Efficacy of postoperative thyroid-stimulating hormone inhibition therapy in differentiated thyroid cancer in China: a systematic literature review and meta-analysis

Introduction

Thyroid carcinoma is the most common endocrine malignancy, and differentiated thyroid cancer (DTC), which arises from follicular thyroid cells, is the most common type (1,2). DTC is subdivided into papillary thyroid carcinoma (84% of cases), follicular thyroid carcinoma (4% of cases), and Hürthle-cell carcinoma (2% of cases); however, only about 5% of tumors are associated with an aggressive phenotype (1). Overall, most patients with thyroid carcinoma have a good prognosis, with a 5-year overall survival rate in China of 92.9% for all stages (3). However, despite considerable advances in disease detection over the last 30 years, thyroid cancer recurrence remains a concern, occurring in 7.2% of early-stage patients and rising to 28.2% in those with advanced-stage disease (4).

Treatment regimens for thyroid cancer include thyroidectomy and lymph node dissection (if indicated), followed by postoperative therapy that is primarily dependent on pathological assessment of the tumor and the patient’s age, although thyroid-stimulating hormone (TSH) suppression is mandatory in patients at risk of recurrence (5,6).

Current clinical evidence regarding the effectiveness of postoperative TSH suppression therapy remains inconclusive. Several studies have reported reductions in recurrence and cancer-related mortality in patients receiving TSH suppression therapy (7,8), some of which suggest benefits across all disease stages (9,10). However, other studies have failed to demonstrate such advantages. For instance, a meta-analysis of five studies involving 2,964 patients with low-risk DTC found that postoperative TSH suppression therapy did not reduce the recurrence rate after hemithyroidectomy (11). Additionally, Disease-free survival was not improved with TSH suppression in a study of Japanese patients, the majority of which are low-risk papillary thyroid carcinoma (12). These conflicting findings highlight ongoing uncertainty about the overall benefits of TSH suppression in patients with DTC (13).

There is a lack of large-scale studies evaluating the efficacy of TSH suppression therapy specifically in Chinese patients with DTC. As a result, the most recent update to the Chinese Society of Clinical Oncology guidelines on the management of DTC continues to rely primarily on evidence from non-Chinese populations (14). This lack of population-specific data is of particular concern given that long-term TSH suppression has been associated with adverse effects, including atrial fibrillation and reduced bone mineral density (15-17). Therefore, population-specific evidence is needed to balance the potential benefits and risks. This meta-analysis aimed to assess the efficacy of TSH suppression treatment in terms of recurrence and metastasis, when compared with regimens without TSH suppression, in Chinese patients who had undergone surgery for DTC. We present this article in accordance with the PRISMA reporting checklist (available at https://gs.amegroups.com/article/view/10.21037/gs-2025-182/rc) (18).

Methods

We performed a systematic literature review and meta-analysis to assess the value of postoperative TSH suppression in patients who had undergone thyroidectomy or thyroid lobectomy due to thyroid cancer.

Data sources and search strategy

A comprehensive literature search of the electronic PubMed (MEDLINE), Embase, and two Chinese databases (Wanfang and China National Knowledge Infrastructure) was conducted to find relevant studies that reported rates of recurrence and metastasis in DTC. The search strategy in English was as follows: (((thyroid cancer[Text Word]) OR (thyroid carcinoma[Text Word]) OR (thyroid neoplasms[MeSH Terms])) AND ((thyroidectomy[MeSH Terms]) OR (thyroid lobectomy[Text Word]) OR (thyrotropin suppression therapy[Text Word])) AND ((thyrotropin[Text Word]) OR (hormone, thyroid stimulating[MeSH Terms])) AND ((TSH suppression[Text Word]) OR (suppression therapy[Text Word]))). The search strategy in Chinese was based on the English search strategy but modified to account for translation mismatches (Appendix 1).

