THE ROLE OF RECOMBINANT HUMAN THYROTROPIN FOR DIAGNOSTIC MONITORING OF PATIENTS WITH DIFFERENTIATED THYROID CANCER

Objective: To describe the evolving role of recombinant human thyrotropin in the diagnostic evaluation of patients treated for differentiated thyroid carcinoma. Methods: A systematic review was performed of published English language articles appearing in PubMed using terms "recombinant thyrotropin" and "thyroid cancer". The author selected articles for inclusion based upon potential for clinical impact of the reported findings. Results: The addition of recombinant human thyrotropin to diagnostic testing replaced the requirement for thyroid hormone withdrawal and symptomatic hypothyroidism that had been necessary to generate sufficient endogenous thyrotropin for radioiodine scanning and thyroglobulin testing. The high negative predictive value of stimulated thyroglobulin testing removed the need for serial radioiodine scanning for many patients, but repeated stimulated testing rarely appeared to add significantly. The development of highly sensitive second generation thyroglobulin assays may replace the need for stimulated testing in a subset of patients. Conclusion: Recombinant human thyrotropin-stimulated testing continues to be a valuable component of follow-up testing in the first year after initial treatment of differentiated thyroid cancer. (Endocr Pract. 2013; 19: 157-161)