Zanotti-Fregonara P, Toubert M E, Taieb D, Ravasi L, Rubello D, Hindie E
DSV/I 2BM/SHFJ/LMNRB, Commissariat à l'Energie Atomique, Orsay, France.
Minerva Endocrinol. 2008 Jun;33(2):53-65. Epub 2008 Mar 11.
Stimulation by recombinant human thyroid-stimulating hormone (rhTSH) has gained wide acceptance as an alternative to thyroid hormone withdrawal in the management of patients with differentiated thyroid cancer. RhTSH has the advantage to avoid both the clinical consequences of hypothyroidism, with a positive impact on quality of life and work productivity, and the risk of cancer growth due to the long-lasting endogenous thyrotropin stimulation. RhTSH is a heterodimeric glycoprotein produced by recombinant DNA technology that has the ability to stimulate thyroglobulin production and radioiodine uptake by thyroid cells. RhTSH is now widely used in the follow-up of thyroid cancer patients in order to improve sensitivity of thyroglobulin (Tg) measurement as well as in preparation of (131)I diagnostic whole-body scan. Although initially approved only for diagnostic purposes, rhTSH has been now approved both in Europe and in the United States for remnant ablation in low-risk patients. As far as residual or metastatic cancer treatment, rhTSH has been initially used on a compassionate need basis for elderly and frailer patients and for patients in whom the withdrawal of thyroid hormone was medically contraindicated. Nowadays, there is a trend for widening the use of rhTSH in therapy, in order to avoid hypothyroidism and the concern about the effect of prolonged endogenous thyroid-stimulating hormone stimulation on cancerous cells. Unfortunately, the studies which address the efficacy of rhTSH in cancer treatment are still scarce and the opportunity of its clinical application remains controversial. In addition, rhTSH has been shown to improve the accuracy of [(18)F]-2-fluoro-deoxy-D-glucose positron emission tomography to detect non-functioning thyroid cancer. Although all studies agree on that rhTSH is much better tolerated from the clinical point of view than thyroid hormone withdrawal, there is some controversy about its comparative ability to raise Tg levels and concentrate radioiodine in cancerous thyroid cells. The aim of this paper is to review the performances of rhTSH as compared to hypothyroidism, considering Tg stimulation and diagnostic whole-body scan sensitivity during follow-up, and its effectiveness for normal remnant ablation and for therapy of metastatic disease.
重组人促甲状腺激素（rhTSH）刺激已被广泛接受，作为分化型甲状腺癌患者管理中甲状腺激素撤药的替代方法。rhTSH具有避免甲状腺功能减退临床后果的优势，对生活质量和工作效率有积极影响，同时避免了因长期内源性促甲状腺素刺激导致癌症生长的风险。rhTSH是一种通过重组DNA技术生产的异源二聚体糖蛋白，具有刺激甲状腺球蛋白产生和甲状腺细胞摄取放射性碘的能力。rhTSH现在广泛用于甲状腺癌患者的随访，以提高甲状腺球蛋白（Tg）测量的敏感性，以及用于（131）I诊断性全身扫描的准备。尽管最初仅被批准用于诊断目的，但rhTSH现在在欧洲和美国均已被批准用于低风险患者的残留消融。至于残留或转移性癌症的治疗，rhTSH最初是在同情用药的基础上用于老年和体弱患者以及甲状腺激素撤药存在医学禁忌的患者。如今，有扩大rhTSH在治疗中应用的趋势，以避免甲状腺功能减退以及对长期内源性促甲状腺激素刺激对癌细胞影响的担忧。不幸的是，关于rhTSH在癌症治疗中疗效的研究仍然很少，其临床应用的机会仍存在争议。此外，rhTSH已被证明可提高[（18）F]-2-氟-脱氧-D-葡萄糖正电子发射断层扫描检测无功能甲状腺癌的准确性。尽管所有研究都一致认为，从临床角度来看，rhTSH比甲状腺激素撤药的耐受性要好得多，但关于其提高Tg水平和使放射性碘在癌性甲状腺细胞中聚集的比较能力仍存在一些争议。本文的目的是回顾与甲状腺功能减退相比rhTSH的表现，考虑随访期间Tg刺激和诊断性全身扫描敏感性，以及其在正常残留消融和转移性疾病治疗中的有效性。
