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Sudden Enlargement of Local Recurrent Thyroid Tumor after Recombinant Human TSH Administration

Division of Endocrinology and Metabolism (M.B., D.S.C.), Sinai Hospital of Baltimore, Baltimore, Maryland 21215; Serviço de Endocrinologia e Metabologia do Paraná (M.B.), Hospital de Clínicas, Universidade Federal do Paraná, Brazil 80.060-240; Section of Endocrinology (M.D.R.), Washington Hospital Center and Medstar Research Institute, Washington, D.C. 20010; and Johns Hopkins University School of Medicine (D.S.C.), Baltimore, Maryland 21205

Address all correspondence and requests for reprints to: David S. Cooper, M.D., Division of Endocrinology, Sinai Hospital of Baltimore, Baltimore, Maryland 21215. E-mail: dcooper{at}lifebridgehealth.org

Abstract

Chronic endogenous TSH stimulation of neoplastic tissue has been reported to stimulate tumor enlargement. However, little is known about changes in normal and neoplastic thyroid tissue after sudden rather than chronic stimulation with TSH. Acute thyroidal tissue reactions, reflected by rapid tumor expansion and/or possible vascular changes, have been reported to occur after bovine TSH stimulation and, more recently, after recombinant human TSH (rhTSH).

In this report, we describe two patients with papillary thyroid carcinoma with local recurrent tumor. Both patients developed tumor growth 12–48 h after the second rhTSH injection, reflected by acute respiratory distress or a palpable, tender mass. In both situations, the enlargement was documented by imaging techniques, showing tumor expansion compared with previous examinations. Rapid improvement with glucocorticoid supports inflammation as the likely etiology. Based on these cases, and other reports of rapid tumor expansion after rhTSH injection, we recommend glucocorticoid coverage before rhTSH administration for patients with known or suspected neoplasia located in a limited space.

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