The clinical benefits of recombinant human
thyroid-stimulating hormone (
rhTSH;
Thyrogen, Genzyme Corp., Cambridge, MA, USA) are well established as an alternative stimulation procedure to
thyroid hormone withdrawal in the follow-up of
thyroid cancer patients.
rhTSH has the advantage to avoid both
hypothyroidism, with a major impact on the quality of life, and the side effects on
tumor growth related to the long-lasting TSH increase. More recently, alternative uses have been proposed, including treatment of
nodular goiter, TSH stimulation to enhance PET scanning and
chemotherapy treatment, and differential diagnosis of
congenital hypothyroidism. In benign
thyroid diseases,
rhTSH administration increases thyroid uptake resulting in a more homogeneous distribution of the tracer, and allows to reduce the dose of 131I maintaining the same effects on thyroid shrinkage. Moreover, rTSH stimulation improves the detectability of occult thyroid
metastases with FDG-PET, and promising results have been obtained in the response rate of poorly differentiated
thyroid cancer submitted to
chemotherapy after
rhTSH stimulation. Finally,
rhTSH testing has been proved to be safe and to lead, in association with ultrasound, to the differential diagnosis of
congenital hypothyroidism during
L-thyroxine, allowing the appropriate clinical/genetic management of the disease and thus representing a valuable alternative to
L-thyroxine withdrawal.