engleski

TSH MONITORING IN PATIENTS WITH THYROID CANCER ON L-T4 SUPPRESSIVE THERAPY

Thyroid suppression serum TSH is currently employed for long-term medical management of patients with thyroid cancer. Current TSH methods with their enhanced sensitivity and specificity are capable of detecting low TSH values, and the measurement of TSH is used as therapeutic endpoint for adjusting the thyroxine suppression dose. Nowadays it is not known what level of TSH suppression is needed to inhibit cancer recurrence, or even if that level should be the same for different type of cancer. For these reasons it is important to individualize serum TSH suppression for each patient. We have employed a third generation assay &#8220; DELFIA hTSH Ultra kit&#8221; for determination TSH in serum of 160 patients with thyroid cancer. The therapeutic endpoint for adjusting the thyroxine suppression dose for each patient was judged by weighing patient, s factors such as age, clinical status including cardiac factors and cancer recurrence risk, against the potentially deleterious effects of iatrogenic mild (subclinical) hyperthyroidism on the heart and bone. In the group of 88 patients on physiological dose of L-T4 therapy 51 (57%) patient had TSH value in the subnormal range (0.05-0.42 mIU/L) and 34 ( (38.6%) patients in this group had TSH value in the normal range (0.4- 4.2mIU/L). Three patients had undetectable TSH (< 0.05 mIU/L). Out of 72 patients on suphraphysiological dose of L-T4 therapy 61 (84.7%) patient had undetectable TSH, and 7 (9.7%) patients had TSH in subnormal range. Four patients in this group had normal TSH value. Thus, the efficacy of L-T4 suppression or substitution therapy in patients with thyroid cancer on long-term medical therapy with L-T4 can be monitored by measuring TSH in serum.

TSH; supressive therapy; Thyroid carcinoma

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