A 50-year-old man undergoes total thyroidectomy for papillary thyroid carcinoma. Postoperatively, he is started on levothyroxine. What is the primary goal of TSH suppression therapy in differentiated thyroid cancer?
- A To prevent hypocalcaemia
- B To suppress TSH to below normal levels to reduce tumour recurrence ✓
- C To maintain TSH in the normal range
- D To stimulate residual thyroid tissue for radioactive iodine uptake
Correct answer: B. To suppress TSH to below normal levels to reduce tumour recurrence
Explanation
TSH suppression therapy aims to keep TSH below the normal range (typically below 0.1 mU/L for high-risk, 0.1 to 0.5 mU/L for low-risk) because TSH stimulates growth of differentiated thyroid cancer cells. This reduces recurrence risk. It does not prevent hypocalcaemia. Maintaining normal TSH is insufficient for cancer control. RAI uptake requires high TSH, achieved by withdrawal or recombinant TSH.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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