What is thyroid hormone withdrawal?

Thyroid hormone withdrawal is a process that focuses on holding or stopping doses of thyroid hormone according to a schedule in an effort to increase the level of TSH in the body. A higher level of TSH helps to drive more 131-Iodine into cells by stimulating uptake from the bloodstream.

Thyroid hormone withdrawal can be managed in different ways. If a patient has just undergone thyroid surgery with removal of most or all of the thyroid gland, thyroid hormone replacement therapy may be held altogether in anticipation of treatment with radioactive iodine. Alternatively, the patient may be given a short-acting form of thyroid hormone called liothyronine to ease the transition to complete thyroid hormone withdrawal. Liothyronine is usually continued up until about two weeks before the patient is scheduled to receive a dose of radioactive iodine. At that point the liothyronine is stopped and the patient is kept off thyroid hormone. Before a dose of radioactive iodine is given, TSH must be measured to see if it has increased to an appropriate level.

If a patient has been taking levothyroxine, thyroid hormone withdrawal is carried out in a series of steps. First the patient is switched from levothyroxine to liothyronine to ease the transition to complete thyroid hormone withdrawal. Liothyronine is usually continued for at least two weeks, up until about two weeks before the patient is scheduled to receive a dose of radioactive iodine. At that point the liothyronine is stopped and the patient is kept off thyroid hormone. Before a dose of radioactive iodine is given, TSH must be measured to see if it has increased to an appropriate level

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