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Forms and Documents

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ThyrogenONE Forms & Documents

Reimbursement Support Form for Thyrogen
Authorization for Release of Health Information
Access to Thyrogen for Appropriate Patient Care
Ordering and Billing Process for Thyrogen
Prescriber Registration Form

Thyrogen Coding & Billing Guides

Physician and Hospital Billing Guide

Additional Documents

CMS-1500 Sample Claim Form
Options for Obtaining Thyrogen If Buy and Bill Required

Thyroid cancer at a glance...

According to the American Cancer Society over 37,340 new cases of thyroid cancer are expected to be diagnosed in the U.S. in 2008.

Downloads

Download these resources about thyroid cancer and Thyrogen for your patients.

Full Prescribing Information (PDF)

Understanding Thyroid Cancer

Managing Thyroid Cancer with Thyrogen

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Indication
Thyrogen (thyrotropin alfa for injection) is indicated for use as an adjunctive diagnostic tool for serum thyroglobulin (Tg) testing with or without radioiodine imaging in the follow-up of patients with well-differentiated thyroid cancer.

Thyrogen (thyrotropin alfa for injection) is indicated for use as an adjunctive treatment for radioiodine ablation of thyroid tissue remnants in patients who have undergone a near-total or total thyroidectomy for well-differentiated thyroid cancer and who do not have evidence of metastatic thyroid cancer.

Important Safety Information

When Thyrogen-stimulated serum thyroglobulin (Tg) testing is performed in combination with radioiodine imaging, there remains a meaningful risk of missing a diagnosis of thyroid cancer or of underestimating the extent of disease.
Although Thyrogen appeared non-inferior to thyroid hormone withdrawal in a study of postsurgical thyroid remnant ablation, long-term clinical outcome data are limited. Due to relatively small clinical experience with Thyrogen in remnant ablation, it is not possible to conclude whether long-term thyroid cancer outcomes would be equivalent after use of Thyrogen or hormone withdrawal for TSH elevation prior to remnant ablation.
Caution should be exercised in patients with a known history of heart disease and with significant residual thyroid tissue. Careful evaluation of benefit risk should be assessed for high risk elderly patients with functioning thyroid tumors undergoing Thyrogen administration, to avoid palpitations or cardiac rhythm disorder.
It is recommended that pretreatment with glucocorticoids be considered for patients in whom local tumor expansion may comprise vital anatomic structures (such as trachea, central nervous system, or extensive macroscopic lung metastases).
In clinical studies, the most common side effects reported were nausea, headache, fatigue, vomiting, dizziness, paraesthesia, asthenia, insomnia, and diarrhea.

Please see accompanying full Prescribing Information.