Risk-benefit ratio for TSH- suppressive Levothyroxine therapy in differentiated thyroid cancer

In the setting of differentiated thyroid cancer (DTC) management, <0.1 mU/L TSH suppression has been proven to be beneficial for patients likely to have microscopic or macroscopic disease, as TSH has a direct trophic effect on thyroid cancer cells. However, the optimal degree of TSH reduction remains unclear for other categories of DTC patients with better prognosis. Excessive thyroid hormone replacement can lead to atrial fibrillation and osteoporosis. Therefore, levothyroxine dose should be carefully adjusted with respect to underlying individual health status, dynamically reassessed risk of relapse and medical monitoring. Future guidelines should give priority to a tailored approach to TSH suppression therapy in DTC patients. (C) 2015 Published by Elsevier Masson SAS. All rights reserved.