A Qualitative Study of Clinician Barriers and Facilitators to De-escalation of Thyroid Stimulating Hormone Suppression in Thyroid Cancer Survivors
Authors' conclusion
We identified barriers and facilitators to de-escalating TSH suppression therapy in thyroid cancer survivors at multiple levels. Understanding these factors will enable clinicians to provide high-value, patient-centered care in order to reduce overtreatment, patient harm and improve quality of life in thyroid cancer survivors.
Study context
- Population
- Clinicians (endocrinology and primary care) caring for differentiated thyroid cancer survivors; 73% female, mean 14 years in clinical practice (range, 1–22)
- Participants
- 8 vs 7
- Comparison
- Endocrinology vs Primary care
- Endocrinologyn = 8
- Primary caren = 7
- Outcome
- Clinician-reported barriers and facilitators to reducing thyroid hormone dose to aim for thyroid stimulating hormone (TSH) in the normal reference range in thyroid cancer survivors
Methodological detailssemistructured focus groups, convenience/snowball sampling, Theoretical Domains Framework, deductive coding and inductive thematic analysis
- Semistructured focus groups
- Convenience/snowball sampling
- Theoretical Domains Framework
- Deductive coding and inductive thematic analysis
Main finding
As reported in the abstract
- Barriers and facilitators emerged at the patient-level, clinician-level, and system-level
- Key barriers: patient distress/anxiety and misinformation, unclear shared survivorship goals and plans between specialties, clinic visit time constraints
- Facilitators: building a trusting relationship, patient-centered education, communication and collaboration between specialties to establish shared long-term survivorship plans
Original publication
A Qualitative Study of Clinician Barriers and Facilitators to De-escalation of Thyroid Stimulating Hormone Suppression in Thyroid Cancer Survivors. Endocr Pract. Published 17 December 2025. doi:10.
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