Recombinant human thyrotropin in thyroid cancer and hypopituitarism due to sella metastasis

We present a patient with thyroid cancer and hypopituitarism who required recombinant human thyrotropin (rhTSH) for I-131 Scanning with respect to subsequent therapy. The thyroid cancer had been unknown until central neurological symptoms developed, leading to the diagnosis of a huge metastasis to the sella that was the only manifestation of metastatic spread. The failure to generate endogenous thyrotropin (TSH) was overcome by the use of rhTSH for performing a I-131 test. Unfortunately, the I-131 uptake was not sufficient for therapy. This subject is the first reported case who required the application of rhTSH due to a single thyroid cancer metastasis in the sella region with secondary failure to generate endogenous TSH.