TSH-Suppressive Therapy: A Thorny Issue

Thyroid stimulating hormone (TSH)-suppressive therapy with levothyroxine is a cornerstone of thyroid carcinoma follow-up therapy, but the achievement of therapeutic goals must be balanced against L-T4 side effects. We describe the case of a 64-year-old cardiopathic patient with papillary thyroid carcinoma and autoimmune thyroiditis, whose cardiac condition worsened during TSH-suppressive therapy. TSH concentrations also fluctuated widely because of changing intestinal absorption due to coeliac disease. LEARNING POINTS: TSH-suppressive therapy with levothyroxine (L-T4) to prevent thyroid carcinoma relapse can be a tricky problem in the presence of comorbidities. The recent American Thyroid Association guidelines are a useful reference for complex cases of thyroid carcinoma. When strict TSH control is crucial, the L-T4 liquid solution may be a valuable tool.