Recombinant human TSH: the Argentinean experience.

With great interest we read the editorial ‘‘Expanding Indications of Recombinant Human TSH (rhTSH) in Thyroid Cancer’’ (1), which considered the extensive worldwide clinical experience with rhTSH. It is a very interesting review; however, we would like to clarify several points regarding the use of rhTSH in Argentina. Thyrogen has been used in Argentina for 7 years, and we have published and presented investigations regarding our experience with rhTSH for remnant ablation and treatment of metastatic disease (2–6). We agree with Dr. Rui Maciel, who believes that there is no enough evidence yet to choose the correct radioiodine dose for ablation after rhTSH. However, the worldwide experience has shown that radioiodine doses higher than 50 mCi 131-I are possibly enough for ablation as shown by the European and American coauthors in the mentioned review (1). We would also like to clarify that it is not correct to affirm that rhTSH is routinely used only for ablation in high-risk patients in Argentina, as addressed by Dr. Medeiros-Neto. We have published our experience in 17 patients with lowrisk thyroid cancer retrospectively analyzed (6). In that study, we have shown that rhTSH was a useful method for ablation of normal thyroid remnants in that population. In addition, a new prospective investigation will be published soon showing the effectiveness of rhTSH for remnant ablation in 20 lowrisk papillary thyroid cancer patients (7). Besides, in Argentina, Iorcansky et al. were one of the first in the world showing the use of rhTSH in the pediatric and adolescent population (8). We have also had the opportunity to use rhTSH for radioiodine administration in patients with thyroid cancer and end-stage renal disease (5). We have suggested the necessity for the reduction in rhTSH dosage, utilizing 0.45 mg rhTSH per injection for two injections considering that rhTSH is mainly cleared by the kidney and appears not be removed by hemodialysis (9). Regarding reimbursement in Argentina, rhTSH is reimbursed 100% for retired people. There are also a number of health insurance companies that will pay for 40–60% of the rhTSH cost. We hope that this information will clarify important information regarding Thyrogen use in Argentina. References