Thyrotropin Suppression for Papillary Thyroid Cancer: A Physician Survey Study

Area of Science:

• Endocrinology
• Oncology
• Thyroid Cancer Management

Background:

• Current guidelines advise against thyrotropin (TSH) suppression for low-risk differentiated thyroid cancer.
• Physician practices regarding TSH suppression in these patients are not well understood.

Purpose of the Study:

• To investigate the approach of endocrinologists and surgeons to TSH suppression in papillary thyroid cancer patients.
• To identify physician characteristics associated with TSH suppression recommendations across different risk categories.

Main Methods:

• Survey of endocrinologists and surgeons identified via SEER registries in Georgia and Los Angeles (2018-2019).
• Physicians reported likelihood of recommending TSH suppression (<0.5 mIU/L) for intermediate, low, and very low-risk papillary thyroid cancer scenarios using a 4-point Likert scale.
• Multivariable logistic regression analysis to determine factors associated with TSH suppression recommendations.

Main Results:

• High likelihood of TSH suppression for intermediate-risk (80.4%) versus lower likelihood for low-risk (48.8%) and very low-risk (29.7%) papillary thyroid cancer.
• Surgeons were less likely than endocrinologists to recommend TSH suppression for intermediate-risk cases.
• Higher physician patient volume correlated with less TSH suppression for low-risk and very low-risk patients.
• Perceived higher recurrence risk increased likelihood of TSH suppression in very low-risk cases.

Conclusions:

• A significant proportion of patients, including those with low-risk thyroid cancer, receive TSH suppressive therapy, indicating a gap between guidelines and practice.
• Further high-quality research is essential to guide thyroid cancer management and address barriers to guideline adoption.