J Clin Endocrinol Metab 1999 Nov;84(11):3877-85
A comparison of recombinant human thyrotropin and thyroid hormone withdrawal
for the detection of thyroid remnant or cancer.
Haugen BR, Pacini F, Reiners C, Schlumberger M, Ladenson PW, Sherman SI, Cooper
DS, Graham KE, Braverman LE, Skarulis MC, Davies TF, DeGroot LJ, Mazzaferri EL,
Daniels GH, Ross DS, Luster M, Samuels MH, Becker DV, Maxon HR 3rd, Cavalieri
RR, Spencer CA, McEllin K, Weintraub BD, Ridgway EC.
Recombinant human TSH has been developed to facilitate monitoring for thyroid
carcinoma recurrence or persistence without the attendant morbidity of
hypothyroidism seen after thyroid hormone withdrawal. The objectives of this
study were to compare the effect of administered recombinant human TSH with
thyroid hormone withdrawal on the results of radioiodine whole body scanning (WBS)
and serum thyroglobulin (Tg) levels. Two hundred and twenty-nine adult patients
with differentiated thyroid cancer requiring radioiodine WBS were studied.
Radioiodine WBS and serum Tg measurements were performed after administration of
recombinant human TSH and again after thyroid hormone withdrawal in each
patient. Radioiodine whole body scans were concordant between the recombinant
TSH-stimulated and thyroid hormone withdrawal phases in 195 of 220 (89%)
patients. Of the discordant scans, 8 (4%) had superior scans after recombinant
human TSH administration, and 17 (8%) had superior scans after thyroid hormone
withdrawal (P = 0.108). Based on a serum Tg level of 2 ng/mL or more, thyroid
tissue or cancer was detected during thyroid hormone therapy in 22%, after
recombinant human TSH stimulation in 52%, and after thyroid hormone withdrawal
in 56% of patients with disease or tissue limited to the thyroid bed and in 80%,
100%, and 100% of patients, respectively, with metastatic disease. A combination
of radioiodine WBS and serum Tg after recombinant human TSH stimulation detected
thyroid tissue or cancer in 93% of patients with disease or tissue limited to
the thyroid bed and 100% of patients with metastatic disease. In conclusion,
recombinant human TSH administration is a safe and effective means of
stimulating radioiodine uptake and serum Tg levels in patients undergoing
evaluation for thyroid cancer persistence and recurrence.
