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Drug therapy of thyroid cancer

All thyroidectomy patients will have either suppression treatment or substitution treatment with thyroid hormones.

Growth of thyroid tissue is stimulated by TSH, therefore, inhibition of TSH secretion reduces the risk for recurrence and increases the chance of survival.

Most patients operated for differentiated thyroid carcinoma must take thyroid hormone (thyroxine) as suppression treatment to reduce endogenous TSH stimulation of remaining tissue/cancer. For papillary and follicular thyroid carcinoma, suppression of TSH is also part of treatment.  

The degree of suppression depends on the likelihood of recurrence or remaining cancer.

  • TSH should be < 0,1 and preferably under the laboratory detection limit (usually 0,03 mIE/l).
  • TSH should be in the lower reference area for patients with a very low risk for recurrence. One should be aware of patients with low a tolerance for thyroxine. 

When starting thyroxine, TSH should be monitored after 6-8 weeks and the daily dose increased by 25 µg or less every 6-8 weeks until the desired TSH level is reached. The blood test for TSH and free T4 should be taken before the daily dose of thyroxine and 6-8 weeks after a dosage adjustment. Thyroxine sodium should be used rather than T3 for suppression treatment.   

The patient's primary care doctor should be informed of the suppression treatment, and changes to the treatment strategy should not take place unless consulting the treating physician.  

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