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Thyrotropin

Thyroid Stimulating Hormone (TSH) is a hormone that originates in the anterior pituitary gland and stimulates the release of T4 (thyroxine) and T3 (tri-iodothyronine) from the thyroid gland.

Thyrotropin alfa is a recombinant form of thyroid stimulating hormone. In humans, it also acts as a prolactin-releasing factor and as a neurotransmitter.

Uses of thyrotropin alfa
  • Used to detect any areas of remaining thyroid tissue in well-differentiated thyroid cancer post thyroidectomy.
    • The treatment of well-differentiated thyroid carcinoma is thyroidectomy.
    • Following the operation patients are given thyroid hormone suppression therapy, such as, thyroxine (T4) or tri-iodothyronine (T3).
    • This acts to suppress thyroid stimulating hormone (TSH). TSH suppression is necessary to avoid stimulation of thyroid remnants or any remaining thyroid cancer.1
    • The aim is for a TSH level to be <0.5 mIU/l.
  • May or may not be used with radioiodine to ablate any remaining neoplasm or healthy thyroid tissue and with serum thyroglobulin testing (see below).
  • It is also used in low risk patients with well-differentiated thyroid carcinoma who have undetectable thyroglobulin levels on thyroid suppression therapy.

The thyroglobulin test to look for remnants of well-differentiated thyroid cancer1

  • The recombinant thyrotropin is injected into the gluteal muscle 0.9 mg i/m every 24 hours for 2 doses OR every 72 hours for 3 doses.2
  • Radioiodine should be administered 24 hours following final thyrotropin alfa injection and scanning should be performed 2 days after radioiodine.
  • The thyroglobulin blood test is done 72 hours after the second injection of recombinant thyrotropin.

Thyroglobulin is the precursor protein for thyroid hormones. Thyroglobulin acts as a tumour marker and the level represents tumour mass. The test will aid discovery of recurrence, progression and metastatic formation of the neoplasm.

Cautions and contraindications3
  • Pregnancy.
  • Children - relative contraindication as there is not enough evidence regarding the safety and effectiveness below the age of 16 years.
  • Cardiovascular disease.
Side effects of thyrotropin alfa3
  • Nausea and vomiting
  • Headache
  • Rarely - hypersensitivity and rash

For full indications, cautions, contra-indications and side-effects see individual drug monographs.

Document References
  1. Luster M, Lippi F, Jarzab B, et al; rhTSH-aided radioiodine ablation and treatment of differentiated thyroid carcinoma: a comprehensive review.; Endocr Relat Cancer. 2005 Mar;12(1):49-64. [abstract]
  2. Thyrogen; Thyrotrophin alfa for injection - Genzyme therapeutics.
  3. Summary of Product Characteristics - Thyrogen® 0.9 mg powder for solution for injection (thyrotropin alfa), Genzyme Therapeutics, updated Jan 2006, electronic Medicines Compendium.
AcknowledgementsEMIS is grateful to Dr Gurvinder Rull for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 425
Document Version: 2
DocRef: bgp25177
Last Updated: 23 Aug 2007
Review Date: 22 Aug 2008
















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