Study note
SurgeryThe thyroid gland

Risk-adapted thyroxine therapy after thyroid cancer surgery

THE CONTEXT
Postoperative thyroxine therapy in differentiated thyroid cancer is tailored to disease risk and the potential harms of prolonged TSH suppression.

Purpose and treatment targets

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High doses of thyroxine can suppress both normal and malignant thyroid cells.
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Although suppressive therapy was once routine for all differentiated thyroid cancers, postoperative risk stratification now guides its use.
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High-risk patients receive thyroxine at levels that suppress TSH without causing biochemical hyperthyroidism.
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Low-risk patients may receive thyroxine replacement at physiological levels.

Balancing benefits and harms

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Low-risk patients have extremely low rates of recurrence or death, so the potential benefit of suppression must be weighed against its risks.
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Long-term TSH suppression can cause cardiac arrhythmia and osteoporosis.
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The multidisciplinary team should consider these competing risks throughout follow-up.
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