Preparation with recombinant humanized thyroid-stimulating hormone before radioiodine ablation after thyroidectomy: a systematic review

BACKGROUND: Standard treatment for differentiated thyroid cancer is thyroidectomy followed in selected cases by radioiodine ablation (ra). Recombinant humanized thyroid-stimulating hormone (rhtsh) is an exogenous source of tsh that can be administered to obviate the need for hormone withdrawal. In this systematic review, we analysed the evidence for the therapeutic use of rhtsh for ra preparation. METHOD: A systematic review of the medline and embase databases from 1996 through January 2008 selected articles reporting randomized controlled trials, cohort studies, and retrospective studies published in English that compared ra using rhtsh with standard hormone withdrawal. RESULTS AND INTERPRETATION: Stimulation by rhtsh is equivalent to thyroid hormone withdrawal in achieving ablation while avoiding detrimental symptoms of hypothyroidism and significantly lowering the whole-body radiation dose. Furthermore, rhtsh may be the only option for patients who either cannot raise endogenous tsh or who would be at risk from the morbidity of hypothyroidism. Based on the results of validated instruments of physical and mental performance, there is agreement that rhtsh maintains a better quality of life. Studies of cost-effectiveness found that rhtsh-prepared patients lost less time from work and required fewer encounters with health care providers.