[Recombinant TSH in ablative therapy and follow-up of patients with differentiated thyroid carcinoma].
The studies evaluating the efficacy and safety of recombinant TSH in the ablative therapy and follow-up of patients with differentiated thyroid carcinoma by serum thyroglobulin (Tg) measurement and iodine scanning were reviewed in this article. Recombinant TSH is comparable to hypothyroidism in the generation of Tg and in the execution of iodine-131 whole-body scanning, with the advantage of sparing patients from the symptoms of hypothyroidism and from impaired quality of life induced by levothyroxine withdrawal, in addition to a reduced exposure to elevated TSH and shorter absence from work, with recombinant TSH being the preparation indicated for the diagnosis of metastases in both low risk (Tg after recombinant TSH) and moderate or high risk patients (Tg and iodine-131 scanning after recombinant TSH). In the case of ablative therapy, the results are promising when using a dose of 100 mCi for remnant ablation, but hypothyroidism is still preferred, except for patients in whom the desired TSH elevation after levothyroxine withdrawal is not achieved, patients with base diseases that are aggravated by acute and severe hypothyroidism (severe heart and lung disease, coronary disease, compromised renal function, history of psychosis due to myxedema), patients debilitated by advanced disease, and elderly individuals. The studies also show that the administration of recombinant TSH is safe, with few mild or moderate adverse effects.
Rosário
Pedro Weslley S do
PW
Departamento de Tireóide, Santa Casa de Belo Horizonte, Belo Horizonte, MG. pedrorosario@globo.com
Fagundes
Tales Alvarenga
TA
Purisch
Saulo
S
Padrão
Eduardo Lanza
EL
Rezende
Leonardo Lamego
LL
Barroso
Alvaro Luís
AL
D002277:Carcinoma / Q000097:blood / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced; D007457:Iodine Radioisotopes; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging*; D013972:Thyrotropin / Q000627:therapeutic use*; D013974:Thyroxine / Q000008:administration & dosage; D014915:Whole-Body Counting
D007457:Iodine Radioisotopes; D013972:Thyrotropin; D013954:Thyroglobulin; D013974:Thyroxine