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Scientific Reports Jan 2023This study was conducted to investigate the effects of thyroid hormone withdrawal (THW) and recombinant human thyroid-stimulating hormone (rhTSH) administration on renal...
This study was conducted to investigate the effects of thyroid hormone withdrawal (THW) and recombinant human thyroid-stimulating hormone (rhTSH) administration on renal function in patients with thyroid cancer after total thyroidectomy. This study included 202 patients who discontinued thyroid hormone therapy and/or received rhTSH after total thyroidectomy. Creatinine (Cr), blood urea nitrogen (BUN) levels, and estimated glomerular filtration rate (eGFR) were assessed at the following three time points: before thyroidectomy, at least 3 weeks after THW, and 1 day after the second injection of rhTSH. The median serum Cr level was significantly higher following THW compared to that before thyroidectomy (0.95 versus 0.70). In contrast, the median BUN level was significantly lower after THW compared to that before thyroidectomy (9.8 versus 11.3). Over a fifth (22.2%) of patients had abnormal eGFR values after THW, which was significantly greater than that before thyroidectomy. In contrast, renal parameter values after rhTSH administration were not significantly different than those before thyroidectomy. In conclusion, THW affects renal function in patients with thyroid cancer who have undergone total thyroidectomy. However, renal function in such patients is not affected by rhTSH administration.
Topics: Humans; Thyrotropin Alfa; Thyrotropin; Thyroid Neoplasms; Thyroid Hormones; Kidney; Recombinant Proteins
PubMed: 36604466
DOI: 10.1038/s41598-023-27455-0 -
The Israel Medical Association Journal... Feb 2014To prevent the unwarranted effects of post-thyroidectomy hypothyroidism prior to radiodine (RAI) ablation, patients with well-differentiated thyroid cancer can currently...
BACKGROUND
To prevent the unwarranted effects of post-thyroidectomy hypothyroidism prior to radiodine (RAI) ablation, patients with well-differentiated thyroid cancer can currently undergo this treatment while in a euthyroid state. This is achieved with the use of recombinant human thyroid-stimulating hormone (rhTSH) injections prior to the ablation.
OBJECTIVES
To demonstrate the efficacy of rhTSH in radioiodine thyroid ablation in patients with differentiated thyroid cancer.
METHODS
We conducted a retrospective study of patients who underwent total thyroidectomy for well-differentiated thyroid cancer with different levels of risk, treated with rhTSH prior to remnant ablation with radioiodine.
RESULTS
Seventeen patients with thyroid cancer were studied and followed fora median of 25 months (range 8-49 months). Ablation (defined as stimulated thyroglobulin < 1 mg/ml and negative neck ultrasonography) was successful in 15 patients (88.2%). One of the patients was lost to follow-up.
CONCLUSIONS
The use of rhTSH with postoperative radioiodine ablation may be an efficient tool for sufficient thyroid remnant ablation, avoiding hypothyroidal state in the management of thyroid cancer patients.
Topics: Ablation Techniques; Adult; Aged; Female; Humans; Hypothyroidism; Iodine Radioisotopes; Israel; Male; Middle Aged; Monitoring, Physiologic; Neoplasm Grading; Neoplasm Staging; Outcome Assessment, Health Care; Postoperative Complications; Retrospective Studies; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Thyrotropin Alfa; Treatment Outcome; Ultrasonography
PubMed: 24645230
DOI: No ID Found -
Archives of Endocrinology and Metabolism 2017To compare the short- and long-term outcomes of adjuvant therapy with radioactive iodine (RAI) preceded by the administration of recombinant human TSH (rhTSH) versus...
Recombinant human TSH versus thyroid hormone withdrawal in adjuvant therapy with radioactive iodine of patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central compartment (cN1b).
OBJECTIVE
To compare the short- and long-term outcomes of adjuvant therapy with radioactive iodine (RAI) preceded by the administration of recombinant human TSH (rhTSH) versus thyroid hormone withdrawal (THW) in patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central neck compartment (cN1b).
