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Remnant Ablation

The initial therapy for most patients with well differentiated thyroid cancer (WDTC) is total or near-total thyroidectomy. Thyroidectomy is often followed by radioactive iodine (¹³¹I) thyroid remnant ablation. Remnant ablation is utilized for two purposes: destroying residual thyroid tissue, which may decrease clinical tumor recurrence,¹ and allowing for long-term surveillance with whole-body scans (WBS) or stimulated thyroglobulin (Tg) measurements.

Elevated thyroid stimulating hormone (TSH) levels are required to promote adequate ¹³¹Iuptake. Increasing TSH levels can be accomplished with two different approaches. One approach, withholding thyroid hormone(s), causes the patient to become hypothyroid and allows the physiologic hypothalamic-pituitary response to increase TSH. Although an effective approach for increasing TSH, hypothyroidism can have a negative impact on the patient’s health and quality of life.² Symptoms of hypothyroidism can include weight gain, fatigue, depression, mood swings, dry hair and skin, and constipation. The other approach, using Thyrogen^® (thyrotropin alfa for injection), increases TSH levels while allowing the patient to avoid hypothyroidism.

In the menu called Clinical Summary you will find information on the clinical evidence for use of Thyrogen in preparation for thyroid remnant ablation.

REFERENCES:

1. Sawka M, Thephamongkhol K, Brouwers M, Thabane L, Browman G, Gerstein C. A systemic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab. 2004; 89:3668–3676.

2. Dow K, Ferrell B, Anello C, et al. Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid. 1997; 7:613–619.

Patient stories

As a result of withholding or removing thyroid hormone replacement the effects of hypothyroidism can vary. In some cases, the symptoms may be minor, while for others, the symptoms can be more significant.

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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.