A “new/old method” for TSH stimulation: could a third way to prepare DTC patients for ¹³¹I remnant ablation possibly exist?

Excerpt

A growing body of evidence supported the possibility to prepare patients affected by differentiated thyroid cancer (DTC) at low and/or intermediate risk with recombinant human thyroid-stimulating hormone (rhTSH) for radioiodine remnant ablation (RRA) [1]. Thus, patients’ quality of life can be improved and the radiation exposure of patients can be reduced at the same time [2‐5]. The efficacy of this type of preparation was recently confirmed by two randomized trials [6, 7] in low-risk DTC patients reporting the same rate of remnant ablation patients pretreated with rhTSH and those with 4–6 weeks of thyroid hormone withdrawal (THW). The novel 2015 American Thyroid Association (ATA) guidelines confirmed that exogenous TSH may replace THW for achieving remnant ablation, based on evidence of superior short-term quality of life, non-inferiority of remnant ablation efficacy and lack of a consistent difference in long-term outcome [1]. The principal limitation of this stimulation method seems to be related [8] to the high cost of rhTSH, which is not necessarily balanced by the reduction of hospitalization or sick days. …