Potential Use of Recombinant Human Thyrotropin in the Treatment of Distant Metastases in Patients with Differentiated Thyroid Cancer |
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| Affiliation: | 1. Division of Endocrinology, Department of Medicine, Washington Hospital Center, Washington, DC;2. Department of Endocrinology and Diabetology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland;3. Division of Nuclear Medicine, Department of Medicine, Washington Hospital Center, Washington, DC;4. Department of Biostatistics and Bioinformatics, Medstar Health Research Institute, Hyattsville, MD;5. Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC (GHUCCTS-CTSA);6. Division of Endocrinology and Medicine, Department of Medicine, Georgetown''s University Hospital, Washington, DC;1. Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, Ohio;2. Education Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio;3. Yale Pediatric Endocrinology Department, Yale University School of Medicine, New Haven, Connecticut;4. Yale Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut;5. Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio;1. Medical Director, Metabolic Institute of America, Tarzana, California;2. Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan;3. Clinical Professor, Department of Medicine, The Mount Sinai School of Medicine, New York, New York;4. Pediatric Endocrinology, National Institutes of Health, Bethesda, Maryland;5. Director, Medical Development, and Senior Vice President, Research & Development, Amylin Pharmaceuticals, Inc., San Diego, California;6. Medical Director, Scripps Whittier Diabetes Institute, La Jolla, California;7. Professor of Medicine, Biochemistry & Molecular Biology and Molecular & Cellular Biology, Baylor College of Medicine, Houston, Texas;8. Professor of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas;9. UAB Diabetes Research and Training Center, University of Alabama at Birmingham, Birmingham, Alabama;10. Chairman, Grunberger Diabetes Institute, Bloomfield Hills, Michigan;11. Professor of Medicine, University of California, San Diego, California;12. The Endocrinology, Weight Control and Metabolic Center, Tarzana, California;13. Pediatric Endocrinology Clinic, East Tennessee Children’s Hospital, Knoxville, Tennessee.;1. University of Maryland School of Medicine, Baltimore, Maryland;2. Baltimore Washington Medical Center Baltimore, Maryland;3. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;4. Boston University Medical Center, Boston, Massachusetts;1. Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel;2. Maccabi Healthcare Services, Israel;3. Center for Clinical Quality and Safety, Jerusalem, Israel;4. Endocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel;1. Sapienza University of Rome Experimental Medicine Department Medical Physiopathology, Food Science and Endocrinology Section Food Science and Human Nutrition Research Unit |
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| Abstract: | ObjectiveIn order to effectively treat differentiated thyroid cancer (DTC) with radioiodine (RAI) it is necessary to raise serum TSH levels either endogenously by thyroid hormone withdrawal (THW) or exogenously by administration of recombinant human TSH (rhTSH). The goal of this review is to present current data on the relative efficacy and side effects profile of rhTSH-aided versus THW-aided RAI therapy for the treatment of patients with distant metastases of DTC.MethodsWe have searched the PubMed database for articles including the keywords "rhTSH", "thyroid cancer", and "distant metastases" published between January 1, 1996 and January 7, 2012. As references, we used clinical case series, case reports, review articles, and practical guidelines.ResultsExogenous stimulation of TSH is associated with better quality of life because it obviates signs and symptoms of hypothyroidism resulting from endogenous TSH stimulation. The rate of neurological complications after rhTSH and THW-aided RAI therapy for brain and spine metastases is similar. The rate of leukopenia, thrombocytopenia, xerostomia, and pulmonary fibrosis is similar after preparation for RAI treatment with rhTSH and THW. There is currently a controversy regarding RAI uptake in metastatic lesions after preparation with rhTSH versus THW, with some studies suggesting equal and some superior uptake after preparation with THW. Analysis of available retrospective studies comparing survival rates, progression free survival, and biochemical and structural response to a dosimetrically-determined dose of RAI shows similar efficacy after preparation for therapy with rhTSH and THW.ConclusionThe rhTSH stimulation is not presently approved by the FDA as a method of preparation for adjunctive therapy with RAI in patients with metastatic DTC. Data on rhTSH compassionate use suggest that rhTSH stimulation is as equally effective as THW as a method of preparation for dosimetry-based RAI treatment in patients with RAI-avid metastatic DTC. (Endocr Pract. 2013;19:139-148) |
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