Studies were independently selected by two investigators (J.M. and S.R.) according to the predefined inclusion criteria. Abstracts were retrieved and screened to exclude irrelevant references. The full-text publications of the remaining studies were then checked against the eligibility criteria, with disagreements between the two independent investigators resolved through consensus or by discussion with a third investigator (T.H.).

Study selection

This meta-analysis included studies that had enrolled Chinese patients aged ≥18 years with DTC, including papillary and follicular tumors, who had undergone thyroid surgery (total or lobectomy). Eligible studies were required to include both a TSH inhibition therapy arm and a control arm; to report data on efficacy indicators, including recurrence and metastasis rates; and to be prospective (including cohort and randomized controlled trials) in design. Articles in both English and Chinese that were published between database inception and 1 April 2023 were included. Studies were excluded if they had incomplete or qualitative data alone. Duplicate publications, reviews, meta-analyses, and case series were also excluded.

During study selection, retrospective studies (n=2) that were identified with the same search criteria were added to the dataset post hoc to increase the data available for evaluating the risk of metastases after 5 years.

Data extraction

Data was extracted and stored in a Microsoft Excel database that was accessible to the principal researcher. Disagreements between the two independent investigators regarding data extraction were resolved either through consensus or by discussion with a third investigator. The following data were extracted from each of the included studies: study information (title, authors, citation, year); study characteristics (study type, population, number of enrolled patients, mixed variables, thyroxin therapy group, control group, primary endpoint); patient characteristics (age, gender, race, prior levothyroxine therapy); and recurrence or metastasis [overall efficacy, recurrence (3 months, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years, 6 years, 8 years, and 10 years), recurrence total, distant metastasis, lymph node metastasis].

Statistical analysis

Meta-analyses were conducted on factors where sufficient relevant and comparable data could be obtained. Relative risks for defined groups (TSH suppression vs. no TSH suppression) were calculated from the data extracted from each study. Relative risk was computed as a risk ratio (RR) using the following formula: RR = [A/(A+B)]/[C/(C+D)] where A is the outcome in the intervention group, A+B is the total number of patients in the intervention group, C is the outcome in the control group, and C+D is the total number of patients in the control group. A random-effects DerSimonian and Laird inverse variance method was used to analyze the overall effects of therapy on outcomes (1-, 3-, and 5-year recurrence; and 3- and 5-year metastases) (19). Data were grouped into subsets based on tumor subtype, and separate pooled effects were computed for distant and central lymph node metastases.

Publication bias was assessed using relative risk estimates and their standard errors, which were used to construct funnel plots based on a DerSimonian and Laird model (19). Funnel plots were interpreted both visually and via an Egger’s regression test to determine asymmetry. The alpha significance level for plot asymmetry was set at 0.05. ‘Leave-one-out’ analysis was used to address the influence of individual studies on the overall effects of treatment. Heterogeneity between studies was assessed using the I² metric. Data were pooled for overall effect and for subgroup effects using a random-effects model to provide the most conservative and robust summary estimate. A two-sided P value of <0.05 was regarded as significant for all analyses, which were performed using RevMan 5.4.1 (Cochrane Community, Copenhagen, Denmark) and R version 3.6.3 with meta-package (R Core Team, Vienna, Austria).

Results

Studies selected

The PRISMA flow diagram is shown in Figure S1. In brief, our literature search identified 2,647 studies of which 322 were assessed for eligibility. In total, 20 clinical trials were included in the main meta-analyses (20-39). Another two retrospective studies (40,41) were included in an additional analysis to evaluate the risk of metastases after 5 years, reaching an overall total of 22 studies. The overall characteristics of the studies included in this meta-analysis are listed in Table 1. In total, 1,814 patients from 20 prospective studies and 190 patients from two retrospective studies were included.

