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Recombinant Human Thyrotropin Is a Potent Stimulator of Thyroid Function in Normal Subjects¹

Department of Medicine, Division of Endocrinology and Metabolism, University of Massachusetts School of Medicine, Worcester, Massachusetts 01655

Address all correspondence and requests for reprints to: Charles H. Emerson, M.D., University of Massachusetts School of Medicine, Worcester, Massachusetts 01655.

Recombinant human TSH (rhTSH) is known to stimulate ¹³¹I uptake and thyroglobulin (Tg) release from the postoperative remnant and metastases in thyroid cancer patients, but its effects on serum thyroid hormone and Tg concentrations in normal subjects have not been reported. Before using rhTSH in the management of thyroid disorders other than cancer, the thyroid response to rhTSH in normal subjects must be assessed. Six subjects, two men and four women, without evidence of thyroid disease, including normal serum free T₄ index and TSH concentrations and negative tests for antithyroid peroxidase and Tg, were studied. Each received 0.1 mg rhTSH, im, 11% of the lowest dose that has been administered to thyroid cancer patients. Blood was obtained before; 2, 4, and 8 h after; and 1, 2, 3, 4, 7, and about 3 weeks after rhTSH administration. Serum TSH significantly increased at 2 h (mean ± SE, 2.4 ± 0.9 to 40.7 ± 7.4 mU/mL), peaked at 4 h (50.9 ± 9.3), remained significantly elevated for 1 day, and was significantly below baseline (0.8 ± 0.5) 7 days after rhTSH administration. Serum T₃ increased significantly at 4 h (115 ± 4 to 190 ± 14 ng/dL), peaked at 24 h (217 ± 23 ng/dL), and remained significantly elevated for 3 days (151 ± 12 ng/dL). Serum T₄ increased significantly at 8 h (7.3 ± 0.2 to 9.8 ± 0.4 µg/dL), peaked at 24 h (11.2 ± 0.5 µg/dL), and remained significantly elevated for 4 days (9.4 ± 0.5 µg/dL). Serum Tg did not change for the first 8 h, increased significantly at 1 day (15.9 ± 3.9 to 34.7 ± 6.0 ng/mL), peaked at 2 days (44.2 ± 7.0 ng/mL), and remained significantly elevated for 4 days (37.7 ± 13.7 ng/mL). All values returned to baseline at 3 weeks. TSH antibodies were not detected at 3 weeks. A single dose of 0.1 mg rhTSH is a potent stimulator of thyroid function in normal subjects. rhTSH may be a useful agent to test thyroid reserve and for use in clinical settings that require direct thyroid stimulation.

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