Use of recombinant human thyroid-stimulating hormone in the management of well-differentiated thyroid cancer

Recombinant human (rh) thyroid-stimulating hormone (TSH) has changed the care of patients with well-differentiated thyroid cancer (DTC). Traditionally, thyroid hormone withdrawal has been used to increase TSH concentrations for optimising trapping and retention of radioiodine for thyroid remnant ablation and for diagnostic procedures (measurement of thyroglobulin and whole body scan) used in the follow-up of patients with DTC. The resulting hypothyroidism is, however, accompanied by substantial morbidity. rhTSH is an effective and safe alternative to thyroid hormone withdrawal for follow-up of DTC. Its ability to detect persistent or recurrent disease is similar to that of thyroid hormone withdrawal. At the present time, rhTSH is approved for diagnostic monitoring of patients with DTC as well as for pretherapeutic stimulation in low-risk patients for remnant ablation with 100 mCi (131)I (in the EU). In addition, rhTSH has potential for use in facilitating the treatment of metastasis in patients with DTC and in patients with non-toxic nodular goiter; however, more clinical trials are needed to confirm its use in these situations.