Main analysis

Results of the meta-analysis on the risk of recurrence between postoperative TSH suppression and no postoperative TSH suppression using a random effects model are shown in Figure 1. Postoperative TSH suppression therapy significantly reduced the risk of recurrence when compared with no postoperative TSH suppression therapy. The RR of recurrence was 0.24 [95% confidence interval (CI): 0.08–0.70; P=0.009, I²=0%; Figure 1A] at 1 year, 0.21 (95% CI: 0.12–0.36; P<0.001, I²=0%; Figure 1B) at 3 years, and 0.26 (95% CI: 0.17–0.41; P<0.001, I²=0%; Figure 1C) at 5 years.

Figure 1 Risk of recurrence after surgery for DTC in relation to post-operative TSH suppression: (A) 1 year, (B) 3 years, and (C) 5 years (main analysis). Values produced from a random effects model [DerSimonian and Laird (19)] in relation to the presence or absence of postoperative TSH suppression therapy. CI, confidence interval; df, degrees of freedom; DTC, differentiated thyroid cancer; I², between-study heterogeneity; IV, random, inverse variance random effects model; M-H, Mantel-Haenszel; TSH, thyroid-stimulating hormone; Z, Z statistic.

Figure 2 shows the risk of distant and central lymph node metastases between TSH suppression and no TSH suppression groups after 3 years. In patients who received TSH suppression therapy, the risk of distant and central lymph node metastases was significantly reduced when compared with outcomes for those who did not receive TSH suppression therapy. RRs were 0.17 (95% CI: 0.08–0.37; P<0.001, I²=0%) for distant metastasis and 0.18 (95% CI: 0.09–0.36; P<0.001, I²=0%) for central lymph node metastasis (Figure 2A).

Figure 2 Risk of distant and central metastases at 3 years after surgery for DTC in relation to post-operative TSH suppression: (A) main analyses and (B) post hoc analyses. Values produced from a random effects model [DerSimonian and Laird (19)] in relation to the presence or absence of postoperative TSH suppression therapy. Retrospective studies included in secondary analysis only. CI, confidence interval; df, degrees of freedom; DTC, differentiated thyroid cancer; I², between-study heterogeneity; IV, random, inverse variance random effects model; M-H, Mantel-Haenszel; TSH, thyroid-stimulating hormone; Z, Z statistic.

Post hoc analysis

As there were too few studies available to accurately analyze the risk of metastases after 5 years (n=4), a post hoc analysis was conducted in which two retrospective studies that were originally identified in our literature search were added to the dataset (Table 1). Both studies (40,41) contained data relating to 5-year metastatic rates. As proof of principle, the effect of adding in retrospective studies to the previous analysis of risk of metastases after 3 years was tested. We found that TSH suppression therapy still significantly reduced the risk of distant (RR: 0.25; 95% CI: 0.13–0.47; P<0.001, I²=0%) and central lymph node (RR: 0.24; 95% CI: 0.13–0.46; P<0.001, I²=0%) metastases compared with no TSH suppression therapy (Figure 2B).

Similarly, it was observed that TSH suppression therapy significantly reduced the risk of distant and central lymph node metastasis at 5 years compared with no TSH suppression therapy (Figure 3). The RR at 5 years was 0.24 (95% CI: 0.14–0.42; P<0.001, I²=0%) for distant metastasis and 0.21 (95% CI: 0.12–0.35; P<0.001, I²=0%) for central lymph node metastasis. TSH treatment was slightly more effective at reducing the risk of distant metastasis (vs. lymph node metastasis) at 5 years. Heterogeneity (I²) was 0% between studies.

Figure 3 Risk of distant and central metastases at 5 years after surgery for DTC in relation to post-operative TSH suppression (post hoc analysis). Values produced from a random effects model [DerSimonian and Laird (19)] in relation to the presence or absence of postoperative TSH suppression therapy. This analysis also included retrospective studies. CI, confidence interval; df, degrees of freedom; DTC, differentiated thyroid cancer; I², between-study heterogeneity; IV, random, inverse variance random effects model; M-H, Mantel-Haenszel; TSH, thyroid-stimulating hormone; Z, Z statistic.

