Recombinant human TSH (rhTSH) has recently become available for the evaluation of patients with differentiated thyroid cancer (DTC). It is well tolerated and avoids the morbidity associated with thyroxine withdrawal. In the past, bovine TSH was used for the same purpose, but caused frequent allergic reactions and stimulated the production of anti-TSH antibodies. Anti-TSH antibodies can potentially compromise the host's ability to mount an effective TSH response to thyroxine withdrawal in future. Although extensive experience has accumulated on the use of rhTSH, and current data suggest that a single use is not associated with production of anti-TSH antibodies, few patients have received the drug on more than one occasion.
We report our experience with three patients with DTC who have received rhTSH on multiple occasions. Patient 1 (LD) was given rhTSH (0.9 mg by deep im injection on two successive days) at 0, 1, 6, 11 and 21 months. Patient 2 (LAR) received rhTSH at 0 and 13 months, and patient 3 (DA) at 0 and 6 months. All three patients tolerated rhTSH well without localised or other reactions. Sera were collected from patients at 5 months, 7 months and 20 months after their most recent exposure to rhTSH. Anti-human TSH antibodies were measured by an ELISA technique. All three sera contained undetectable amounts of anti-human TSH antibodies.
As predicted, rhTSH does not appear to stimulate anti-human TSH antibodies in patients with thyroid cancer after multiple injections.
Paterakis T, Ebels H, Mallick UK, Proud G, Jones N, Lennard T, Lucraft H, Fenwick J, et al. Lack of antigenicity of recombinant human thyrotropin after multiple injections in patients with differentiated thyroid cancer. Thyroid 2000; 10: 623.
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