SUBJECTS AND METHODS
The sample consisted of 178 cN1b patients at intermediate risk who underwent total thyroidectomy with apparently complete tumor resection [including postoperative ultrasonography (US) without anomalies] and who received adjuvant therapy with RAI (30-100 mCi) preceded by the administration of rhTSH (n = 91) or THW (n = 87).
RESULTS
One year after RAI, the rates of excellent response to therapy, i.e., nonstimulated thyroglobulin (Tg) ≤ 0.2 ng/mL with negative antithyroglobulin antibodies and negative neck US, and of structural disease were similar for the two preparations (84% and 4.5%, respectively, in both groups). During follow-up (median 66 months), the rate of structural or biochemical (nonstimulated Tg > 1 ng/mL, with increment) recurrence was also similar in the two groups (4.5%). In the last assessment, the percentage of patients without evidence of disease, i.e., nonstimulated Tg < 1 ng/mL and no evidence of structural disease, was similar for the two preparations [92.3% in the rhTSH group and 97.7% in the THW group (p = 0.17)].
CONCLUSION
Preparation with rhTSH was equally effective (short- and long-term) as THW for adjuvant RAI therapy of cN1b patients at intermediate risk and with apparently complete tumor resection.
Topics: Adolescent; Adult; Aged; Carcinoma; Carcinoma, Papillary; Female; Follow-Up Studies; Humans; Iodine Radioisotopes; Luminescent Measurements; Lymphatic Metastasis; Male; Middle Aged; Neck; Prospective Studies; Radiotherapy, Adjuvant; Statistics, Nonparametric; Thyroid Cancer, Papillary; Thyroid Hormones; Thyroid Neoplasms; Thyroidectomy; Thyrotropin Alfa; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 28226001
DOI: 10.1590/2359-3997000000247 -
Thyroid : Official Journal of the... Mar 2012To effectively treat differentiated thyroid cancer (DTC) with radioiodine (RAI) it is necessary to raise serum thyrotropin (TSH) levels either endogenously by thyroid... (Comparative Study)
Comparative Study
Radioiodine treatment of metastatic thyroid cancer: relative efficacy and side effect profile of preparation by thyroid hormone withdrawal versus recombinant human thyrotropin.
BACKGROUND
To effectively treat differentiated thyroid cancer (DTC) with radioiodine (RAI) it is necessary to raise serum thyrotropin (TSH) levels either endogenously by thyroid hormone withdrawal (THW) or exogenously by administration of recombinant human TSH (rhTSH). The aim of our study was to compare the relative efficacy and side effect profile of rhTSH versus THW preparation for RAI therapy of metastatic DTC.
METHODS
Fifty-six patients (31 women and 25 men) with RAI-avid distant metastases of DTC treated with either rhTSH-aided (n=15) or THW-aided RAI (n=41) and followed for 72±36.2 months were retrospectively analyzed. The groups were comparable in regard to mean size of target lesions (rhTSH vs. THW 6.4 vs. 4.8 cm, p=0.41), mean baseline thyroglobulin level (6995 vs. 5544 ng/mL, p=0.83), distribution of micronodular and macronodular pulmonary metastases (67% vs. 63%, p=0.54, 13% vs. 15% p=0.64, respectively), osseous (53% vs. 29%, p=0.09), brain (0% vs. 2%, p=0.73), and liver/kidney metastases (13% vs. 2%, p=0.61). Patients in the rhTSH group were older (rhTSH vs. THW mean 62 vs. 49 years, p=0.01), and received lower cumulative RAI dose (256 vs. 416 mCi, p=0.03), which was more frequently based on dosimetric calculations (80% vs. 46%, p=0.024). Responses to treatment were based on RECIST 1.1 criteria.
