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Substitution Therapy

All thyroidectomy patients must either have suppression therapy or substitution therapy with thyroid hormones.

Substitition therapy after primary treatment

Patients operated for thyroid carcinoma must take thyroid hormone (levothyroxin, Levaxin®) to replace the hormone deficiency.

The goal of treatment is for the TSH level to be 0.5-1.0 mIE/l. The following patient groups must have substitution treatment:

  • patients treated for medullary thyroid carcinoma
  • patients treated for anaplastic (undifferentiated) thyroid carcinoma
  • patients treated for micro papillary thyroid carcinoma or minimally invasive follicular thyroid carcinoma
  • low risk patients treated for differentiated thyroid carcinoma without sign of remaining cancer (undetected Tg, normal ultrasound and normal ultrasound of throat)

Thyroxine sodium is preferred over triiodothyronine for substitution treatment.  

The maintenance dose of thyroxine sodium is usually 125-150 µg daily and should be managed according to the TSH value which should lie around 1 mIE/l or based on physical symptoms. The daily dosage can be increased by 25 µg or less every 6-8 weeks until the desired TSH level is reached and no physical symptoms.  

The blood test for measurement of TSH and free T4 should be taken in the absence of thyroxine supplementation 6-8 weeks after a dosage adjustment.

The patient's primary doctor should be informed of treatment and the treatment plan. The treatment plan should not be changed without consulting the treating hospital physician.

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