Near-lethal respiratory failure after recombinant human thyroid-stimulating hormone use in a patient with metastatic thyroid carcinoma.
A patient with widely metastatic differentiated thyroid cancer who had been heavily pretreated with (131)I was given recombinant human thyroid stimulating hormone (rhTSH) prior to (131)I treatment. Clinical and physical data from both this case and the literature suggest that the recombinant hormone, not the (131)I, may have caused a significant portion of the tumor swelling, which in turn was the most likely cause of the patient's symptoms. The potential effect of (131)I-induced tumor swelling and direct radiation effect on the lung is also analyzed. We review the potential hazards associated with rhTSH in patients with metastasis and propose means of minimizing this risk.
Goffman
Thomas
T
Department of Radiation Oncology, Eastern Virginia Medical School, Norfolk, Virginia, USA. Goffmate@EVMS.EDU
Ioffe
Vladimir
V
Tuttle
Michael
M
Bowers
John T
JT
Mason
M Elizabeth
ME
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011877:Radionuclide Imaging; D011994:Recombinant Proteins / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D013972:Thyrotropin / Q000009:adverse effects*; D014018:Tissue Distribution; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin