ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Thyroid Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1607927
This article is part of the Research TopicLevothyroxine Therapy in Patients with Hypothyroidism: Volume IIView all 15 articles
High TSH levels during TSH suppression therapy in DTC postoperative patients are associated with low DIO2 expression in the thyroid and impaired thyroid hormone sensitivity
Provisionally accepted
- 1Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- 2Department of Basic Courses, Chongqing Medical and Pharmaceutical College, Chongqing, China
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Some patients with differentiated thyroid cancer exhibit persistently elevated TSH levels despite undergoing TSH suppression therapy after surgery. This study aims to investigate the expression of type 2 deiodinase (DIO2) in the thyroid, as well as central and peripheral thyroid hormone sensitivity in these patients. The study enrolled 162 patients who had total thyroidectomy and received TSH suppression therapy. They were divided into Low TSH and High TSH groups based on TSH levels.The study compared thyroid function and hormone sensitivity indices pre-and post-treatment and analyzed DIO2 expression in normal thyroid tissue. After TSH suppression therapy, all patients exhibited significantly higher FT4 levels. In the High TSH group, FT3 levels decreased postoperatively. Compared with the Low TSH group, the High TSH group had significantly lower FT3/FT4 ratios and higher central thyroid sensitivity indices. Immunohistochemical analysis revealed that DIO2 expression in the thyroid was lower in the High TSH group than in the Low TSH group.Among patients with normal FT4 levels, DIO2 expression was also significantly lower in the High TSH group compared to the Low TSH group. After sufficient administration of L-T4, the DTC patients with high postoperative TSH levels had lower DIO2 expression in normal thyroid tissues.Individuals with poor response to TSH suppression therapy inherently have poorer central and peripheral thyroid hormones sensitivity, and total thyroidectomy will worsen the situation. Elevated TSH index helps to predict therapeutic outcomes in TSH suppression therapy when L-T4 is used as monotherapy.
Keywords: thyroid papillary carcinoma, Levothyroxine, TSH suppression therapy, type 2 deiodinase, Thyroid hormone sensitivity indices
Received: 08 Apr 2025; Accepted: 31 Jul 2025.
Copyright: © 2025 Wu, Huang, Yan, Anqi, Song and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hui Huang, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610000, Sichuan Province, China
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