We reported the availability of Thyrogen in Thyroid Flyer Volume 2 Number 2 of April 2001 and its use during follow up screening for residual or recurrent thyroid cancer. We can now report its inclusion on the Medicare Benefits Schedule from 1 May 2004.

The usual approach to preparing thyroid cancer patients for a whole body radioiodine scan or thyroglobulin assay is to stop their thyroxine replacement therapy for a number of weeks prior to the scan. This causes the patient to become significantly hypothyroid with a markedly elevated serum Thyroid Stimulating Hormone (TSH) level. The elevated serum TSH is the purpose of the approach because it stimulates any thyroid cells to produce thyroglobulin and take up the radioiodine.

Unfortunately the induced hypothyroid state can have adverse consequences for some patients including severe psychiatric disturbances. Thyrogen is designed to alleviate these problems.

Thyrogen is a synthetic TSH manufactured by Genzyme Corporation. It has been approved for use with patients undergoing follow up investigations for thyroid cancer for whom the standard approach of withdrawing thyroxine therapy is not recommended.

Unfortunately, not everybody will qualify for the drug. It will only be made available to privately treated patients who:

• Have had a total thyroidectomy and at least one ablative dose of radioiodine, but are still considered at risk of recurrence;
• Are receiving thyroxine replacement therapy;
• Have had at least one previous whole body scan or thyroglobulin assay following thyroxine withdrawal which was clear; and
• Withdrawal of thyroxine resulted in severe psychiatric disturbances; or
• Withdrawal is contraindicated because the patient has:
  • Unstable coronary artery disease; or
  • Hypopituitarism; or
  • A high risk of relapse or exacerbation of a previous serious psychiatric illness.

There will be some out of pocket expenses. This could vary from doctor to doctor but generally will be no less than $60.00 including a consultation fee.

Please talk to your doctor to see whether Thyrogen is appropriate for your circumstances. You can also contact Genzyme or visit their web site at www.genzyme.com.au

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