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NCCN Guidelines for Patients



Thyroid Cancer, Version 1.2017


Cancer treatment Thyroid hormone replacement therapy | Chemotherapy

Thyroid hormone replacement therapy

After a thyroidectomy, you will need to replace the

hormones made by the thyroid. Drugs can be given

to replace the thyroid hormones that your body

needs in order to function. A replacement hormone

is needed to control your metabolism and keep your

TSH low. If thyroid hormones are too low in your

blood stream, this signals the pituitary gland to make

more TSH. If the TSH is high, this may cause thyroid

cancer cells to grow, or for thyroid cancer to come

back. When thyroid cancer returns, it is called a


Doctors recommend levothyroxine to keep your

TSH in the low normal range. Levothyroxine is

a thyroid hormone. It is a common treatment for

thyroid cancer, hypothyroidism (not enough thyroid

hormone), and an enlarged thyroid (goiter). It comes

in pill form and is taken by mouth once a day. Giving

enough levothyroxine to keep your TSH low is called

“TSH suppression." TSH suppression is especially

useful for papillary, follicular, or Hürthle cell thyroid

cancer. You may also need to take a calcium and

vitamin D supplement.

Common side effects of levothyroxine may include:



Weight loss









Trouble sleeping

Your doctor or pharmacist can share a full list of side

effects with you. When given in excess, this drug

can affect bone density (bone strength), cause heart

rhythm problems, and cause thyrotoxicosis (condition

caused by too much thyroid hormone).

Your doctor needs to consider the benefits and risks

before deciding how much levothyroxine you should

take. Your doctor will also monitor you closely to

find out what dose of hormones you need. Thyroid

hormone replacement therapy is needed for life so

you will have regular blood tests to check your TSH

and hormone levels. If you take thyroid replacement

hormone therapy, ask your doctor or nurse to go over

the dose and schedule.

The right dosage of thyroid hormone

replacement is critical to decent

quality of life for thyroid cancer

patients who have their thyroid


- Peter


Chemotherapy, or chemo, is a main systemic cancer

treatment. Systemic treatment travels throughout

the body to treat or control areas of cancer.

Chemotherapy, or “chemo,” includes drugs that

disrupt the life cycle of cancer cells. Some damage

DNA directly; others get in the way of processes that

help cancer cells build DNA.

Most chemotherapy drugs are given as liquids that

are slowly injected into a vein. Some chemotherapy is

in the form of pills that are swallowed. Chemotherapy

may consist of one or more drugs. When only one

drug is used, it is called a single agent.