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Thyroid suppression therapy: risks and indications

Thyroid hormone suppression therapy has long been used to treat benign and malignant thyroid disorders. Significant side effects are increasingly recognized, including cardiac dysfunction, osteoporosis, and symptomatic thyrotoxicosis. These risks may be reduced with more selective use, less aggressive suppression, adjunctive medical therapy, and involvement of an endocrinologist. Currently, thyroid hormone suppression therapy is widely recommended after initial therapy for well-differentiated thyroid cancer. In contrast, routine thyroid hormone suppression therapy is increasingly discouraged for benign thyroid disorders because of side effects. In diffuse, sporadic, nontoxic goiter, thyroid hormone suppression therapy may reduce thyroid volume for certain patients, but goiter recurs after cessation of therapy. For patients with endemic goiter, iodide is safer than thyroid hormone suppression therapy and equally effective. After partial thyroidectomy, thyroid hormone suppression therapy may prevent goiter recurrence in selected patients with evidence of remnant growth. In sum, thyroid hormone suppression therapy is rarely indicated for benign nodular disease but may reduce nodule volume and prevent new nodule formation for a minority of patients.