{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:53:25Z","timestamp":1788785605431,"version":"build-2803163510"},"reference-count":33,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T00:00:00Z","timestamp":1735171200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Levothyroxine to suppress thyrotropin (TSH) to &lt;0.5 mIU\/L following thyroidectomy in differentiated thyroid cancer (DTC) may reduce recurrence in higher-risk DTC. However, there is limited evidence to support guideline recommendations to maintain TSH in the low-normal range of 0.5\u20132 mIU\/L to reduce recurrence in patients with lower risk DTC. The primary objective was to assess the association between exposure to high normal serum TSH (2\u20134 mIU\/L) as compared with low normal TSH (0.5\u20132 mIU\/L) target ranges and cancer recurrence in patients with DTC after thyroidectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This population-based retrospective cohort study used linked, administrative health care databases from Ontario, Canada, to follow patients with DTC post-thyroidectomy from 2007 to 2018. The exposure was time updated, serum TSH, treated as a cumulative and instantaneous exposure. Multivariable cause-specific proportional hazard regression analyses were performed to determine time to DTC recurrence from index date, defined as a composite of repeat neck surgery, radioactive iodine (RAI) treatment, and\/or DTC-specific death. Results were also stratified by initial treatment as a marker of baseline recurrence risk in a sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>This cohort of 26,336 individuals (78% female) with DTC and a median age of 50 years were followed for a median of 5.9 (interquartile range 3.6\u20138.6) years; 40.9% were initially treated with a hemi-thyroidectomy only and 38.2% received a total thyroidectomy and RAI. Compared with exposure to TSH 0.5 to \u22642 mIU\/L, DTC recurrence rate was similar for each additional 3 months of exposure to TSH &gt;2 to \u22644 mIU\/L (adjusted cause specific [cs] hazard ratio [HR] 0.99 [confidence interval or CI 0.97\u20131.02]) but was significantly increased with each additional 3 months of exposure to TSH &gt;4 mIU\/L (adjusted csHR 1.07 [CI 1.04\u20131.09]). Results were similar across baseline treatment groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>There was no difference in clinically significant recurrence in those with low-risk DTC maintained with a TSH of 0.5\u20132 mIU\/L compared with 2\u20134 mIU\/L. Guidelines should consider liberalizing target TSH level post thyroidectomy in low-risk cohorts. These results cannot be applied to patients with high-risk DTC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/thy.2024.0330","type":"journal-article","created":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T12:15:26Z","timestamp":1735215326000},"page":"208-215","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["Association Between Serum Thyrotropin and Cancer Recurrence in Differentiated Thyroid Cancer: A Population-Based Retrospective Cohort Study"],"prefix":"10.1177","volume":"35","author":[{"given":"Judy K.","family":"Qiang","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada."},{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada."},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinku","family":"Sutradhar","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada."},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Everett","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada."},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Eskander","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada."},{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iliana C.","family":"Lega","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada."},{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada."},{"name":"Women\u2019s College Research Institute, Women\u2019s College Hospital, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshan","family":"Zahedi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada."},{"name":"Women\u2019s College Research Institute, Women\u2019s College Hospital, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine","family":"Lipscombe","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada."},{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada."},{"name":"Women\u2019s College Research Institute, Women\u2019s College Hospital, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,12,26]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-022-03274-7"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(21)00027-9"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.2719"},{"key":"e_1_3_7_5_2","unstructured":"Changing trends in thyroid cancer incidence in Canada: A histologic examination 1992 to 2016. 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