Thyroid-Stimulating Hormone Suppression Therapy in Thyroid Cancer: Balancing Benefits and Harms

Thyroid-stimulating hormone (TSH) suppression therapy is a widely used strategy in the management of differentiated thyroid carcinoma to reduce the risk of recurrence and disease progression. However, the benefit of the TSH suppression in terms of clinical outcomes in patients with differentiated thyroid cancer has been questioned in recent studies. The TSH suppression could be associated with potential adverse effects, including cardiovascular risks, bone loss, and poor quality of life. While considering TSH suppression in patients with differentiated thyroid cancer, a careful assessment of risks and benefits should be made based on the patient's risk of recurrence, response to therapy, and comorbidities. Aggressive TSH suppression should be avoided if possible in patients with osteoporosis, atrial fibrillation, coronary artery disease, and older patients, since the risk might be more than the benefit in these patients. This review explores the benefits and harms of TSH suppression therapy.