Diagnostic and therapeutic use of recombinant human TSH (rhTSH) in differentiated thyroid cancer.
Traditionally, withdrawal of thyroid hormone to increase serum levels of thyroid-stimulating hormone (TSH) has been used in patients with differentiated thyroid carcinoma (DTC) to optimize radio-iodine uptake and serum thyroglobulin (Tg) stimulation during follow-up and in preparation for radio-iodine therapy. However, this procedure is associated with signs and symptoms of hypothyroidism which negatively affect the patient's quality of life. Recombinant human thyrotropin (rhTSH) has provided an effective alternative to thyroid hormone withdrawal. After favourable experimental trials in humans, rhTSH obtained regulatory approval in North America and in Europe as a diagnostic tool, and more recently as a preparation for radio-iodine thyroid remnant ablation. Since then, rhTSH has radically changed the diagnostic and therapeutic management of DTC patients. This review will focus on the clinical application of rhTSH in the management of DTC, highlighting current indications and future perspectives.
Pacini
Furio
F
Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, Section of Endocrinology & Metabolism, University of Siena, Italy. pacini8@unisi.it
Castagna
Maria Grazia
MG
D018265:Carcinoma, Papillary, Follicular / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy; D013972:Thyrotropin / Q000627:therapeutic use*
D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin; D013954:Thyroglobulin