随着时间的推移，低风险分化型甲状腺癌 (DTC) 的治疗已朝着治疗降级的方向发展。然而，尽管有当前的临床指南，超生理剂量的左旋甲状腺素 (LT4) 的过度治疗仍然存在。本研究旨在评估曼谷内分泌中心低风险 DTC 患者的实际促甲状腺素抑制治疗。这项回顾性研究纳入了 2016 年至 2022 年间在 Theptarin 医院定期随访至少 18 个月的低危 DTC 患者。血清促甲状腺激素 (TSH) 水平分层为 TSH < 0.1 mIU/L；促甲状腺激素 0.1 至 0.5 mIU/L；促甲状腺激素 0.5 至 2.0 mIU/L； TSH > 2.0 mIU/L。初始风险分层 (IRS) 和动态风险分层是在完成初始治疗后 12 个月的随访和最后一次访视时确定的。分析了与 LT4 过度治疗相关的临床因素。共有 102 名患者（83.3% 为女性，诊断时年龄 41.8±13.6 岁，平均肿瘤大小 1.6±1.0cm）接受评估，平均随访时间为 5.9 年。 IRS 将初次治疗后 92.2% 的患者和最后一次随访时 93.1% 的患者分类为优异缓解类别。最后一次随访时的平均 LT4 每日剂量为 121.3±44.8 µg/天。根据 IRS，只有 8.8% (9/102) 的患者血清 TSH 水平处于适当的目标范围，然后在最后一次随访时改善至 19.6% (20/102)。进一步分析表明，执业医师年限≥10年与严重TSH抑制治疗（TSH < 0.1 mIU/L）相关。尽管有当前的临床指南建议和科学证据，但只有不到五分之一的低风险 DTC 患者达到了适当的血清 TSH 目标。虽然最佳 LT4 抑制的比例在研究期间有所改善，但仍需要进一步努力克服这种临床惯性。作者版权所有 © 2024。由 Wolters Kluwer Health, Inc. 出版

The management of low-risk differentiated thyroid cancer (DTC) has evolved over time toward treatment de-escalation. However, overtreatment with supraphysiological dose of levothyroxine (LT4) continues to be observed despite current clinical guideline. This study aimed to assess the actual thyrotropin suppressive therapy for low-risk DTC patients at an endocrine center in Bangkok. This retrospective study included patients with low-risk DTC who were regularly follow-up for at least 18 months at Theptarin Hospital between 2016 and 2022. The serum thyroid stimulating hormone (TSH) levels were stratified as TSH < 0.1 mIU/L; TSH 0.1 to 0.5 mIU/L; TSH 0.5 to 2.0 mIU/L; and TSH > 2.0 mIU/L. The initial risk stratification (IRS) and dynamic risk stratification were determined at 12 months of follow-up after completing the initial treatment and at the last visit. The clinical factors associated with overtreatment with LT4 were analyzed. A total of 102 patients (83.3% female, age at diagnosis 41.8 ± 13.6 years, mean tumor size 1.6 ± 1.0 cm) were evaluated with a mean follow-up of 5.9 years. The IRS classified 92.2% of patients after the initial treatment and 93.1% of patients at the last follow-up visit into the excellent response category. The mean LT4 daily dosage at the last follow-up was 121.3 ± 44.8 µg/day. Serum TSH levels were in an appropriate target range according to IRS in only 8.8% (9/102) of the patients and then improved to 19.6% (20/102) at the last follow-up visit. Further analysis showed that treating physicians with ≥10 years of practice was associated with severe TSH suppression therapy (TSH < 0.1 mIU/L). Despite the current clinical guideline recommendations and scientific evidences, less than one-fifth of low-risk DTC patients achieved the appropriate serum TSH target. While the proportion of an optimum LT4 suppressive had improved during the study period, further efforts are needed to overcome this clinical inertia.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.