TSH Suppression after Differentiated Thyroid Cancer Surgery and Osteoporosis / 대한내분비외과학회지

ABSTRACT

Thyroid stimulating hormone (TSH) suppression therapy has been known to play an important role in lowering the risk of recurrence after surgery for differentiated thyroid carcinoma. Osteoporosis is a major complication of TSH suppression. The purpose of this study is to review the current thyroid stimulating hormone suppression therapy and osteoporosis risk and examine the proper TSH suppression after surgery for patients with differentiated thyroid cancer. Previous studies and current guidelines on TSH suppression and osteoporosis were collected from databases in Korea and other countries and reviewed. According to the recommendations of the Korean Thyroid Association in 2010, initial TSH suppression to below 0.1 mU/L is recommended for high-risk and intermediate-risk thyroid cancer patients, while TSH level at or slightly below the lower limit of normal (0.1~0.5 mU/L) is appropriate for low-risk patients. During follow-up, in patients with persistent disease, the serum TSH should be maintained below 0.1 mU/L indefinitely in the absence of specific contraindications, while in patients free of disease, especially those at low risk for recurrence, the serum TSH may be kept within the low normal range (0.3~2 mU/L). In 2015, the American Thyroid Association recommended revised guidelines considering the initial ATA risk classification, Tg level, Tg trend over time, and risk of TSH suppression during the long term follow-up period. Appropriate recommendations considering the risk stratification of thyroid cancer and adverse effects of TSH suppression are required to improve the survival of differentiated thyroid cancer patients and minimize the adverse effects of long-term therapy.