive Therapy for Low-Risk Small Thyroid Cancer: A Propensity Score-Matched Cohort Study

Thyroid. 2017 Sep;27(9):1164-1170. doi: 10.1089/thy.2017.0177. Epub 2017 Aug 8.


Background: Thyrotropin (TSH) suppression has improved the clinical outcomes of patients with differentiated thyroid cancer (DTC). However, the efficacy of TSH suppressive therapy (TST) is unclear in patients with low-risk DTC. This study aimed to evaluate the efficacy of TST and optimal TSH levels of patients with low-risk DTC.

Methods: This retrospective propensity score-matched cohort study included DTC patients (n = 446) who underwent lobectomy from 2002 to 2008 with or without TST (TST group and No-TST group). Disease-free survival (DFS) and dynamic risk stratification were compared between both groups using serum TSH levels.

Results: Approximately 74% of TST patients and 11% of No-TST patients had suppressed serum TSH levels (<2 mIU/L). The median follow-up period was 8.6 years. During follow-up, the disease recurred in 10 (2.7%) patients, with no significant difference in DFS between the groups (p = 0.63). The proportion of patients with excellent treatment response was similar between the TST (65.2%) and No-TST (64.4%) groups. Incomplete biochemical response was noted in 17.2% of the TST group patients and 9.4% of the No-TST group patients. No significant difference was observed in the DFS between both groups by comparing serum TSH level (p = 0.57).

Conclusions: TST did not improve clinical outcomes, and serum TSH levels were not associated with recurrence in patients with low-risk small DTC. No clinical benefits were shown for TSH suppression in low-risk patients who underwent lobectomy. Thus, levothyroxine is not necessary for patients without evidence of hypothyroidism.

Keywords: differentiated thyroid cancer; disease recurrence; low risk; thyrotropin suppressive therapy.

MeSH terms

  • Adenocarcinoma, Follicular / drug therapy
  • Adenocarcinoma, Follicular / pathology
  • Adult
  • Antineoplastic Agents, Hormonal / therapeutic use*
  • Carcinoma, Papillary / drug therapy
  • Carcinoma, Papillary / pathology
  • Cohort Studies
  • Combined Modality Therapy
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Matched-Pair Analysis
  • Middle Aged
  • Neoplasm Recurrence, Local / prevention & control
  • Neoplasm Staging
  • Organ Sparing Treatments
  • Propensity Score
  • Retrospective Studies
  • Secondary Prevention
  • Thyroid Cancer, Papillary
  • Thyroid Gland / drug effects*
  • Thyroid Gland / pathology
  • Thyroid Gland / surgery
  • Thyroid Neoplasms / drug therapy*
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / prevention & control
  • Thyroid Neoplasms / surgery
  • Thyroidectomy
  • Thyrotropin / therapeutic use*
  • Tumor Burden


  • Antineoplastic Agents, Hormonal
  • Thyrotropin

Supplementary concepts

  • Thyroid cancer, follicular