Risk of bias assessment

Funnel plots on studies that reported the risk of recurrence (Figure 4A-4C) showed symmetry for publications reporting data at 1, 3, and 5 years, indicating that there was little or no publication bias. The corresponding Egger’s tests also indicated a lack of publication bias (P=0.98, P=0.89, and P=0.30, respectively).

Figure 4 Funnel plots with bias risk descriptions for studies that report the risk of recurrence: (A) 1 year, (B) 3 years, and (C) 5 years.

Funnel plots on studies that report the risk of metastases are shown in Figure 5A-5C. Egger’s test indicated significant publication bias at 3 years (P=0.001), which became non-significant after including retrospective studies (P=0.09). At 5 years, publication bias remained significant (P=0.002). Although these significant results are indicative of publication bias, the subjective features of these plots (i.e., all studies are within the threshold lines), as well as the combination of two metastases subgroups, which had slightly different overall significant effects and no heterogeneity, suggest that any bias was not sufficient to confound the results of the analyses.

Figure 5 Funnel plots with bias risk descriptions for studies that report the risk of metastasis (distant and central lymph node): (A) 1 year, (B) 3 years, and (C) 5 years.

‘Leave-one-out’ meta-analysis showed that no individual study significantly affected the results. All combinations of studies with one study omitted remained significant with no heterogeneity observed, indicating the robustness of our findings. Table S1 shows a cross-validation analysis on studies reporting recurrence at 1, 3, and 5 years. Table S2 shows a cross-validation analysis on studies reporting metastases (distant and central lymph node) at 3 years, and post hoc analyses on prospective and retrospective studies reporting metastases (distant and central lymph node) at 3 and 5 years.

Discussion

In this analysis, we examined clinical outcomes after thyroidectomy to treat DTC in patients who received postoperative TSH suppression therapy vs. those who did not. Using a random effects model, the main analysis observed a significant reduction in risk of recurrence at 1, 3, and 5 years, and a significant reduction in risk of metastasis (distal and central lymph node) at 3 years with postoperative TSH suppression therapy vs. no TSH suppression therapy. A post hoc analysis that included retrospective studies found a significant reduction of metastasis risk at 5 years for both distal and central lymph node metastases with TSH suppression. For studies that reported on risk of recurrence, heterogeneity was low (0%) and risk of bias analysis demonstrated there was no publication bias. For studies that reported on risk of metastases, the Egger’s test results indicated publication bias. However, the subjective features of the funnel plots and the low heterogeneity (0%) suggest that the bias observed was insufficient to confound the results.

Meta-analyses increase sample sizes, thereby increasing statistical power (41); thus, this type of study can be useful for determining clinically significant effects. To date, the clinical benefits of TSH suppression after thyroidectomy have been somewhat unclear. For example, one of the studies included in the meta-analysis reported no difference in recurrence between patients who were treated with TSH suppression therapy and those who were not at 3 years (24); another reported the same at 5 years (23). Han et al. also reported no difference in distal and central lymph node metastases at 3 years (24). However, these findings were reported for only two of the 20 prospective studies included, and both included few patients (30–38 patients per group) (23,24). By overcoming the limitations of small sample sizes, the present meta-analysis provides high-quality evidence that postoperative TSH suppression treatment provides significant benefit to patients with DTC after thyroidectomy in terms of both recurrence and metastases. An earlier meta-analysis conducted in 2002 by McGriff et al., based on case series and cohort studies, found that TSH suppression was associated with a reduced risk of major adverse clinical events. The authors concluded that such treatment was justified for patients with DTC following initial therapy, though they emphasized the need for further research to confirm and better characterize the effects of TSH suppression (42). Our study utilized prospective and randomized controlled studies, along with two retrospective studies, to draw our conclusions. These types of studies provide more reliable data compared with case series and small cohort studies.

