EP125 – Differentiated thyroid cancer management: are we suppressing TSH inappropriately?

     

    Toghey, Sopozme1; Ahmed, Timothy1
    1 Faculty of Otorhinolaryngology, Basingstoke Hospital, Hampshire, United Kingdom

     

    Background: Traditionally all patients with differentiated thyroid cancer were suppressed with thyroxine but recent guidelines from the British Thyroid Association do not support TSH suppression in low risk patients. Our study reviews current practice in a North Hampshire hospital and it’s compliance with the new guidelines.

    Methods: We conducted a 12 month retrospective review of all patients under treatment for differentiated thyroid cancer at Hampshire Hospital. Patients were risk stratified into low, intermediate and high and their response to radioiodine treatment..

    Results: 45 differentiated thyroid cancer patients identified attending clinic over last 12 months: 8 male and 37 female. Mean age 51.6 years (SD 15.7) Interval since treatment 0 – 22 years. Mean 6.2 years (SD 5.07).

    Recommendations for TSH levels:
    •       Maintenance of TSH in the low-normal range 0.2-2.0 mU/L: 14 patients (31.1%)
    •       Suppression of TSH between 0.1-0.5 mU/L for 5-10 years: 13 patients (28.9%)
    •       Suppression of TSH <0.1 mU/L for 5-10 years (historical patients): 5 patients (11.1%)
    •       Indefinite suppression of TSH below <0.1mU/L: 13 patients (28.9%)

    Discussion & conclusion: High risk of unwanted outcomes with TSH suppressions e.g. osteoporosis, atrial fibrillation.Aggressive suppression of TSH may not be required for all thyroid cancer patients, particularly for low risk patients. In 2007 the British Thyroid Association said that long term data to support this practice was not robust. Decision on TSH suppression should be made for all thyroid cancer patients as part of their thyroid cancer MDT discussion.

 

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