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patient, get rid of the hypothyroid systems and keep them normal, but in fact in thyroid cancer, levothyroxine therapy goes far beyond that.

Numerous studies over the last 30 years have shown that if we use what we call levothyroxine suppression, in fact an overdose of levothyroxine, to suppress that TSH, we see a marked decrease in recurrence and better outcomes.  So, the goal in thyroid cancer is, A, yes, to replace them, so they don't have the hypothyroid symptoms, but more importantly for us, I frequently call this to my patients, this is our chemotherapy that they're going to be on for the next 20, 30, 40 years, depending on how old they are.

If you put this into some perspective, you've heard this morning, our usual goal for primary hypothyroidism is a TSH around 1, a T4 in the normal range.  In my clinic, our goal is much different.  Our goal is to have a TSH that's very, very low, bordering on undetectable, and to do that, we have to get their T4 elevated.  On purpose in my clinic, we make folks subclinically hyperthyroid.  The goal is to get them on just enough T4 so that they don't feel it clinically but

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