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Factors influencing postoperative thyroid-stimulating hormone suppression therapy in low-risk papillary thyroid
Bingbin Dong1, Shuguang Xiao1, Zheng Wang1
1Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China.
Background:
Thyroid-stimulating hormone (TSH) suppression therapy remains an important treatment option for patients with low-risk differentiated thyroid cancer (DTC). This study aimed to analyze the potential influencing factors affecting TSH suppression outcomes in patients with postoperative low-risk papillary thyroid cancer (PTC).
Methods:
A total of 223 low-risk PTC patients were enrolled in this single-center cross-sectional study between September 2024 and February 2025. Based on the TSH level measured at 4-6 months post-lobectomy, the patients were divided into three groups: an excessive TSH suppression group (TSH <0.5 mU/L), optimal TSH suppression group (TSH 0.5-2.0 mU/L), and insufficient TSH suppression group (TSH >2.0 mU/L). The clinicopathological data of the patients, including demographic, clinical laboratory, pathological, and lifestyle characteristics, were analyzed to investigate the factors influencing TSH suppression therapy.
Results:
There were no statistically significant differences in age, marital status, preoperative free triiodothyronine (FT3), free thyroxine (FT4), thyroglobulin antibody (TG-Ab), thyroid peroxidase antibody (TPO-Ab), thyroglobulin (Tg) level, longest tumor diameter, lesion site, central lymph node metastasis, Hashimoto's thyroiditis, BRAF V600E mutation, levothyroxine intake habits, dietary habits, or sleep habits among the three groups (all P>0.05). The distributions of sex, body mass index (BMI), comorbidities, preoperative TSH levels, multifocal lesions, levothyroxine dose, physical activity, and sedentary time differed significantly among the three groups (all P<0.05). Multivariate logistic regression analyses demonstrated that excessive TSH suppression was significantly associated with female sex, a higher levothyroxine dose (≥1.6 µg/kg/day), lower preoperative TSH levels, lower physical activity, and higher sedentary time. Conversely, insufficient TSH suppression was independently associated with higher BMI and lower levothyroxine dose (<1.6 µg/kg/day).
Conclusions:
A complex interplay exists among demographic, clinical, and lifestyle factors in postoperative TSH management. Prospective studies with objective lifestyle measurements are needed to confirm these associations before clinical implementation.
