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The Journal of Clinical Endocrinology & Metabolism Vol. 84, No. 11 3877-3885
Copyright © 1999 by The Endocrine Society

From the Clinical Research Centers

A Comparison of Recombinant Human Thyrotropin and Thyroid Hormone Withdrawal for the Detection of Thyroid Remnant or Cancer1

Bryan R. Haugen, Furio Pacini, Christoph Reiners, Martin Schlumberger, Paul W. Ladenson, Steven I. Sherman, David S. Cooper, Kathryn E. Graham, Lewis E. Braverman, Monica C. Skarulis, Terry F. Davies, Leslie J. DeGroot, Ernest L. Mazzaferri, Gilbert H. Daniels, Douglas S. Ross, Markus Luster, Mary H. Samuels, David V. Becker, Harry R. Maxon, III, Ralph R. Cavalieri, Carole A. Spencer, Kevin McEllin, Bruce D. Weintraub and E. Chester Ridgway

Division of Endocrinology, University of Colorado Health Sciences Center (B.R.H., E.C.R.), Denver, Colorado 80262; the Division of Endocrinology, University of Pisa (F.P.), 56124 Pisa, Italy; Klinik und Poliklinik fuer Nuklearmedezin der Universitaet Wuerzburg (C.R., M.L.), Wuerzburg D-97070, Germany; Service de Medecine Nucleaire, Institut Gustave Roussy (M.S.), Villejuif 94805; the Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine (P.W.L.), Baltimore, Maryland 21287; the Department of Medical Specialties, M. D. Anderson Cancer Center (S.I.S.), Houston, Texas 77030; the Division of Endocrinology, Sinai Hospital of Baltimore (D.S.C.), Baltimore, Maryland 21215; the Division of Endocrinology, Oregon Health Sciences University (K.E.G., M.H.S.), Portland, Oregon 97201; the Genetics Division, Brigham and Women’s Hospital (L.E.B.), Boston, Massachusetts 02115; the Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (M.C.S.), Bethesda, Maryland 20892; the Division of Endocrinology, Mount Sinai School of Medicine (T.F.D.), New York, New York 10029; the Department of Medicine, University of Chicago Medical Center (L.J.D.), Chicago, Illinois 60637; the Department of Internal Medicine, Ohio State University Health Sciences Center (E.L.M.), Columbus, Ohio 43210; the Thyroid Unit, Massachusetts General Hospital (G.H.D., D.S.R.), Boston, Massachusetts 02114; the Division of Nuclear Medicine, New York Hospital-Cornell Medical Center (D.V.B.), New York, New York 10021; Nuclear Medicine, University of Cincinnati Medical Center (H.R.M.), Cincinnati, Ohio 45267; Nuclear Medicine, Veterans Administration Medical Center (R.R.C.), San Francisco, California 94121; the Department of Medicine, University of Southern California (C.A.S.), Los Angeles, California 90033; Genzyme Transgenics Corp. (K.E.), Boston, Massachusetts 02139; and the Laboratory of Molecular Endocrinology, University of Maryland School of Medicine (B.D.W.), Baltimore, Maryland 21201

Address all correspondence and requests for reprints to: Bryan R. Haugen, M.D., University of Colorado Health Sciences Center, B151, 4200 E 9th Avenue, Denver, Colorado 80262.

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.




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M. Braga, M. D. Ringel, and D. S. Cooper
Sudden Enlargement of Local Recurrent Thyroid Tumor after Recombinant Human TSH Administration
J. Clin. Endocrinol. Metab., November 1, 2001; 86(11): 5148 - 5151.
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W.-A. Nieuwlaat, A. R. Hermus, F. Sivro-Prndelj, F. H. Corstens, and D. A. Huysmans
Pretreatment with Recombinant Human TSH Changes the Regional Distribution of Radioiodine on Thyroid Scintigrams of Nodular Goiters
J. Clin. Endocrinol. Metab., November 1, 2001; 86(11): 5330 - 5336.
[Abstract] [Full Text] [PDF]

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A. David, A. Blotta, M. Bondanelli, R. Rossi, E. Roti, L. E. Braverman, L. Busutti, and E. C. d. Uberti
Serum Thyroglobulin Concentrations and 131I Whole-Body Scan Results in Patients with Differentiated Thyroid Carcinoma After Administration of Recombinant Human Thyroid-Stimulating Hormone
J. Nucl. Med., October 1, 2001; 42(10): 1470 - 1475.
[Abstract] [Full Text] [PDF]

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E. L. Mazzaferri and R. T. Kloos
Current Approaches to Primary Therapy for Papillary and Follicular Thyroid Cancer
J. Clin. Endocrinol. Metab., April 1, 2001; 86(4): 1447 - 1463.
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