[en] Aim: Recombinant human TSH (rhTSH) is now available to facilitate monitoring for differentiated thyroid carcinoma. Initial experiences seem to indicate that rhTSH can modify the guidelines for this disease. Our study reports 2-year experience with rhTSH on 27 consecutive patients undergone total removal of the thyroid for differentiated cancer followed by radioiodine therapy. Aim of the study was to evaluate the accuracy of the thyroglobulin (Tg) in predicting of disease status after primary therapies. Sensitivity and specificity of rhTSH testing was compared with neck ultrasound (US) and whole body scan (WBS) after 131I and 99mTc-Sestamibi (MIBI). Materials and Methods: Forty-eight cycles of rhTSH administration (0.9 mg i.m. in two consecutive days) were performed on l-T4 therapy. Favourable results were considered Tg levels <1 g/l after rhTSH, no image indicative of thyroid tissue or suspect neck nodes, negative WBS after 131I and 99mTc-MIBI. 24 h after the second dose of rhTSH, 131I (185 MBq) was administered in all subjects; WBS was acquired with a gamma-camera Orbiter 7500 (Siemens). In all but two patients, 99mTc-MIBI scintigraphy (555-740 MBq) was performed using a gamma-camera SP6HR (Elscint). Results: Baseline unfavourable Tg levels were noted in 15% of patients with recurrence disease. After rhTSH testing unfavourable Tg levels were noted in further 17%. A concordance between rhTSH testing and neck US was found in 85%. A concordance among rhTSH, neck US and 131I and 99mTc-MIBI was found in 46% of subjects. Specificity of Tg after rhTSH administration, neck US, 131I and 99mTc-MIBI was 100%, 70%, 31% and 50%, while sensitivity was 100%, 94%, 83% and 84%, respectively. Mean TSH levels at the time of radioiodine administration were significantly higher (p=0.03) after rhTSH than after LT4 withdrawal. Concordance between 131I WBS under suppressive L-T4 and overt hypothyroidism was found in 71% of patients. Pain at the injection site and mild nausea were the most reported side effects. Conclusions: Our data show that side effects of rhTSH are low. Neck US is the most sensitive method of imaging for detection of local or neck node recurrence. 99mTc-MIBI is the less specific, but radiosisotopic technique's allow the localization of distant recurrences. The use of rhTSH before radioiodine therapy could be a promising tool to reduce the discomfort of overt hypothyroidism in some patients requiring further therapeutic procedures