title: A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer.
abstract: Recombinant human TSH has been developed to facilitate monitoring for thyroid carcinoma recurrence or persistence without the attendant morbidity of hypothyroidism seen after thyroid hormone withdrawal. The objectives of this study were to compare the effect of administered recombinant human TSH with thyroid hormone withdrawal on the results of radioiodine whole body scanning (WBS) and serum thyroglobulin (Tg) levels. Two hundred and twenty-nine adult patients with differentiated thyroid cancer requiring radioiodine WBS were studied. Radioiodine WBS and serum Tg measurements were performed after administration of recombinant human TSH and again after thyroid hormone withdrawal in each patient. Radioiodine whole body scans were concordant between the recombinant TSH-stimulated and thyroid hormone withdrawal phases in 195 of 220 (89%) patients. Of the discordant scans, 8 (4%) had superior scans after recombinant human TSH administration, and 17 (8%) had superior scans after thyroid hormone withdrawal (P = 0.108). Based on a serum Tg level of 2 ng/mL or more, thyroid tissue or cancer was detected during thyroid hormone therapy in 22%, after recombinant human TSH stimulation in 52%, and after thyroid hormone withdrawal in 56% of patients with disease or tissue limited to the thyroid bed and in 80%, 100%, and 100% of patients, respectively, with metastatic disease. A combination of radioiodine WBS and serum Tg after recombinant human TSH stimulation detected thyroid tissue or cancer in 93% of patients with disease or tissue limited to the thyroid bed and 100% of patients with metastatic disease. In conclusion, recombinant human TSH administration is a safe and effective means of stimulating radioiodine uptake and serum Tg levels in patients undergoing evaluation for thyroid cancer persistence and recurrence.
authors.affiliation: Division of Endocrinology, University of Colorado Health Sciences Center, Denver 80262, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Haugen
authors.forename: F
authors.initials: F
authors.lastname: Pacini
authors.forename: C
authors.initials: C
authors.lastname: Reiners
authors.forename: M
authors.initials: M
authors.lastname: Schlumberger
authors.forename: P W
authors.initials: PW
authors.lastname: Ladenson
authors.forename: S I
authors.initials: SI
authors.lastname: Sherman
authors.forename: D S
authors.initials: DS
authors.lastname: Cooper
authors.forename: K E
authors.initials: KE
authors.lastname: Graham
authors.forename: L E
authors.initials: LE
authors.lastname: Braverman
authors.forename: M C
authors.initials: MC
authors.lastname: Skarulis
authors.forename: T F
authors.initials: TF
authors.lastname: Davies
authors.forename: L J
authors.initials: LJ
authors.lastname: DeGroot
authors.forename: E L
authors.initials: EL
authors.lastname: Mazzaferri
authors.forename: G H
authors.initials: GH
authors.lastname: Daniels
authors.forename: D S
authors.initials: DS
authors.lastname: Ross
authors.forename: M
authors.initials: M
authors.lastname: Luster
authors.forename: M H
authors.initials: MH
authors.lastname: Samuels
authors.forename: D V
authors.initials: DV
authors.lastname: Becker
authors.forename: H R
authors.initials: HR
authors.lastname: Maxon
authors.forename: R R
authors.initials: RR
authors.lastname: Cavalieri
authors.forename: C A
authors.initials: CA
authors.lastname: Spencer
authors.forename: K
authors.initials: K
authors.lastname: McEllin
authors.forename: B D
authors.initials: BD
authors.lastname: Weintraub
authors.forename: E C
authors.initials: EC
authors.lastname: Ridgway
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011877:Radionuclide Imaging; D011994:Recombinant Proteins / Q000008:administration & dosage; D013954:Thyroglobulin / Q000097:blood*; D013963:Thyroid Hormones / Q000008:administration & dosage*; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D013972:Thyrotropin / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood
chemical_list: D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013963:Thyroid Hormones; D013972:Thyrotropin; D013954:Thyroglobulin