Aggressive Suppression of TSH for Thyroid Cancer: No Added Benefits

New research shows that aggressive suppression of TSH after thyroid cancer has no benefits over moderate suppression. / Photo: istockphoto
The current standard of care for differentiated thyroid cancer is to suppress the thyroid stimulating hormone (TSH) level -- keeping TSH below <0.1 mU/L or even undetectable -- with thyroid hormone replacement medication. The goal of suppression is to aid in prevention of thyroid cancer recurrence.

At the 2014 American Thyroid Association annual meeting, this standard of care was challenged by researchers, who presented findings from a study of 5000 thyroid cancer patients that showed that aggressive TSH suppression is no better than moderate TSH suppressive therapy, even in patients who have metastatic thyroid cancer.

According to key researcher Dr. Aubrey Carhill:

Aggressive [TSH] suppression confers no additional survival advantage as compared with moderate suppression in differentiated thyroid cancer — even when limiting the analysis to patients with distant metastatic disease, which remains particularly relevant, given the risks associated with long-term thyrotoxicosis.

The researchers' key findings as relate to TSH suppression and thyroid cancer are summarized as follows:

  • No suppression of TSH resulted in worse outcomes for low-risk patients with stage I and II thyroid cancer
  • Moderate suppression was as effective as aggressive suppression in low-risk patients with stage I and II thyroid cancer in terms of outcomes
  • Moderate suppression was as effective as aggressive suppression in higher-risk patients with stage III and IV thyroid cancer in terms of outcomes
  • Moderate suppression was associated with significantly improved overall survival and disease-free survival in all thyroid cancer stages
  • When comparing the three therapies typically used for thyroid cancer -- full or partial surgical thyroid removal, radioactive iodine (RAI) and TSH suppression -- only TSH suppression was an independent factor in overall and disease-free survival.

According to Dr. Carhill:

Only TSH suppression was associated with both improved overall and disease-free survival. In contrast with our earlier reports, only moderate TSH suppression is associated with better outcomes in all stages (including low-risk stage I patients), and aggressive TSH suppression may not be warranted even in patients diagnosed with distant metastatic disease during follow-up. Moderate TSH suppression continued at least 3 years after diagnosis may be indicated in higher-risk patients.


While the standard of care remains aggressive TSH suppression, it's likely that physicians may start to raise the target TSH suppression levels for thyroid cancer patients from the "aggressive" suppression level of less than 0.1 to "moderate" suppression levels of less than 1.0 mull.

It's also likely that as new guidelines are developed for thyroid cancer followup, the recommendations regarding aggressive TSH suppression will be relaxed.

But a key step to take now: If you are a thyroid cancer patient on aggressive TSH suppression, discuss these findings with the physician providing your thyroid cancer follow-up care, to determine whether your targeted TSH level should be changed.


Carhill, et. al. "Long-Term Moderate Thyroid Hormone Suppression Therapy Is Associated with Improved Outcomes in Differentiated Thyroid Carcinoma: National Thyroid Cancer Treatment Cooperative Study Group Registry Analysis 1987-2012," 2014 Annual Meeting of the American Thyroid Association; October 30, 2014; San Diego, CA. Abstract 11.

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