Radioiodine (RAI) ablation following
thyroidectomy is standard of care treatment for patients with intermediate or high risk differentiated
thyroid cancer. Traditionally, this has been achieved by forgoing
thyroid hormone replacement postoperatively, allowing endogenous
thyroid stimulating hormone (TSH) levels to rise. This rise in TSH provides the stimulus for RAI uptake by the thyroid remnant, but is associated with clinical
hypothyroidism and its associated morbidities.
Recombinant human TSH (
rhTSH,
thyrotropin alfa [
Thyrogen(®)], Genzyme Corporation, Cambridge, MA, USA) was developed to provide TSH stimulation without withdrawal of
thyroid hormone and clinical
hypothyroidism. Phase III studies reported equivalent detection of recurrent or residual disease when
rhTSH was used compared with
thyroid hormone withdrawal (THW). These trials led to its approval as an adjunctive diagnostic tool for serum
thyroglobulin (Tg) testing with or without RAI imaging in the surveillance of patients with differentiated
thyroid cancer. Recently,
rhTSH was given an indication for adjunctive preparation for thyroid remnant ablation after phase III studies demonstrated comparable outcomes for
rhTSH preparation when compared with THW. Importantly,
rhTSH stimulation has been found to be safe, well tolerated, and to result in improved quality of life. Here, we review the efficacy and tolerability studies leading to the approval for the use of
rhTSH in well-differentiated
thyroid cancer management.