Estudio comparativo entre la utilización de TSH recombinante y la estimulación endógena con TSH. Valoración en el seguimiento de los pacientes con carcinoma diferenciado de tiroides

Abstract

Recombinant human thyrotropin (rhTSH) has been introduced recently in follow up of differentiated thyroid cancer (DTC) patients, as an alternative of thyroid hormone withdrawal. The aim of this retrospective study is to compare recombinant human thyrotropin versus endogenous stimulation. Thirty-three patients with DTC with previous thyroidectomy and thyroid ablation were selected. All patients underwent whole-body radioiodine scanning and third day serum thyroglobulin (TG) measurement by two techniques, the first one after conventional thyroid hormone withdrawal (TSHe, TGe), and the second one after rhTSH stimulation (TSHr, TGr). Measurement of TG was performed on the third day due to the infrastructure. We only included patients with stable disease, without therapeutic interventions between two consecutive controls in an interval inferior to one year. Two qualitative categories were defined for TG (positive TG > 2 ng/ml or negative TG<2 ng/ml) and whole-body radioiodine scan (positive or negative). TSHe: 62.9 +/- 55.48; TSHr: 113.16 +/- 50.6; (p: ns); TGe: 62.5 +/- 115.7; TGr: 54.6 +/- 111.1; (p: 0.044). Quantitative data analysis showed significant differences between two techniques. Qualitative data analysis showed no significant differences in clinical setting based in TG and radioiodine scan. Administration of rhTSH produces a significantly higher increase of TSH than thyroid hormone withdrawal and lower increase in TG levels. There were no significant differences in the stage of disease (TG and whole-body radioiodine scan).