ABSTRACT
Levothyroxine is used for both hormone replacement and suppression of thyroid stimulating hormone (TSH) secretion from pituitary gland at supraphysiological doses in differentiated thyroid cancer (DTC). The impact of TSH suppression on the prognosis of DTC has been debated. The requirement for long term suppression therapy and target TSH levels are determined according to the response to initial treatment which is evaluated after 6-18 months. Thyroid hormone suppression is not required for patients who achieved excellent response to treatment. Supression therapy is strictly required for patients with biochemical or structural incomplete response. Except these two conditions, recommendations about TSH suppression are weak with low quality evidence. Comorbidities like osteoporosis, osteopenia, atrial fibrillation, tachiaritmia and menopause should be considered when TSH aims are determined, and targets should be individualized. Synthetic levothyroxine (LT4) is the choice for treatment which has been proved to be efficaous for improvement of hypothyroidism symptoms and laboratory findings, and recommended by international guidelines. Essentials of thyroid hormone treatment were discussed in this review article.
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