Thyroid Hormone Suppression Therapy

Bernadette Biondi; David S Cooper

doi:10.1016/j.ecl.2018.10.008

Thyroid Hormone Suppression Therapy

Endocrinol Metab Clin North Am. 2019 Mar;48(1):227-237. doi: 10.1016/j.ecl.2018.10.008. Epub 2018 Dec 4.

Authors

Bernadette Biondi¹, David S Cooper²

Affiliations

¹ Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Naples 80131, Italy.
² Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA. Electronic address: dscooper@jhmi.edu.

PMID: 30717904
DOI: 10.1016/j.ecl.2018.10.008

Abstract

Thyroid hormone suppression therapy is designed to lower serum thyrotropin (TSH) levels using doses of thyroid hormone in excess of what would normally be required to maintain a euthyroid state. The basis of this therapy is the knowledge that TSH is a growth factor for thyroid cancer, so that lower serum TSH levels might be associated with decreased disease activity. However, clinical studies have not documented improved outcomes with TSH suppression, except in patients with the most advanced disease. Furthermore, there are a number of negative outcomes related to aggressive thyroid hormone therapy, including osteoporosis, fracture, and cardiovascular disease. Therefore, a graded approach to TSH suppression is recommended by the American Thyroid Association, based on initial risk and ongoing risk assessment.

Keywords: Bone; Cardiovascular system; Levothyroxine; Mortality; Thyroid cancer; Thyrotropin.

Publication types

Review

MeSH terms

Cardiovascular Diseases / chemically induced*
Humans
Hyperthyroidism / chemically induced*
Thyroid Neoplasms / blood*
Thyroid Neoplasms / drug therapy*
Thyrotropin* / blood
Thyrotropin* / drug effects
Thyroxine / adverse effects*
Thyroxine / therapeutic use*

Substances

Thyrotropin
Thyroxine