In DTC patients, the major post-operative challenge is to minimize cancer recurrence risk while also limiting adverse events associated with TSH suppression. The use of supraphysiologic doses of levothyroxine to suppress TSH is a common therapeutic modality in patients with thyroid cancer that effectively reduces the risk of recurrence. However, in recent years, the scope of TSH suppressive therapy has gradually changed, from the tapering of post-operative TSH suppression (43) to the current recommendations that clinicians need to consider both the risk of recurrence and progression of DTC before initiating TSH suppression (44). There remains controversy around whether there is a clear benefit for TSH suppression therapy in preventing recurrence in patients with low- and intermediate-risk DTC (6,12,13,45,46). The current body of literature regarding the use of postoperative TSH suppression and associated outcomes is difficult to interpret, partially due to small patient numbers (Table 1) and low event rates, which may contribute to this controversy. The present meta-analysis included studies regardless of the risk level of patients (i.e., low-, intermediate-, or high-risk) due to the limited number of studies that included information on patient risk level and the limited number of patients in each study. A more recent meta-analysis based on seven studies of patients with low-risk DTC found a lack of evidence for the efficacy of TSH suppression treatment in this patient population (46). This indicates that stratification of patients based on DTC risk level is likely an important consideration when evaluating treatment benefits.

Indeed, treatment guidelines recommend less stringent suppression levels (i.e., low-intensity treatment) in some low-risk patients, although these are acknowledged to be weak recommendations with low quality evidence (6). It would be beneficial to analyze RRs for recurrence and metastasis according to whether postoperative TSH suppression treatment was received and stratified by patient risk. However, to achieve this, larger studies that use consistent methods for classification of risk level and are designed to provide higher quality evidence are needed. Such studies would be expected to provide additional evidence-based treatment guidance to better inform future clinical decision-making.

A limitation of this study was the inability to summarize time-to-event indicators, which would have resulted in greater accuracy of the results presented herein. However, this was not feasible given that most of the studies included in this meta-analysis did not report hazard ratios.

Conclusions

In conclusion, this meta-analysis assessed the efficacy of TSH suppression therapy on reducing the risk of recurrence and metastases in Chinese patients with DTC after thyroidectomy. It was observed that postoperative TSH suppression therapy was efficient in reducing the risk of recurrence and metastases when compared to non-TSH suppression therapy. Findings from this meta-analysis will help strengthen the use of post-operative TSH suppression therapy in DTC; however, appropriate follow-up studies are required to determine the long-term risk of significant adverse events.

Acknowledgments

The authors thank Sarah Bubeck, PhD, of Edanz (www.edanz.com) for linguistic assistance during the preparation of this manuscript.

Footnote

Reporting Checklist: The authors have completed the PRISMA reporting checklist. Available at https://gs.amegroups.com/article/view/10.21037/gs-2025-182/rc

