Sudden enlargement of local recurrent thyroid tumor after recombinant human TSH administration.
Chronic endogenous TSH stimulation of neoplastic tissue has been reported to stimulate tumor enlargement. However, little is known about changes in normal and neoplastic thyroid tissue after sudden rather than chronic stimulation with TSH. Acute thyroidal tissue reactions, reflected by rapid tumor expansion and/or possible vascular changes, have been reported to occur after bovine TSH stimulation and, more recently, after recombinant human TSH (rhTSH). In this report, we describe two patients with papillary thyroid carcinoma with local recurrent tumor. Both patients developed tumor growth 12-48 h after the second rhTSH injection, reflected by acute respiratory distress or a palpable, tender mass. In both situations, the enlargement was documented by imaging techniques, showing tumor expansion compared with previous examinations. Rapid improvement with glucocorticoid supports inflammation as the likely etiology. Based on these cases, and other reports of rapid tumor expansion after rhTSH injection, we recommend glucocorticoid coverage before rhTSH administration for patients with known or suspected neoplasia located in a limited space.
Braga
M
M
Division of Endocrinology and Metabolism, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA.
Ringel
M D
MD
Cooper
D S
DS
D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000139:chemically induced* / Q000473:pathology*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D009364:Neoplasm Recurrence, Local / Q000139:chemically induced* / Q000473:pathology*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D013964:Thyroid Neoplasms / Q000139:chemically induced* / Q000473:pathology*; D013965:Thyroidectomy; D013972:Thyrotropin / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014284:Triiodothyronine / Q000627:therapeutic use
D011994:Recombinant Proteins; D014284:Triiodothyronine; D013972:Thyrotropin