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Frequently Asked Questions

Each month thyroid specialists at Johns Hopkins answer your questions about thyroid diseases. We hope that the responses to frequently asked questions below will help you understand thyroid diseases and their treatments better.

This month's topics are the follow-up of patients with treated thyroid cancer and the role of a brand new tool, recombinant thyroid stimulating hormone (rTSH, Thyrogen®). Thyrogen is used to help detect recurrent thyroid cancer in patients who have been treated for it.

Why do patients with previously treated thyroid cancer need follow-up? And how is it done?

Although the treatments for most forms of thyroid cancer -- surgery, radioiodine, and thyroixine therapy -- are very effective, almost one-third of patients have a recurrence of their disease later in life. So it is important for thyroid cancer patients to be followed by their doctor for the rest of their lives, typically every 6 to 12 months. The earlier recurrent cancer is detected, the easier it is to treat.

The tools to detect recurrent thyroid cancer are a doctor's examination; the thyroglobulin blood test; and for some patients, the radioactive iodine scan, neck sonogram, and other imaging studies.

The doctor typically asks about symptoms (such as difficulty swallowing, persistent hoarseness, or pain in the front of the neck) and feels the neck carefully to detect any lumps that might indicate reappearance of disease.

The thyroblobulin (Tg) blood test detects this protien, which is only made by thyroid cells -- either from thyroid cancer or remaining normal thyroid tissue. Tg testing is more sensitive when there is thyroid stimulating hormone (TSH) around to promote thyroid tissue to make more Tg. In most patients, this testing is very helpful, but one in five thyroid cancer patients have antibodies in their blood that make it impossible to detect Tg accurately with current testing techniques.

Because thyroid cells take up iodine, radioactive iodine can reveal the presence of some recurrent thyroid cancers. Radioiodine scans are only accurate when there is thyroid stimulating hormone (TSH) around to promote iodione uptake by thyroid tissue.

Until recently, the only way to provide the TSH stimulation needed for testing was to temporarily stop a patient's thyroxine treatment so their own pituitary would make more TSH. Of course, this causes all of the symptoms of thyroid hormone deficiency (hypothyroidism).

What is this new medication Thyrogen? And how does it help with the performance of tests to find recurrent thyroid cancer?

Thyrogen is genetically engineered human TSH, exactly like what your own pituitary gland makes. Injections of Thyrogen (in your buttock) stimulate remaining thyroid tissue to make Tg and take up radioiodine. And it does it without stopping thyroxine medication and all of the symptoms of hypothyroidism that this causes.

Will my insurance pay for this medication?

Every effort will be made to assist your insurance company verify prescription coverage for this $1000 medication. Benefits for Thyrogen® administration can range from full coverage to co-payments and reimbursement.

Will I have to stop my thyroid medication? Will I have any hypothyroid symptoms?

Patients continue their thyroid medication while receiving Thyrogen®. You will be able to continue all your normal daily activities at home and work. Most patients feel fine. Occasionally, patients complain of transient nausea or headache after the injections.

Is this type of testing accurate?

    Research studies have shown that whole body scanning accompanied by a thyroglobulin blood test after Thyrogen® is as sensitive as the previous hormone withdrawal method.

  1. Ladenson PW. Strategies for thyrotropin use to monitor patients with treated thyroid carcinoman. Thyroid 1999;9:429-433.

  2. Ladenson PW, Braverman LE, Mazzaferri EL, et al. Comparison of recombinant human thyrotropin administration to thyroid hormone withdrawal for radioactive iodione scanning in patients with thyroid carcinoma. New Engl J Med 1997;337:888-96.

  3. Haugen BR, Pacini F, Reiners C, et al. A comparision of recombinant thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab, in press.