TSHsuppressionsterapi

TSH suppression therapy is a medical approach that aims to lower activity of the thyroid-stimulating hormone (TSH) by providing higher-than-normal doses of thyroid hormone, typically in the form of levothyroxine. The goal is to reduce TSH levels to below the normal reference range, thereby limiting stimulation of residual thyroid tissue or cancer cells.

The therapy works by providing exogenous thyroid hormone, which feeds back to the pituitary gland to suppress TSH production. In practice, the dose is adjusted to achieve a target TSH level that is lower than normal, often near undetectable or below 0.1 mIU/L for higher-risk thyroid cancer patients. Dosing is individualized based on factors such as age, cardiovascular health, pregnancy status, bone density, and cancer risk category. Regular monitoring of TSH and free thyroxine (free T4) is required, especially after starting therapy or changing the dose, with follow-up typically every 6–12 weeks until stable, then at longer intervals.

Indications are most established in the management of differentiated thyroid carcinoma after thyroidectomy and radioactive iodine ablation, where TSH suppression is intended to reduce the chance of cancer recurrence. In benign thyroid conditions, suppression therapy is used less often and with greater caution due to the risk of adverse effects; some guidelines limit or avoid suppression in low-risk cases or in populations at higher risk for side effects.

Potential risks include cardiovascular events such as atrial fibrillation or heart failure, and bone loss or osteoporosis, particularly in older adults and postmenopausal women. Benefits must be weighed against these risks, and therapy is often adjusted or discontinued if adverse effects or comorbidities arise.