On-demand l -thyroxine replacement therapy in post-lobectomy papillary thyroid cancer: a prospective nonrandomized...

Area of Science:

• Endocrinology
• Oncology
• Thyroid Cancer Research

Background:

• The necessity of TSH suppression therapy for papillary thyroid cancer (PTC) post-lobectomy is increasingly questioned.
• This study evaluates an on-demand L-thyroxine replacement strategy for these patients.

Purpose of the Study:

• To assess the efficacy and safety of on-demand L-thyroxine therapy in patients with low- to intermediate-risk PTC after lobectomy.
• To compare treatment outcomes with historical controls receiving standard TSH suppression therapy.

Main Methods:

• Prospective cohort of adult patients with low- to intermediate-risk PTC undergoing lobectomy (2021-2023).
• L-thyroxine administered only if serum TSH exceeded 5.91 mU/L.
• Comparison with retrospective controls (2000-2014) treated with TSH 0.5-2 mU/L.

Main Results:

• No elevated TSH requiring L-thyroxine was detected in the prospective cohort one year post-surgery.
• 72.3% of patients in the prospective group did not require L-thyroxine supplementation.
• No significant difference in 2-year recurrence-free survival (RFS) or biochemical response compared to historical controls.

Conclusions:

• On-demand L-thyroxine therapy enables approximately three-fourths of post-lobectomy PTC patients to avoid supplementation.
• This strategy preserves equivalent short-term treatment response and RFS.
• On-demand therapy offers a viable alternative to TSH suppression for select PTC patients.