THW may be used to raise TSH levels for certain diagnostic procedures and/or RAI ablation. In order to raise TSH levels sufficiently, thyroid hormone replacement medication typically needs to be discontinued for a period of 4-6 weeks. This may cause your patients to experience the signs and symptoms of acute hypothyroidism.2
The symptoms of acute hypothyroidism are sometimes debilitating and may include tiredness, weight gain, sleepiness, constipation, muscle aches, reduced concentration, emotional changes resembling depression, and others. Not all patients experience symptoms in the same degree of severity. Some patients may experience more severe symptoms than others.1
Stopping thyroid hormone medication for 4-6 weeks may cause your patients to have unwanted symptoms.1,3
Discuss Options with your patients that may help them avoid thyroid hormone withdrawal and some of the associated symptoms of acute hypothyroidism
Symptoms Associated with Hypothyroidism3*
*Not a complete list
How will you decide what to prescribe for your patient?
When determining how to prepare patients for RAI or Stim Tg testing (with or without WBS), consider:
- Acute short-term hypothyroidism induced by THW may be a distressing time and may result in unwanted symptoms and impaired quality of life.4
- Delayed symptoms like fatigue, edema, and constipation are signs of acute hypothyroidism and it should not be assumed that these symptoms are caused by RAI treatment alone.5
Abbreviations:
RAI=radioactive iodine, Stim Tg=stimulated thyroglobulin, THW=thyroid hormone withdrawal, TSH=thyroid stimulating hormone, WBS=whole body scan.
Important Safety Information
References
1) K. Burman; Hypothyroidism Symptoms Following Temporary Withdrawal from Thyroid Hormone; Excerpted, with permission, from pages 92-93 of “Withdrawal of Thyroid Hormones,” Chapter 915 of the reference book “Thyroid Cancer: A Guide for Patients”, Keystone Press, 2010. Douglas Van Nostrand, M.D., Gary Bloom, and Leonard Wartofsky, M.D. See Thyroid Cancer: A Guide for Patients - ThyCa [Accessed March 19, 2025].
2) RADIOACTIVE IODINE FOR THE TREATMENT OF THYROID CANCER. MyThyroid.com: Search and Site Map ; http://www.mythyroid.com/radioactiveiodinecancer.html. [Accessed March 19, 2025].
3) Jason Baker MD; The Effects of Hypothyroidism in the Body; Effects of Hypothyroidism: Thinning Hair, Heart Attack and More [Accessed March 19, 2025].
4) Duntas LH, Biondi B. Short-term hypothyroidism after Levothyroxine-withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences. Eur J Endocrinol. 2007;156(1):13-19.
5) Lim et al. Differences in Physicians’ and Patients’ Perception of Acute Hypothyroid Symptoms Induced by Thyroid Hormone Withdrawal in Thyroid Cancer Patients: A Multicenter Survey in Korea; Eur Thyroid J; 2015 Mar;4(1):48-54.doi: 10.1159/000371512. Epub 2015 Feb 19; NCBI - WWW Error Blocked Diagnostic [Accessed March 19, 2025].