rhTSH Use for Thyroid Cancer Patients Post-Surgery

Hello, I would like to ask a few things about the use of radioactive iodine after thyroid cancer surgery?

Dr.
Yang informed me that I am a thyroid cancer patient with a 1.2 cm tumor on the right lobe of my thyroid.
I have undergone a total thyroidectomy and am currently preparing to receive radioactive iodine treatment in December.
I initially heard that I would need to stop taking thyroid hormone for 4 to 6 weeks before the radioactive iodine therapy, but due to my busy schedule with graduate school, I would prefer not to discontinue my medication.
Therefore, my attending physician suggested that I could use recombinant human TSH (rhTSH), administered in two doses two days prior to the radioactive iodine treatment, which would allow me to continue my medication while still achieving good therapeutic results.

However, the attending physician mentioned that rhTSH is not covered by health insurance and that we would need to purchase it directly from the manufacturer (the physician only provided a contact number) rather than through the hospital.
Additionally, the manufacturer would provide the medication to a nurse for administration before the radioactive iodine treatment, without going through a physician.
The quoted price for rhTSH from the manufacturer is 24,000 NTD, and I am somewhat concerned about this arrangement.

I would like to ask Dr.
Yang the following questions:
1.
Is rhTSH a legally approved medication for medical use? What is its usage like in other countries?
2.
Are there any potential risks associated with using rhTSH without a physician's involvement?
3.
Given the circumstances, would you recommend that I use rhTSH?
4.
In Taiwan, is there a way to obtain rhTSH through a hospital or pharmacy rather than an unknown manufacturer? Are there any legitimate distributors available?
I hope I am not bothering you with these numerous questions.

Sincerely,
Hong Shou-Mao, Tainan

Hong, 20~29 year old female. Ask Date: 2002/11/02

Dr. Yang Hongzhi reply Internal Medicine

rhTSH has been studied extensively abroad, showing that its effectiveness in radioiodine scanning diagnosis is comparable to discontinuing thyroid hormone therapy, making it an acceptable option.
However, its efficacy in radioiodine treatment appears to be slightly inferior to that of stopping thyroid hormone therapy.
This drug has been approved by the FDA in the United States, and its safety profile is generally acceptable.
The main issue is that the medication is quite expensive and is not covered by insurance, which is why hospitals typically do not keep it as a standard medication.
Whether it can be ordered as a special medication depends on the hospital's policies, and it is usually not very easy to obtain.
To my knowledge, there is only one distributor in Taiwan, which is likely the one your physician mentioned.

Reply Date: 2002/11/02

More Info

The use of recombinant human Thyroid-Stimulating Hormone (rhTSH) in the context of thyroid cancer treatment, particularly for patients preparing for radioactive iodine (RAI) therapy, is a significant topic in modern endocrinology. Your situation, as a thyroid cancer patient preparing for RAI treatment after total thyroidectomy, raises several important questions regarding the use of rhTSH, its legality, potential risks, and availability.

1. Legality and Usage of rhTSH: rhTSH is an FDA-approved medication in the United States and is used to stimulate the thyroid gland in patients who have undergone thyroidectomy. It allows for the preparation for RAI therapy without the need to withdraw from thyroid hormone replacement therapy, which can be particularly beneficial for patients who may experience significant symptoms from hypothyroidism. In many countries, including the U.S., rhTSH is considered a legitimate medical treatment, and its use is supported by clinical studies demonstrating its efficacy in facilitating RAI uptake in thyroid cancer patients.

2. Potential Risks of rhTSH: While rhTSH is generally considered safe, like any medication, it is not without potential risks. The most common side effects include headache, nausea, and transient increases in thyroid hormone levels. Importantly, the administration of rhTSH should ideally be supervised by a healthcare professional, as they can monitor for any adverse effects and ensure proper dosing. The concern about obtaining rhTSH from an unknown vendor without physician oversight is valid; it raises questions about the quality and authenticity of the medication. It is crucial to ensure that any medication is obtained from a reputable source to avoid counterfeit products.

3. Recommendation for Use: Given your busy schedule and the potential difficulties associated with stopping thyroid hormone therapy, the use of rhTSH appears to be a reasonable option. However, it is essential to have a thorough discussion with your healthcare provider about the benefits and risks associated with its use in your specific case. They can provide personalized advice based on your medical history and current health status. If your physician is supportive of using rhTSH, it may facilitate your RAI treatment without the need for a prolonged withdrawal from thyroid hormone therapy.

4. Availability of rhTSH: In terms of obtaining rhTSH, it is unfortunate that it is not covered by insurance in your case. In many healthcare systems, medications like rhTSH are typically ordered through hospitals or pharmacies, but the availability can vary. If your physician has provided you with a contact for a supplier, it is advisable to verify the legitimacy of that supplier. Additionally, you may want to inquire if there are any other hospitals or pharmacies in your area that can procure rhTSH for you. It is also worth checking if there are any licensed distributors or agents in your country that can provide rhTSH through official channels.

In conclusion, rhTSH represents a valuable option for patients like you who are preparing for RAI therapy after thyroid surgery. While it is a legal and effective treatment, it is vital to ensure that it is obtained safely and under the guidance of a healthcare professional. Open communication with your healthcare team will be key in navigating this process and ensuring the best possible outcome for your treatment.

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