This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
When dealing with TSH-dependent thyroid cancer, it would appear wise to err on the side of maximal TSH suppression. Most would be willing to trade off a slight risk of thyroxine-induced osteopenia for adequate TSH suppression. I would not quibble with Dr Caplan's suggestion of giving 0.3 mg/day of levothyroxine sodium in such a patient. The longterm deleterious effect on bone with the larger dose would appear to be minimal. The possibility of measuring maximal TSH suppression with TRH is interesting and is worthy of study.
Frame B. Levothyroxine Dosage After Thyroidectomy for Metastatic Papillary Cancer-Reply. JAMA. 1976;236(5):448. doi:10.1001/jama.1976.03270050012012