Protocol for the combined diagnostic and therapeutic use of recombinant human thyroid-stimulating hormone

Patients may be prepared for radioiodine diagnostic imaging by withdrawal of all thyroid medication or by the administration of extrinsic thyroid-stimulating hormone (TSH). Although purified human and bovine TSHs were used in the past, they are no longer recommended because of their adverse effects. Recently, a new extrinsic TSH called recombinant human TSH (rhTSH) was developed and is commercially available. It is a highly purified, recombinant form of the naturally occurring human TSH. It was introduced to decrease complications associated with temporary hypothyroid states required at times in the follow-up evaluation of patients with thyroid cancer. Although rhTSH is currently used for patient preparation in diagnosis only, its use in preparations for subsequent radioiodine therapy may be helpful in some clinical circumstances. The authors describe a patient with papillary thyroid cancer in whom a 2-day rhTSH protocol was used for diagnosis and extended for therapeutic purposes. The protocol was useful to obtain the diagnostic information needed to determine whether to treat, and it allowed rapid progress to therapy without further patient preparation. Until rhTSH is fully approved for both diagnostic and therapeutic uses, this modified 2-day protocol would allow patients with special clinical circumstances to be evaluated and treated rapidly.