Tailoring TSH suppression in differentiated thyroid carcinoma: evidence, controversies, and future directions.

IF 3.7 3区医学 Q2 Medicine

Endocrine Pub Date : 2025-04-09 DOI:10.1007/s12020-025-04223-w

Xinxin Song, Xin Zhi, Linxue Qian

{"title":"Tailoring TSH suppression in differentiated thyroid carcinoma: evidence, controversies, and future directions.","authors":"Xinxin Song, Xin Zhi, Linxue Qian","doi":"10.1007/s12020-025-04223-w","DOIUrl":null,"url":null,"abstract":"Purpose: This review focus on the controversial benefits of thyroid hormone suppression therapy (THST) in differentiated thyroid carcinoma (DTC) and its associated risks, highlighting the need for individualized strategies to optimize therapeutic outcomes and guide future research.Methods: A systematic literature search on TSH suppression in DTC over the past 10 years was conducted, prioritizing RCTs, large cohort studies, and non-inferiority trials, with additional references identified from retrieved articles.Results: Tailored postoperative TSH strategies should consider factors such as risk stratification, treatment modality, histologic subtype, and adverse effect risks. In this context, mechanistic studies offer potential insights that could inform personalized TSH management, though further validation is required. Clinical evidence on THST in DTC remains controversial, particularly for high-risk patients, where support for stringent TSH suppression (<0.1 mU/L) is limited. Data for intermediate-risk DTC are insufficient due to cohort heterogeneity, while TSH suppression in low-risk DTC is largely discouraged. The well-documented adverse effects of excessive THST, including cardiovascular complications and osteoporosis, further provide a strong rationale against its routine use. Additionally, achieving and maintaining target TSH levels in real-world practice remains challenging, underscoring the need for refined approaches.Conclusion: Current evidence provides limited support for the TSH targets recommended by the 2015 ATA guidelines. Optimizing postoperative TSH management should account for individualized factors, including risk stratification, treatment modalities, histologic subtypes, and susceptibility to adverse effects. Future research should prioritize well-designed studies with clearly defined suppression levels and appropriate confounder adjustments, emphasizing personalized approaches to balance therapeutic benefits and adverse effects.","PeriodicalId":11572,"journal":{"name":"Endocrine","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endocrine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12020-025-04223-w","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: This review focus on the controversial benefits of thyroid hormone suppression therapy (THST) in differentiated thyroid carcinoma (DTC) and its associated risks, highlighting the need for individualized strategies to optimize therapeutic outcomes and guide future research.

Methods: A systematic literature search on TSH suppression in DTC over the past 10 years was conducted, prioritizing RCTs, large cohort studies, and non-inferiority trials, with additional references identified from retrieved articles.

Results: Tailored postoperative TSH strategies should consider factors such as risk stratification, treatment modality, histologic subtype, and adverse effect risks. In this context, mechanistic studies offer potential insights that could inform personalized TSH management, though further validation is required. Clinical evidence on THST in DTC remains controversial, particularly for high-risk patients, where support for stringent TSH suppression (<0.1 mU/L) is limited. Data for intermediate-risk DTC are insufficient due to cohort heterogeneity, while TSH suppression in low-risk DTC is largely discouraged. The well-documented adverse effects of excessive THST, including cardiovascular complications and osteoporosis, further provide a strong rationale against its routine use. Additionally, achieving and maintaining target TSH levels in real-world practice remains challenging, underscoring the need for refined approaches.

Conclusion: Current evidence provides limited support for the TSH targets recommended by the 2015 ATA guidelines. Optimizing postoperative TSH management should account for individualized factors, including risk stratification, treatment modalities, histologic subtypes, and susceptibility to adverse effects. Future research should prioritize well-designed studies with clearly defined suppression levels and appropriate confounder adjustments, emphasizing personalized approaches to balance therapeutic benefits and adverse effects.

查看原文本刊更多论文

分化型甲状腺癌中定制TSH抑制：证据、争议和未来方向。

目的：本文综述了甲状腺激素抑制疗法（THST）治疗分化型甲状腺癌（DTC）的益处及其相关风险，强调了个性化治疗策略的必要性，以优化治疗效果并指导未来的研究。方法：对过去10年DTC中TSH抑制的文献进行系统检索，优先考虑随机对照试验、大队列研究和非劣效性试验，并从检索到的文章中确定额外的参考文献。结果：量身定制的术后TSH策略应考虑风险分层、治疗方式、组织学亚型和不良反应风险等因素。在这种情况下，机制研究提供了潜在的见解，可以为个性化TSH管理提供信息，尽管需要进一步验证。DTC中THST的临床证据仍然存在争议，特别是对于高危患者，他们支持严格抑制TSH(结论：目前的证据对2015年ATA指南推荐的TSH目标提供有限的支持。优化术后TSH管理应考虑个体化因素，包括风险分层、治疗方式、组织学亚型和对不良反应的易感性。未来的研究应优先考虑设计良好的研究，明确定义抑制水平和适当的混杂因素调整，强调个性化的方法来平衡治疗益处和不良反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Endocrine 医学-内分泌学与代谢

CiteScore

6.40

自引率

5.40%

发文量

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.