Dr. Boucai and his colleagues at Memorial Sloan Kettering Cancer Center in New York found that long-term thyrotropin (TSH) suppression therapy in low-risk patients without risk of tumor recurrence after thyroidectomy does more harm than good. The results were derived from a chart review of more than 700 patients with differentiated thyroid cancer at low and moderate risk after total thyroidectomy and were published in the thyroid column of MedscapeMedicalNews. For low- to intermediate-risk patients, there was no significant difference in tumor recurrence or disease-free survival beyond 6.5 years between not receiving postoperative levothyroxine suppression thyrotropin (TSH) therapy and receiving suppressive therapy. And, patients receiving thyrotropin suppressive therapy have more than three times the risk of developing osteoporosis as those who do not, with a further increase with age in women. The current common treatment for thyroid cancer is thyroxine suppression for every patient with thyroid cancer after thyroidectomy or radioactive iodine therapy, so that they often receive TSH suppression for life, with the goal of stopping the growth of thyroid cancer cells. However, thyroid cancer has a very low recurrence rate, and whether doctors really need to medicate low-risk patients to keep TSH at a low level forever is, in fact, over-medication in light of the results in this article. In 2009, the American Thyroid Association (ATA) released new guidelines, and Dr. Cooper, who chaired the panel, recommended lifelong TSH suppression of less than 0.1 mIU/L for patients at high risk of tumor recurrence, but only one year of low TSH suppression for patients at low or intermediate risk to ensure that no tumor cells remain. The new ATA guidelines, expected to be released in 2015, will not recommend TSH suppression for low-risk patients after thyroidectomy “Low-risk patients may be cured by surgery, so there is no benefit in keeping TSH levels low because they don’t have any cancer. If they are older this is not beneficial, but rather harmful. If they’re mildly hyperthyroid, this can cause them to slowly lose calcium in their bones.” Dr. Cooper explained. However, many first-line endocrinologists have not fully understood the previous ATA risk-based guidance and continue to apply the same treatment to all post-operative thyroid cancer patients. Overtreatment and secondary osteoporosis and other potential complications have the potential to drive up healthcare costs given the recent explosion in the identification of microscopic thyroid cancer. The researchers analyzed 771 patients with differentiated thyroid cancer who underwent thyroidectomy at Memorial Sloan Kettering Cancer Center between 2000-2006 and had a low or moderate risk of tumor recurrence based on ATA criteria (i.e., they had no macroscopic tumor invasion, residual lesions, or distant metastases), but no baseline status of osteoporosis or atrial fibrillation at the time of their diagnosis was documented. Of these 771 patients, 465 received TSH suppression (0.4 mIU/L or less), while the other 306 did not (TSH greater than 0.4 mIU/L). Patients who were suppressed were usually younger, had tumors that were probably larger than 1 cm in diameter, and were treated with radioiodine (P<0.01).