Document Detail


Using recombinant human TSH in the management of well-differentiated thyroid cancer: current strategies and future directions.
MedLine Citation:
PMID:  11041454     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Mortality rates from thyroid cancer have fallen significantly in recent decades, almost certainly as the result of earlier diagnosis and improved treatment of differentiated (papillary and follicular) thyroid cancer. Enhanced survival is likely a result of early diagnosis and therapy applied at a disease stage when treatment is most effective. In the United States and Europe, most patients at high risk for relapse and death from thyroid cancer are treated with total or near-total thyroidectomy and receive radioiodine ablation of residual normal or malignant thyroid tissue, followed by treatment with thyroid hormone, a strategy that cures more than 80% of patients. Still, some die of the disease and nearly 15% have local recurrences, while another 5% to 10% develop distant metastases. Over 50% of recurrences appear in the first five years, but distant metastases may surface years, and sometimes decades, after initial therapy. Much has been learned about risk stratification to predict recurrence and death from thyroid cancer but individual patients continue to have adverse outcomes not always foreseen by a low tumor stage. Follow-up must accordingly be meticulous and prolonged. The National Cancer Center Network (NCCN) has recently established consensus practice guidelines that give explicit advice about the diagnosis and management of benign and malignant thyroid tumors, including paradigms for long-term follow-up and the treatment of recurrent disease. The guidelines confirm that diagnostic scanning with 131I and measurement of serum thyroglobulin (Tg) levels are the mainstay of follow-up, offering the opportunity to detect recurrent or persistent cancer at very early stages. These guidelines advocate TSH-stimulated serum Tg measurements, done either during thyroid hormone withdrawal or stimulation with recombinant human TSH (rhTSH, Thyrogen), that often identify the presence of cancer well before diagnostic whole-body scanning or other imaging studies can spot the tumor, which offers the opportunity to treat recurrent disease at an early stage. The use of rhTSH adds a new dimension to long-term follow-up that avoids putting patients through the symptoms of hypothyroidism, and offers the opportunity to follow some patients with rhTSH-stimulated serum Tg levels without performing 131I whole-body scans. A multicenter international study has shown that serum Tg measurements alone are not as sensitive in the identification of patients with persistent or recurrent tumor as are rhTSH-stimulated serum Tg determinations. Although not yet approved for preparation of patients for 131I therapy, rhTSH has been used successfully in a compassionate use program for this purpose in a relatively large number of patients. Formal clinical investigations now planned to provide guidelines for the use of rhTSH for therapeutic 131I portend a new set of effective therapeutic paradigms for the management of differentiated thyroid cancer.
Authors:
E L Mazzaferri; R T Kloos
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  10     ISSN:  1050-7256     ISO Abbreviation:  Thyroid     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2001-01-17     Completed Date:  2001-02-01     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  767-78     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, The Ohio State University, Columbus, USA. mazz01@bellsouth.net
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MeSH Terms
Descriptor/Qualifier:
Combined Modality Therapy
Humans
Iodine Radioisotopes / diagnostic use,  therapeutic use
Neoplasm Recurrence, Local
Recombinant Proteins / therapeutic use
Thyroglobulin / blood
Thyroid Neoplasms / drug therapy*,  pathology,  therapy
Thyroidectomy
Thyrotropin / therapeutic use*
Chemical
Reg. No./Substance:
0/Iodine Radioisotopes; 0/Recombinant Proteins; 9002-71-5/Thyrotropin; 9010-34-8/Thyroglobulin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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