Ongoing treatment with thyroid stimulating hormone (TSH) suppression for differentiated thyroid cancer

Ongoing treatment with thyroid stimulating hormone (TSH) suppression for differentiated thyroid cancer

Do not offer thyroid stimulating hormone (TSH) suppression to people who:

• do not meet the threshold for radioactive iodine (RAI)
• have significant comorbidities that mean low TSH levels should be avoided

Thyroid hormone at doses that will suppress TSH to below 0.1 mIU/litre, should be offered to people who have had total or completion thyroidectomy and RAI. TSH suppression should be continued until follow-up review at 9 to 12 months after initial treatment has been completed

Assessing and managing response to TSH suppression

Dynamic risk stratification should be used to determine further management at 9 to 12 months after completion of initial radioactive iodine (RAI) ablation, as follows:

• reduce TSH suppression to achieve a TSH level of between 0.3 mIU/litre and 2.0 mIU/litre and continue this for life in people with an excellent response to treatment
• continue TSH suppression to achieve a TSH level of between 0.1 mIU/litre and 0.5 mIU/litre in people who have an intermediate response to initial treatment

Continue to suppress TSH to less than 0.1 mIU/litre in people who have biochemical or structural evidence of persistent or recurrent disease

Long-term duration of TSH suppression

• a review should be offered to people who have had ongoing TSH suppression for more than 10 years. Decide whether the TSH suppression can be reduced after an individualised assessment of risks and benefits, and explain that:
  • lifelong suppression is not necessary unless they have high-risk or metastatic disease
  • reducing TSH suppression may lower the risk of developing bone and cardiac problems.

Reference:

• NICE (December 2022). Thyroid cancer: assessment and management