On-demand l-thyroxine replacement therapy (given only when TSH >5.91 mU/L) allowed approximately three-fourths of post-lobectomy low- to intermediate-risk PTC patients to avoid l-thyroxine supplementation while preserving equivalent short-term treatment response and recurrence-free survival compared to TSH suppression therapy.
Key Findings
Results
No significant difference in 2-year recurrence-free survival was observed between the on-demand l-thyroxine group and the historical TSH suppression control group.
2-year RFS was 99.4% in the test group versus 98.5% in the control group (P = 0.917)
Comparison was conducted in 204 matched pairs of cases
Recurrence-free survival was estimated using Kaplan-Meier curves and compared using the log-rank test
Control group was treated according to guideline TSH target of 0.5–2 mU/L
Results
Biochemical responses were equivalent between the on-demand therapy group and the historical TSH suppression control group among patients with negative thyroglobulin antibody.
The rate of patients with increasing Tg was 21.6% in both the test group and the control group (P > 0.05)
Analysis was restricted to patients with negative thyroglobulin (Tg) antibody
Comparison was conducted in 204 matched pairs
Results
The majority of post-lobectomy low- to intermediate-risk PTC patients did not require l-thyroxine supplementation under the on-demand protocol.
72.3% of patients never underwent l-thyroxine supplementation during follow-up
l-Thyroxine was only given if serum TSH exceeded 5.91 mU/L (upper limit of the reference range)
No new cases requiring l-thyroxine for elevated TSH were detected beyond one year post surgery
333 cases were included in the prognostic evaluation with a mean follow-up of 17 months
Methods
The study enrolled 381 adult patients with low- to intermediate-risk PTC who underwent lobectomy between 2021 and 2023.
Median age was 39 years and 70.6% were female
This was a prospective nonrandomized controlled study
Retrospective controls were selected from the institute database (2000–2014) and matched with prospective patients
l-Thyroxine supplementation was given only if serum TSH exceeded 5.91 mU/L
Background
TSH suppression therapy necessity for PTC after lobectomy has been challenged, forming the rationale for evaluating on-demand replacement therapy.
The study was designed to evaluate on-demand l-thyroxine replacement therapy specifically for the post-lobectomy PTC setting
Primary endpoints were structural recurrence and biochemical response
Secondary endpoint was the euthyroidism rate without thyroxine supplementation
The control group followed guideline-recommended TSH suppression to a target of 0.5–2 mU/L
Xu S, Liao L, Xian K, Wang K, Xing C, Liu R, et al.. (2026). On-demand l -thyroxine replacement therapy in post-lobectomy papillary thyroid cancer: a prospective nonrandomized controlled study.. International journal of surgery (London, England). https://doi.org/10.1097/JS9.0000000000003905