[Recombinant human TSH use in differentiated thyroid cancer]

Area of Science:

• Endocrinology
• Oncology
• Nuclear Medicine

Context:

• Differentiated thyroid carcinoma (DTC) management traditionally involves 131I thyroid remnant ablation (TRA) during hypothyroidism post-total thyroidectomy (TT).
• Late DTC follow-up includes T4 suppression, thyroglobulin (Tg) monitoring, 131I whole body scans (WBS), and cervical ultrasound (US).

Purpose:

• To evaluate the efficacy and impact of recombinant human TSH (rhTSH)-aided TRA in DTC patients.
• To assess the role of stimulated Tg and cervical US in identifying low-risk DTC patients for adjusted TSH suppression.
• To explore the clinical benefit of rhTSH in metastatic DTC.

Summary:

• TRA with rhTSH avoids hypothyroidism symptoms and maintains quality of life, demonstrating equal efficacy to TRA during endogenous TSH elevation.
• Stimulated Tg levels (9-12 months post-treatment) combined with cervical US identify patients with high cure probability, allowing less strict TSH suppression and mitigating side effects.
• While randomized data for metastatic DTC is limited, rhTSH combined with 131I shows clinical benefits in most treated patients.

Impact:

• rhTSH offers an improved quality of life for DTC patients undergoing TRA.
• Optimized TSH suppression strategies based on stimulated Tg and US can reduce long-term complications.
• rhTSH represents a promising therapeutic option for DTC, including metastatic disease.