분화갑상선암 수술 후 갑상선자극호르몬 억제요법과 골다공증

TSH Suppression after Differentiated Thyroid Cancer Surgery and Osteoporosis

Thyroid stimulating hormone (TSH) suppression therapy has been known to play animportant role in lowering the risk of recurrence after surgery for differentiated thyroidcarcinoma. Osteoporosis is a major complication of TSH suppression. The purpose of thisstudy is to review the current thyroid stimulating hormone suppression therapy andosteoporosis risk and examine the proper TSH suppression after surgery for patients withdifferentiated thyroid cancer. Previous studies and current guidelines on TSH suppressionand osteoporosis were collected from databases in Korea and other countries and reviewed.According to the recommendations of the Korean Thyroid Association in 2010, initial TSHsuppression to below 0.1 mU/L is recommended for high-risk and intermediate-risk thyroidcancer patients, while TSH level at or slightly below the lower limit of normal (0.1∼0.5mU/L) is appropriate for low-risk patients. During follow-up, in patients with persistentdisease, the serum TSH should be maintained below 0.1 mU/L indefinitely in the absenceof specific contraindications, while in patients free of disease, especially those at low riskfor recurrence, the serum TSH may be kept within the low normal range (0.3∼2 mU/L). In2015, the American Thyroid Association recommended revised guidelines considering theinitial ATA risk classification, Tg level, Tg trend over time, and risk of TSH suppressionduring the long term follow-up period. Appropriate recommendations considering the riskstratification of thyroid cancer and adverse effects of TSH suppression are required toimprove the survival of differentiated thyroid cancer patients and minimize the adverseeffects of long-term therapy.