Thyroid Hormone Suppression Therapy
Abstract
Thyroid hormone suppression therapy is designed to lower serum thyrotropin (TSH) levels using doses of thyroid hormone in excess of what would normally be required to maintain a euthyroid state. The basis of this therapy is the knowledge that TSH is a growth factor for thyroid cancer, so that lower serum TSH levels might be associated with decreased disease activity. However, clinical studies have not documented improved outcomes with TSH suppression, except in patients with the most advanced disease. Furthermore, there are a number of negative outcomes related to aggressive thyroid hormone therapy, including osteoporosis, fracture, and cardiovascular disease. Therefore, a graded approach to TSH suppression is recommended by the American Thyroid Association, based on initial risk and ongoing risk assessment.
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Suppressed TSH has in population studies consistently been associated with higher mortality and other adverse effects compared to people with normal or even higher TSH concentrations.
“Thus, suppressed TSH has in population studies consistently been associated with a higher mortality and other adverse effects compared to people with normal or even higher TSH concentrations ( Table 5 ) (87–90).”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [87]
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- Authors
- Biondi, B., & Cooper, D. S.
- Affiliations
- Federico II University Hospital (IT)
- Johns Hopkins University (US)
- Corresponding author
- Cooper, David S.
- Venue
- Endocrinology and Metabolism Clinics of North America
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 48
- Issue
- 1
- Pages
- 227-237
- ISSN
- 0889-8529 (ISSN-L)
- OpenAlex
- W2902292705
- Cited by
- 81
- References
- 76
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 15 · 2023: 13 · 2022: 14 · 2021: 15 · 2020: 9 · 2019: 2
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrinology and Metabolism Clinics of North America (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Keywords
- thyroid hormone suppression therapy, thyroid-stimulating hormone, thyroid cancer, osteoporosis, fracture risk, cardiovascular risk, risk stratification, American Thyroid Association guidelines
- MeSH terms
- Cardiovascular Diseases, Humans, Hyperthyroidism, Thyroid Neoplasms, Thyrotropin, Thyroxine
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