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Levothyroxine Suppressive Therapy in Thyroid Cancer

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. Estimated New Cases United States, 2003.

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Levothyroxine Suppressive Therapy in Thyroid Cancer

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  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 Total Thyroidectomy Radioactive Iodine Treatment Destroy any microscopic residual thyroid tissue Without any functional thyroid tissue Completely dependent on exogenous levothyroxine Remove the thyroid with all cancerous tissue

  4. Levothyroxine Therapy Thyroid Cancer Suppress TSH Normalize TSH Without any functional thyroid tissue Decreased Risk of Recurrence of Thyroid Cancer Prevent Symptoms of Hypothyroidism

  5. Levothyroxine Suppression Primary Hypothyroidism Thyroid Cancer Hyperthyroid Symptoms Increased Recurrence 2.0 Free T4 Normal Range (ng/dL) 0.8 4.4 TSH Normal Range (mcU/mL) 0.4 TSH Suppression 0.1 <0.01

  6. Levothyroxine Suppression Thyroid Cancer Thyroid Cancer Hyperthyroid Symptoms Increased Recurrence 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 <0.01

  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 28;156(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-Jun;7(3):202-20. • British Thyroid Association. Guidelines for the management of thyroid cancer. London: Royal College of Physician, 2002.

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