Thyroid cancer and lt4 suppression

® The growth and spread of thyroid carcinoma is stimulated by TSH. An important component of thyroid carcinoma management is the use of LT4 to suppress TSH secretion. Early in therapy, patients receive the lowest LT4 dose sufficient to fully suppress TSH to undetectable levels. Controlled trials show that suppressive LT4therapy reduces tumor growth and improves survival. These patients are purposefully "over-treated" with LT4, sometimes to a fully-suppressed TSH level and rendered subclin-ically hyperthyroid. Postmenopausal women should receive aggressive osteoporosis therapy to prevent LT4-induced bone loss. Other thyrotoxic complications, such as at-rial fibrillation, should be monitored and managed appropriately.

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