Open Access, Peer-reviewed
pISSN 2508-8149
eISSN 2508-8459
    Korean J Endocr Surg. 2016 Mar;16(1):1-5. Korean.
    Published online Mar 15, 2016.
    https://doi.org/10.16956/kjes.2016.16.1.1
    Copyright © 2016 Korean Association of Thyroid and Endocrine Surgeons; KATES. All Rights Reserved.
    Review

    TSH Suppression after Differentiated Thyroid Cancer Surgery and Osteoporosis

    Kyoung Sik Park
      • Department of Surgery, Konkuk University School of Medicine, Seoul, Korea.
    • Correspondence: Kyoung Sik Park. Department of Surgery, Konkuk University School of Medicine, 120 Neung dong-ro, Gwangjin-gu, Seoul 05029, Korea. Tel: +82-2-2030-7697, Fax: +82-2-2030-8270, Email: ks2002p@hanmail.net
    Received January 02, 2016; Revised February 03, 2016; Accepted February 10, 2016.

    This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    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.

    Keywords
    Thyroid cancer; Hormone; Osteoporosis; Risk

    Tables

    Table 1
    TSH suppression range goal of Korean Thyroid Association Guideline

    Table 2
    TSH suppression range goal of American Thyroid Association Guideline

    Notes

    This study was supported by Konkuk University School of Medicine in 2016.

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    MeSH Terms
    Classification
    Follow-Up Studies
    Humans
    Korea
    Osteoporosis*
    Recurrence
    Reference Values
    Thyroid Gland*
    Thyroid Neoplasms*
    Thyrotropin
    Metrics
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