Adjuvant treatment with thyrotropin alpha for remnant ablation in thyroid cancer

Bernadette Biondi, Melania Pulcrano, Loredana Pagano, Gaetano Lombardi

Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II, Naples, Italy

Abstract: Various studies have demonstrated the safety and efficacy of recombinant human thyroid-stimulating hormone (rhTSH) for radioiodine remnant ablation. On this basis, rhTSH was approved in Europe for the radioiodine ablation of low-risk differentiated thyroid cancer (DTC) during thyroid hormone therapy with L-thyroxine (L-T4). Moreover, in December 2007, the US Federal Drug Administration approved the use of rhTSH for adjuvant treatment with radioiodine in patients with DTC without evidence of metastatic thyroid cancer. Quality of life was found to be better with rhTSH preparation than with L-thyroxine withdrawal, thereby resulting in benefits for society as a whole. Furthermore, rhTSH for radioiodine remnant ablation results in a longer effective radioiodine half-life within remnant thyroid tissue and a lower specific absorbed dose in the blood and exposure of bone marrow to X-rays. More studies are required to establish the amount of radioiodine to be administered especially in high-risk patients.

Keywords: thyroid cancer, thyrotropin, radioiodine (¹³¹I) remnant ablation (RRA), quality of life, ray exposure