Abstract
Thyroid hormone replacement therapy in patients following thyroidectomy for thyroid cancer, although a potentially straightforward clinical problem, can present the clinician and patient with a variety of challenges. Most often the problems are related to the dose and preparation of thyroid hormone (TH) to use. Some patients feel less well following thyroidectomy and/or radioiodine ablation than they did before their diagnosis. We present evidence that levothyroxine (L-T4) is the preparation of choice, and keeping the thyroid-stimulating hormone (TSH) between detectable and 0.1 mU/L should be the standard of care in most cases. In unusual circumstances, when the patient remains clinically hypothyroid despite a suppressed TSH, we acknowledge there may be as yet unidentified factors influencing the body’s response to TH, and individualized therapy may be necessary in such patients.
Highlights
OverviewThyroid hormone replacement (THR) therapy in athyreotic patients following thyroidectomy for thyroid cancer should be a relatively straightforward clinical problem to solve
As simple a clinical intervention as this seems, one of the most common dissatisfactions for athyreotic patients is the perception that the dose of thyroid hormone (TH) is incorrect, resulting in complaints of lethargy, weight gain, fatigue, and “brain fog.”[8,9] some patients hesitate to have a thyroidectomy for thyroid cancer because of the widespread perception that all patients following surgery end up with the problems above
The aim of this paper is to review the basis for rational THR and to identify the main pitfalls encountered in patients following thyroidectomy for thyroid cancer
Summary
OverviewThyroid hormone replacement (THR) therapy in athyreotic patients following thyroidectomy for thyroid cancer should be a relatively straightforward clinical problem to solve. Synthetic levothyroxine (L-T4) has been available since the 1960s, and despite its availability for 60 years physicians can be divided in their treatment of these patients.[1] Standard of care is to titrate the L-T4 to suppress the serum thyroidstimulating hormone (TSH) level, which is otherwise trophic for growth of normal as well as malignant thyroid cells.[2,3,4,5,6,7] as simple a clinical intervention as this seems, one of the most common dissatisfactions for athyreotic patients is the perception that the dose of thyroid hormone (TH) is incorrect, resulting in complaints of lethargy, weight gain, fatigue, and “brain fog.”[8,9] some patients hesitate to have a thyroidectomy for thyroid cancer because of the widespread perception that all patients following surgery end up with the problems above. The aim of this paper is to review the basis for rational THR and to identify the main pitfalls encountered in patients following thyroidectomy for thyroid cancer
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