Recombinant human TSH (rhTSH) brought revolutionary change in the management of patients with differentiated thyroid cancer since it was first approved for clinical use in the United States and Europe. Follow-up management of differentiated thyroid cancer is based on the detection of recurrent or residual cancer, traditionally achieved by measurement of serum thyroglobulin level and various imaging techniques including 131I whole body scan. Previously, TSH stimulation was achieved only by induction of hypothyroidism following withdrawal of thyroid hormone. However, hypothyroidism is uncomfortable and is association with a reduction in quality of life. RhTSH can provide elevated TSH without making patients hypothyroid. In the United States and Europe, rhTSH is approved for use only in monitoring of differentiated thyroid cancer. In this article, we reviewed the role of rhTSH in the diagnosis and management of differentiated thyroid cancer.