PANCE Endocrinology Practice Test

Which statement best describes the role of TSH suppression in differentiated thyroid cancer management?

Do nothing; monitor clinically Use radioactive iodine therapy exclusively to suppress TSH Levothyroxine to suppress TSH to below the reference range Levothyroxine to suppress TSH above the reference range

Correct Answer:

Levothyroxine to suppress TSH to below the reference range

Explanation:

TSH acts as a growth signal for thyroid cells, including residual cancer cells in differentiated thyroid cancer. Keeping TSH suppressed minimizes this stimulus, reducing the risk of cancer recurrence or progression. Levothyroxine is used to keep TSH below the normal reference range, which is the best way to achieve this suppression. In higher-risk patients, targets may be even more stringent (often below 0.1 mIU/L), but the core idea is suppression of TSH to limit cancer cell growth. The other approaches either ignore the growth-stimulating role of TSH, rely on radioactive iodine for purposes other than suppression, or keep TSH at or above normal levels, which would promote stimulation of any remaining cancer cells.

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