Use of TSH-suppressing doses of thyroid hormone after thyroidectomy or radioactive iodine treatment for thyroid cancers has long been a common practice.
In more recent years, opinion appears to have moved to using a TSH-suppressing dose to begin with, then reducing it to a more standard dosing level (e.g. one which sees TSH rise towards the reference interval).
While this paper continues down this route, without access to the full paper it is difficult to properly and fully appreciate their rationale.
ReviewVolume 13, Issue 4p 333-346 April 2025
The role of the hypothalamic–pituitary–thyroid axis in thyroid cancer
Laura Abaandou, PhD† ∙ Raisa Ghosh, MD† ∙ Joanna Klubo-Gwiezdzinska, MD PhD joanna.klubo-gwiezdzinska@nih.gov
DOI: 10.1016/S2213-8587(24)00364-4
Summary
The hypothalamic–pituitary–thyroid axis plays a crucial role in the pathogenesis, diagnosis, risk stratification, effectiveness of radioiodine therapy, and treatment response evaluation in epithelial thyroid cancer. Supraphysiological doses of levothyroxine are used in patients with intermediate-risk and high-risk thyroid cancer to suppress thyroid-stimulating hormone (TSH) to prevent tumour progression. However, free thyroxine and tri-iodothyronine have also been found to promote tumour growth in thyroid cancer preclinical models. Moreover, current evidence remains inconclusive about the role of TSH suppression in improving survival outcomes and reveals an increased risk of cardiovascular and skeletal adverse events after long-term exposure to excess levothyroxine. Stimulation of the axis with either recombinant human TSH or thyroid hormone withdrawal has been proven equally effective for diagnostic purposes and for facilitating radioiodine uptake for thyroid remnant ablation, but evidence is insufficient for non-inferiority of recombinant human TSH-based vs thyroid hormone withdrawal-based stimulation before radioiodine therapy of distant metastases.
This paper is, as so many papers are, behind a paywall:
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00364-4/abstract
This is also available on link below - which includes few extra snippets:
https://www.sciencedirect.com/science/article/abs/pii/S2213858724003644
