Management of thyroid patients post-surgery is a delicate balancing act between thyroid hormone levels by primary, secondary and tertiary care clinicians. Following total thyroidectomy, and sometimes for those who undergo lobectomy alone, whether it is for thyroid cancer, benign thyroid disease such as Graves’ disease, or multinodular goitre, patients require thyroid hormone replacement [Grani, 2019; Ahmad, 2025], but thyroid hormone requirements differ. For those with benign thyroid disease, LT4 is recommended to achieve euthyroidism and to prevent symptoms of hypothyroidism [Ahmad, 2025]. For those with thyroid cancer at high risk of recurrence  (papillary and follicular carcinoma), high doses of LT4 are used to suppress TSH as TSH acts as a growth factor for thyroid follicular cells (including those that are neoplastic) [Grani, 2019]. Thus, suppressing TSH reduces the risk of cancer recurrence [Ahmad, 2025]. Primary care physicians, who usually monitor all patients on LT4, should be aware that thyroid cancer patients should not be included in routine annual thyroid checks, and any dose adjustment should be under the guidance of secondary/tertiary care. Patients with ongoing TSH suppression may present to primary care because under-suppression is causing symptoms of overt hypothyroidism, or over-suppression is producing cardiovascular symptoms [Grani, 2019].