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Levothyroxine Suppressive Therapy in Thyroid Cancer

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Title: Levothyroxine Suppressive Therapy in Thyroid Cancer


1
Levothyroxine Suppressive Therapy in Thyroid
Cancer
  • R Michael Tuttle, MD
  • Attending Endocrinologist
  • Assistant Professor of Medicine
  • Memorial Sloan Kettering Cancer Center
  • Sanford Weill Medical College of Cornell
    University
  • New York, NY

2
Estimated New CasesUnited States, 2003
22,000 new cases 1,400 deaths
50 k 100k 150k 200k 250k
American Cancer Society
3
Standard Initial Treatment Usual Pathway
Remove the thyroid with all cancerous tissue
4
Levothyroxine Therapy Thyroid Cancer
5
Levothyroxine Suppression
2.0
Free T4 Normal Range (ng/dL)
0.8
4.4
TSH Normal Range (mcU/mL)
0.4
TSH Suppression
0.1
lt0.01
6
Levothyroxine Suppression
2.0
Free T4 Normal Range (ng/dL)
0.8
12-15 increase
12-15 decrease
4.4
TSH Normal Range (mcU/mL)
0.4
TSH Suppression
0.1
lt0.01
7
Levothyroxine Suppression Therapy
  • Thyroid cancer
  • Very narrow therapeutic window
  • Small changes in administered dose
  • Symptomatic hyperthyroidism
  • Recurrence of disease
  • Product substitution with alternatives that vary
    by more than 5-10 from the brand name product
    would be unacceptable in the treatment of
    thyroid cancer.

8
Treatment GuidelinesThyroid Cancer
  • Singer PA, Cooper DS, Daniels GH et al.
    Treatment guidelines for patients with thyroid
    nodules and well-differentiated thyroid cancer.
    American Thyroid Association. Arch Intern Med.
    1996 Oct 28156(19)2165-72.
  • AACE/AAES medical/surgical guidelines for
    clinical practice management of thyroid
    carcinoma. American Association of Clinical
    Endocrinologists. American College of
    Endocrinology. Endocr Pract. 2001
    May-Jun7(3)202-20.
  • British Thyroid Association. Guidelines for the
    management of thyroid cancer. London Royal
    College of Physician, 2002.
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