Use of recombinant human thyroid-stimulating hormone (rhTSH) in children and adolescents with differentiated thyroid cancer
Marketa Mackova, Pavla Sykorova & Petr Vlcek
Paediatric thyroid cancer is rare but belongs to the most frequent malignancies in children and its incidence increases. The difference from adult disease subsists in good curability despite of quicker proliferation and earlier development of metastases. Influence of previous radioactivity exposure in the pathogenesis has been proven.
For the optimal uptake of radioiodine 131I in the post-operative thyroid remnants its necessary to achieve level of serum TSH higher than 30 mIU/l. Stimulation with rhTSH before diagnostic or therapeutic radioiodine administration is a widely used effective and safe alternative of traditional 4-5 weeks lasting thyroxin withdrawal.
Our department provides diagnostic and treatment with radioiodine to 85% of patients with thyroid cancer in the Czech Republic. In years 2008 and 2009, rhTSH was administered to 19 patients aged 717 years. Nine patients received rhTSH before diagnostic administration of 131I (140 MBq) within the follow-up after previous radioiodine treatment. Ten patients were stimulated before receiving the therapeutic activity of 131I. 4 of them underwent radioiodine ablation of post-surgical thyroid remnants. Other 4 patients were in need of rhTSH stimulation because of prior finding of metastases, 2 of them were administered rhTSH twice in following courses. The remaining 2 patients were administered rhTSH-assisted radioiodine therapy due to elevated level of serum thyroglobulin during suppression thyroxin therapy in follow-up.
All these patients tolerated either the intramuscular administration of rhTSH and following radioiodine diagnostic or treatment well with no specific side effects. We suppose the use of rhTSH in children is the same efficient and safe as in adult patients, bringing more comfort to patients, less secondary morbidity associated with hypothyroidism, reduced risk of tumour progression and lowered radiotoxicity due to fully retained renal clearance of radioiodine in the euthyroid status. However, wider use of this preparation is limited by the economical aspects.