The management of well-differentiated thyroid cancer requires endogenous or exogenous thyrotropin (TSH) stimulation for diagnostic and therapeutic purposes. The rationale is to increase the sensitivity of follow-up tests and to optimize the radioiodine uptake, respectively. Withdrawal of L-thyroxine therapy in order to provoke endogenous stimulation and elevation of TSH is associated with symptomatic hypothyroidism that significantly affects quality of life. More importantly, because TSH stimulates growth of thyroid cells, prolonged TSH elevation may worsen the thyroid cancer, and the profound hypothyroidism may aggravate other underlying systemic diseases.
As an alternative to thyroxine withdrawal, exogenous stimulation consists of two intramuscular injections of recombinant human thyrotropin α (rhTSH). This procedure is effective in terms of sufficient TSH stimulation and obviates development in the patient of the signs and symptoms of hypothyroidism. Taking into consideration the increased incidence of thyroid cancer, as well as the necessity for life-long follow-up, the optimal management of the disease must meet goals for efficacy, safety, quality of life and optimal cost/benefit ratio.
This article reviews current standard procedures and potential novel clinical applications of rhTSH for the management of well-differentiated thyroid cancer.