Peer Review File: Available at https://gs.amegroups.com/article/view/10.21037/gs-2025-182/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-2025-182/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Boucai L, Zafereo M, Cabanillas ME. Thyroid Cancer: A Review. JAMA 2024;331:425-35. [Crossref] [PubMed]
2. Elia G, Patrizio A, Ragusa F, et al. Molecular features of aggressive thyroid cancer. Front Oncol 2022;12:1099280. [Crossref] [PubMed]
3. Zeng H, Zheng R, Sun K, et al. Cancer survival statistics in China 2019-2021: a multicenter, population-based study. J Natl Cancer Cent 2024;4:203-13. [Crossref] [PubMed]
4. Sun JH, Li YR, Chang KH, et al. Evaluation of recurrence risk in patients with papillary thyroid cancer through tumor-node-metastasis staging: A single-center observational study in Taiwan. Biomed J 2022;45:923-30. [Crossref] [PubMed]
5. Chinese Society of Endocrinology, Thyroid and Metabolism Surgery Group of the Chinese Society of Surgery, China Anti-Cancer Association, et al. Guidelines for the diagnosis and management of thyroid nodules and differentiated thyroid cancer (Second edition). Chinese Journal of Endocrinology and Metabolism 2023;39:181-226.
6. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016;26:1-133. [Crossref] [PubMed]
7. Abiri A, Goshtasbi K, Torabi SJ, et al. Outcomes and Trends of Treatments in High-Risk Differentiated Thyroid Cancer. Otolaryngol Head Neck Surg 2023;168:745-53. [Crossref] [PubMed]
8. Abiri A, Nguyen T, Goshtasbi K, et al. A comparative analysis of treatment efficacy in intermediate-risk thyroid cancer. Eur Arch Otorhinolaryngol 2023;280:2525-33. [Crossref] [PubMed]
9. Jonklaas J, Sarlis NJ, Litofsky D, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid 2006;16:1229-42. [Crossref] [PubMed]
10. Carhill AA, Litofsky DR, Ross DS, et al. Long-Term Outcomes Following Therapy in Differentiated Thyroid Carcinoma: NTCTCS Registry Analysis 1987-2012. J Clin Endocrinol Metab 2015;100:3270-9. [Crossref] [PubMed]
11. Wang X, Ye Y, Amdulla M, et al. The necessity of thyroid-stimulating hormone suppression therapy for low-risk differentiated thyroid carcinoma following hemithyroidectomy: A systematic review and meta-analysis. Heliyon 2024;10:e40574. [Crossref] [PubMed]
12. Sugitani I, Fujimoto Y. Does postoperative thyrotropin suppression therapy truly decrease recurrence in papillary thyroid carcinoma? A randomized controlled trial. J Clin Endocrinol Metab 2010;95:4576-83. [Crossref] [PubMed]
13. Song X, Zhi X, Qian L. Tailoring TSH suppression in differentiated thyroid carcinoma: evidence, controversies, and future directions. Endocrine 2025;89:1-19. [Crossref] [PubMed]
14. Guidelines Working Committee of Chinese Society of Clinical Oncology. Guidelines of Chinese Society of Clinical Oncology (CSCO) differentiated thyroid cancer. Journal of Cancer Control and Treatment 2021;34:1164-201.
15. Yu J, Kaur R, Ayeni FE, et al. Cardiovascular Outcomes of Differentiated Thyroid Cancer Patients on Long Term TSH Suppression: A Systematic Review and Meta-Analysis. Horm Metab Res 2023;55:379-87. [Crossref] [PubMed]
16. Ku EJ, Yoo WS, Lee EK, et al. Effect of TSH Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2021;106:3655-67. [Crossref] [PubMed]
17. Einspieler H, Walter C, Hacker M, et al. Effects of short- and long-term TSH suppression on lumbar bone mineral density in both genders using PET/CT. Sci Rep 2023;13:22640. [Crossref] [PubMed]
18. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372: [Crossref] [PubMed]
19. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88. [Crossref] [PubMed]
20. Cao J. The role of thyrotropin inhibitory therapy in the treatment of differentiated thyroid cancer. Heilongjiang Science 2019;10:46-7.
21. Feng XY. Value of thyroid stimulating hormone suppression therapy in differentiated thyroid carcinoma. Medicine Frontier 2017;7:150-1.
22. Feng SS, Zhu JM, Qiu ZC. Post-surgery efficacy of thyroid-stimulating hormone (TSH) suppression therapy in patients with differentiated thyroid carcinoma. J Clin Med 2018;5:21-4.
