The use of recombinant human TSH in the follow-up of differentiated thyroid cancer: experience from a large patient cohort in a single centre.
BACKGROUND
Periodic evaluation of serum thyroglobulin (Tg) and whole body 131I imaging (131I-WBS) are essential in the follow-up of differentiated thyroid carcinoma (DTC); both diagnostic modalities require stimulation by high levels of TSH. Administration of recombinant human TSH (rhTSH) is an alternative to the withdrawal of thyroid hormone therapy.


OBJECTIVE
The aim of this study was to report our experience in the use of rhTSH for the management of patients with DTC.


METHODS
One hundred and four patients were enrolled in the study. A dose of 10 U of rhTSH therapy was injected intramuscularly for 2 consecutive days; 24 h after the second dose of rhTSH the patients were administered 4--5 mCi of 131I and, 48 h later, WBS was performed.


RESULTS
In all patients, baseline mean serum Tg and TSH levels were 2.4 +/- 1.9 ng/ml and 0.0153 +/- 0.0232 mIU/l, respectively. Basal Tg levels were detectable in 58 out of 104 patients. After rhTSH injection, mean serum TSH levels rose to 122.67 +/- 47.36 mIU/l. Stimulated serum Tg levels increased to greater-than-or-equal 5 ng/ml and the 131I-WBS showed an uptake in 18 patients (17.4%). Among them there were three with bone metastases and one with brain metastases, who reported violent skeletal pain and a severe headache, respectively. These were caused by the growth of tumour mass of metastases induced by rhTSH administration.


CONCLUSIONS
The use of rhTSH avoids the debilitating effects of hypothyroidism and its use successfully promotes iodine uptake and increases the sensitivity of serum Tg testing. The risk of causing serious side-effects recommends performing skull magnetic resonance and radionuclide bone scan in cases of suspected brain or skeletal metastases.
Giovanni
Vitale
V
Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica and Dipartimento di Scienze Biomorfologiche e Funzionali, Università degli Studi di Napoli Federico II, Naples, Italy. vanni10@yahoo.com
Arianna
Lupoli Gelsy
LG
Antonio
Ciccarelli
C
Francesco
Fonderico
F
Michele
Klain
K
Giovanni
Squame
S
Marco
Salvatore
S
Giovanni
Lupoli
L
D000328:Adult; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary; D002291:Carcinoma, Papillary / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018265:Carcinoma, Papillary, Follicular / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000139:chemically induced; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018365:Neoplasm, Residual / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D010146:Pain / Q000139:chemically induced; D011877:Radionuclide Imaging; D011994:Recombinant Proteins / Q000009:adverse effects; D013954:Thyroglobulin / Q000032:analysis; D013964:Thyroid Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D013972:Thyrotropin / Q000009:adverse effects / Q000097:blood; D014915:Whole-Body Counting
D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin; D013954:Thyroglobulin