Abstract
Background: This study aimed to identify the clinical results after thyrotropin suppression therapy (TST) cessation and evaluated clinical factors associated with successful TST cessation. Methods: Patients who underwent lobectomy due to low-risk papillary thyroid carcinoma (PTC) were included in this study. We compared clinical characteristics and outcomes between patients who succeeded to stop TST and failed to stop TST. Results: A total of 363 patients were included in the study. One hundred and ninety-three patients (53.2%, 193/363) succeeded to stop TST. The independent associated factors for successful TST cessation were the preoperative thyroid-stimulating hormone (TSH) level and the maintenance period of TST. Patients with low TSH level showed a higher success rate for levothyroxine (LT4) cessation than patients with high TSH level (1.79 ± 1.08 and 2.76 ± 1.82 mU/L, p < 0.001). Patients who failed to discontinue TST showed a longer maintenance period of TST than patients who succeeded to discontinue TST (54.09 ± 17.44 and 37.58 ± 17.68 months, p < 0.001). Conclusions: Preoperative TSH level and maintenance period of TST are important factors for successful cessation of TST. If TST cessation is planned for patients who are taking LT4 after lobectomy, a higher success rate of TST cessation is expected with low preoperative TSH level and early cessation of LT4.
Highlights
Total thyroidectomy with thyrotropin suppression therapy (TST) is the typical treatment for patients who were treated for differentiated thyroid carcinoma (DTC)
After propensity matching analysis of patients who underwent lobectomy for American Thyroid Association (ATA) low-risk DTC, we found that there was no difference in disease-free survival (DFS) and similar dynamic risk stratification between the TST and non-TST groups
It is needed to consider to stop LT4 to low-risk DTC patients who have already started TST according to the previous guidelines
Summary
Total thyroidectomy with thyrotropin suppression therapy (TST) is the typical treatment for patients who were treated for differentiated thyroid carcinoma (DTC). Unlike the 2009 guidelines that recommended a strict TST policy to all patients [8], the 2015 revised guidelines of the American Thyroid Association (ATA) recommended a modest degree of TSH suppression to patients with low-risk DTC [9]. They suggested that TST might not be needed if patients who underwent lobectomy could maintain their serum TSH at the lower limit of the normal range (0.5–2.0 mU/L). The independent associated factors for successful TST cessation were the preoperative thyroid-stimulating hormone (TSH) level and the maintenance period of TST. If TST cessation is planned for patients who are taking LT4 after lobectomy, a higher success rate of TST cessation is expected with low preoperative TSH level and early cessation of LT4
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
