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Thyroid-stimulating hormone suppression therapy for differentiated thyroid cancer: The role for a combined T3/T4 approach.

Thyroid-stimulating hormone suppression therapy for differentiated thyroid cancer: The role for a combined T3/T4 approach.
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Fussey JM, Khan H, Ahsan F, Prashant R, Pettit L,


Fussey JM, Khan H, Ahsan F, Prashant R, Pettit L, (click to view)

Fussey JM, Khan H, Ahsan F, Prashant R, Pettit L,

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Head & neck 2017 09 2739(12) 2567-2572 doi 10.1002/hed.24926

Abstract
BACKGROUND
In the management of differentiated thyroid carcinoma, surgery with or without postoperative radioiodine, and thyroid-stimulating hormone (TSH) suppression is the standard of care in most patients. Levothyroxine is recommended for long-term TSH suppression. For some patients, this may be difficult to tolerate due to adverse effects, such as impaired cognitive function.

METHODS
This article reviews the evidence for the role of combination treatment with triiodothyronine (T3) and levothyroxine (T4) in these patients.

RESULTS
The evidence for combination T3 and T4 treatment comes mainly from studies on hypothyroidism, and research into its use for TSH suppression is limited.

CONCLUSION
Although the evidence base is not strong, there is a small group of patients who may benefit from combination T3 and T4 treatment due to difficulty tolerating thyroxine. Until further evidence is available, a case-by-case approach is recommended.

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