23. Gao W. Efficacy analysis of TSH suppression therapy in the treatment of differentiated thyroid carcinoma. China Pract Med 2019;14:105-6.
24. Han M, Zhou C, Zhao K. Comparison of thyroid hormone suppression therapy and thyroid hormone replacement therapy after thyroidectomy. The Practical Journal of Cancer 2018;33:1550-2.
25. He Q. Analysis of the efficacy and safety of thyroid stimulating hormone in the treatment of differentiated thyroid carcinoma after operation. The Practical Journal of Cancer 2017;32:511-3.
26. Li ZH. Value of thyroid stimulating hormone inhibition therapy in differentiated thyroid carcinoma. Journal of Clinical Medicine in Practice 2013;17:107-8.
27. Li WJ. Application of TSH suppression therapy in the treatment of differentiated thyroid carcinoma. Medical Information 2016;29:226-7.
28. Li L, Niu GH, Qiu FX. Efficacy and Safety of Thyrotropin Inhibition Therapy in Differentiated Thyroid Cancer. The Practical Journal of Cancer 2019;34:587-9.
29. Liu DL, Gu RJ. Analysis of the effect of thyroid stimulating hormone inhibition therapy in the treatment of differentiated thyroid cancer patients. Chinese Community Doctors 2016;32:81-3.
30. Ma JF, Tang B, Li TH, et al. Value of Thyroid Stimulating Hormone Inhibition Therapy in Differentiated Thyroid Carcinoma. Chinese Journal of Bases and Clinics in General Surgery 2009;16:348-50.
31. Meng ZZ, Li C, Wang C. Effects of TSH suppression therapy on immune functions, prognosis and serum CD44V6 and TSGF levels in elderly patients with thyroid carcinoma. Chinese J Gerontology 2018;38:1086-9.
32. Qiu XD. Comparison of thyroid stimulating hormone (TSH) suppression therapy and replacement therapy after thyroid cancer operation. Chin Med J Metall Indus 2018;35:699-700.
33. Song Q, Yuan HQ, Wang JJ. The role of TSH suppression therapy in the treatment of differentiated thyroid carcinoma. Electronic J Pract Gynecologic Endocrinology 2019;6:101.
34. Tan XY. Value of thyroid stimulating hormone suppression therapy in differentiated thyroid carcinoma. Contemporary Medical Symposium 2018;16:144-6.
35. Wang P, Yang XC, Sun W, et al. Post-surgery efficacy and safety of thyroid-stimulating hormone (TSH) suppression therapy in patients with differentiated thyroid carcinoma. J Clin Med 2019;6:102-3.
36. Xu XC, Wang KJ. Clinical value of thyroid stimulating hormone suppression therapy after surgery for differentiated thyroid carcinoma. Chin J General Practice 2015;13:740-2.
37. Yang L, Zhao JG. Analysis of post-surgical use of thyroid stimulating hormone suppression therapy in differentiated thyroid carcinoma. Heilongjiang Medical Journal 2017;41:1204-5.
38. Zhang XS, Wu P, Lai JW. Efficacy of surgery combined with 131I and thyroid tablet in the treatment of thyroid papillary carcinoma. Heilongjiang Chinese Med 2019;48:102-3.
39. Zhu X, Zhou M. Application of thyroid-stimulating hormone suppression therapy in female patients with thyroid cancer. China Cont Med Educ 2019;11:141-3.
40. Liao AD, Zhang WF, Hu DT, et al. Effects of thyroid stimulating hormone on postoperative recurrence and metastasis in patients with differentiated thyroid carcinoma. J Clin Med Practice 2016;20:100-2.
41. Zhang LL, Li XJ, Liao MG, et al. The value of thyroid stimulating hormone suppression therapy in the post-operative treatment of differentiated thyroid carcinoma. J Clin Med 2018;5:61.
42. McGriff NJ, Csako G, Gourgiotis L, et al. Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann Med 2002;34:554-64. [Crossref] [PubMed]
43. Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-214. [Crossref] [PubMed]
44. National Comprehensive Cancer Network (NCCN). Thyroid Carcinoma (Version 1.2025). 2025. Available online: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf
45. Papaleontiou M, Chen DW, Banerjee M, et al. Thyrotropin Suppression for Papillary Thyroid Cancer: A Physician Survey Study. Thyroid 2021;31:1383-90. [Crossref] [PubMed]
46. Won HR, Jeon E, Chang JW, et al. Is Maintaining Thyroid-Stimulating Hormone Effective in Patients Undergoing Thyroid Lobectomy for Low-Risk Differentiated Thyroid Cancer? A Systematic Review and Meta-Analysis. Cancers (Basel) 2022;14:1470. [Crossref] [PubMed]