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Background: Guidelines widely recommend thyrotropin suppression to reduce the risk of recurrence in intermediate- and high-risk papillary thyroid cancer PTC after total thyroidectomy. Patients and methods: We constructed a retrospective cohort including PTC patient encounters. Using propensity score matching and logistic regression models, we determined the independent risk factors affecting levothyroxine therapy at different ages.

Over the past several decades, there has been an increase in the incidence of thyroid cancer, with the vast majority being papillary thyroid cancer PTC 1. Total thyroidectomy is recommended by the American Thyroid Association ATA, edition to reduce the risk of recurrence 2. After total thyroidectomy, levothyroxine LT4 is prescribed to replace the function of the removed thyroid gland.

Meanwhile, a supraphysiological dose of LT4 is applied to suppress the secretion of thyroid-stimulating hormone TSH , which further reduces the risk of recurrence 3 , 4. For patients with different levels of predicted risks, different postoperative TSH targets are recommended.

In addition, the benefits of TSH suppression treatment could be outweighed by the side effects as age advances. It is widely acknowledged that iatrogenic thyrotoxicosis resulting from aggressive suppression therapy is associated with an increased risk of fracture and cardiovascular events 5 , 6 , 2- to 4-fold higher in elderly patients 7 , 8.