Before Moving Towards Recombinant Thyrotropin, Can We Benefit From Anti-Thyroid Drugs? A Case Study

In patients with thyroid papillary carcinoma, performing an effective radioactive iodine abla-tion after total thyroidectomy requires adequate levels of serum thyrotropin. Administration of recombinant human thyroid stimulating hor-mone (rhTSH) is the current established method for patients with insufficient serum TSH levels four to six weeks after surgery and levothyroxine discontinuation. Two major problems with rhTSH are its cost and availability in most countries worldwide. We have used propylthiouracil (PTU), a routine anti-thyroid drug, for the first time to induce a TSH rise. Our patient was a 33-year-old woman with remnant thyroid tissue of 11. 5×4 mm after thyroidectomy. Her TSH was 12.7 µIU/ml, five weeks after surgery, and rose to 30. 0 µIU/ml after a 10 day trial of PTU. Radioiodine uptake index also increased from 28% to 56%. Radioiodine ablation was successfully done and patient showed no sign of recurrence or me-tastasis after 4 years. We propose that anti-thyroid drugs may be considered for post-operative induction of TSH rise in patients con-sidered for radioiodine ablation of thyroid can-cer. This may increase the chance of successful ablations with least possible cost.