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Two Cases of Thyroid Carcinoma That Were Not Stimulated by Recombinant Human Thyrotropin

Department of Nuclear Medicine (A.A.D.), London Health Science Centre, London, Ontario, Canada N6A 4G5; and Division of Nuclear Medicine (A.A.D.) and Faculty of Medicine (N.K.), University of Western Ontario, London, Ontario, Canada N6A 5B8

Address all correspondence and requests for reprints to: Dr. A. A. Driedger, Department of Nuclear Medicine, London Health Science Centre, 375 South Street, London, Ontario, Canada N6A 4G5. E-mail: al.driedger{at}lhsc.on.ca.

Recombinant human TSH (rhTSH) is being widely used to monitor patients who were previously treated for differentiated thyroid cancers for evidence of recurrence. Its value lies in the avoidance of recurrent episodes of hypothyroidism in the follow-up protocols. rhTSH is also being evaluated as a potential therapeutic adjunct that would spare patients the experience of becoming hypothyroid when undergoing thyroid remnant ablation or treatment for metastases. In some centers, rhTSH is also used to support compassionate care of patients with advanced disease who cannot safely become hypothyroid. The ¹³¹I uptake response to rhTSH, presently an off-label application, is expected to be similar to that of endogenously raised TSH levels. The two cases presented here are cautionary tales in which ¹³¹I uptake by metastases was present under hypothyroid conditions, but absent in one patient and present in only a portion of the lesions in the other, with rhTSH stimulation.

Abbreviations: rhTSH, Recombinant human TSH; Tg, thyroglobulin.

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