[Current status and controversies of thyroid stimulating hormone suppression therapy in low-risk differentiated...

Thyroid-stimulating hormone (TSH) suppression therapy plays an important role in the postoperative management of patients with differentiated thyroid cancer (DTC). However, its role in low-risk DTC (LR-DTC) remains controversial. This article reviewed domestic and international guidelines and relevant literature on TSH suppression therapy, finding that current guidelines worldwide generally show a trend toward gradually relaxing TSH suppression targets for LR-DTC patients. The latest guidelines from the American Thyroid Association (ATA), the National Comprehensive Cancer Network Thyroid Carcinoma Guidelines, and the Japanese Guidelines for the Treatment of Thyroid Tumors advocate a more lenient TSH suppression strategy for LR-DTC patients, recommending no suppression for those with excellent response or those who have undergone lobectomy. The most recent European Society for Medical Oncology Clinical Practice Guidelines for thyroid cancer and the Chinese Guidelines for the Diagnosis and Treatment of Thyroid Nodules and Differentiated Thyroid Cancer primarily reference the 2015 ATA guidelines, currently adopting a mild suppression approach by recommending that the TSH levels be maintained at the low end of the normal range. Recent large-scale studies tend to support further relaxation of TSH suppression targets for LR-DTC patients. There has still been no consensus regarding the optimal duration of TSH suppression therapy, as well as its application during active surveillance and after thermal ablation. There is an urgent need for more large-scale, multicenter prospective studies to provide stronger evidence-based support for formulating TSH suppression strategies in LR-DTC patients.