RESULTS
Adjusted by age rates of complete response (CR), stable disease (SD), progressive disease (PD), and progression free survival (PFS) were not different between the groups (rhTSH vs. THW CR hazard ratio [HR] 0.97, 95% CI 0.08-11.42, p=0.982; SD HR 3.22, 95% CI 0.79-13.18, p=0.104, PD HR 0.26, 95% CI 0.52-1.26, p=0.094; PFS HR 0.41, 95% CI 0.14-1.23, p=0.112). The only independent risk factor for nonresponding to treatment and presentation with PD was age (HR 1.06, 95% CI 1.02-1.11, p=0.008). Age was also an independent factor affecting PFS (HR 1.04 for each year, 95% CI 1.02-1.07, p=0.001). Rates of leukopenia, thrombocytopenia, xerostomia, and restrictive pulmonary disease after RAI were not significantly different (rhTSH vs. THW 30% vs. 28%, p=0.61, 10% vs. 0%, p=0.37, 0% vs. 12%, p=0.20, 0% vs. 2%, p=0.73, respectively).
CONCLUSIONS
Patients with metastatic DTC prepared with rhTSH achieve comparable benefit of RAI therapy as those treated after THW.
Topics: Adult; Aged; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Metastasis; Radiopharmaceuticals; Retrospective Studies; Thyroid Hormones; Thyroid Neoplasms; Thyrotropin Alfa
PubMed: 22313411
DOI: 10.1089/thy.2011.0235 -
Thyroid : Official Journal of the... Apr 2014Enhanced reduction of multinodular goiter (MNG) can be achieved by stimulation with recombinant human thyrotropin (rhTSH) before radioiodine ((131)I) therapy. The... (Randomized Controlled Trial)
Randomized Controlled Trial
Long-term efficacy of modified-release recombinant human thyrotropin augmented radioiodine therapy for benign multinodular goiter: results from a multicenter, international, randomized, placebo-controlled, dose-selection study.
BACKGROUND
Enhanced reduction of multinodular goiter (MNG) can be achieved by stimulation with recombinant human thyrotropin (rhTSH) before radioiodine ((131)I) therapy. The objective was to compare the long-term efficacy and safety of two low doses of modified release rhTSH (MRrhTSH) in combination with (131)I therapy.
METHODS
In this phase II, single-blinded, placebo-controlled study, 95 patients (57.2 ± 9.6 years old, 85% women, 83% Caucasians) with MNG (median size 96.0 mL; range 31.9-242.2 mL) were randomized to receive placebo (n=32), 0.01 mg MRrhTSH (n=30), or 0.03 mg MRrhTSH (n=33) 24 hours before a calculated (131)I activity. Thyroid volume (TV) and smallest cross-sectional area of trachea (SCAT) were measured (by computed tomography scan) at baseline, six months, and 36 months. Thyroid function and quality of life (QoL) was evaluated at three-month and yearly intervals respectively.
RESULTS
At six months, TV reduction was enhanced in the 0.03 mg MRrhTSH group (32.9% vs. 23.1% in the placebo group; p=0.03) but not in the 0.01 mg MRrhTSH group. At 36 months, the mean percent TV reduction from baseline was 44 ± 12.7% (SD) in the placebo group, 41 ± 21.0% in the 0.01 mg MRrhTSH group, and 53 ± 18.6% in the 0.03 mg MRrhTSH group, with no statistically significant differences among the groups, p=0.105. In the 0.03 mg MRrhTSH group, the subset of patients with basal (131)I uptake <20% had a 24% greater TV reduction at 36 months than the corresponding subset of patients in the placebo group (p=0.01). At 36 months, the largest relative increase in SCAT was observed in the 0.03 mg MRrhTSH group (13.4 ± 23.2%), but this was not statistically different from the increases observed in the placebo or the 0.01 mg MRrhTSH group (p=0.15). Goiter-related symptoms were reduced and QoL improved, without any enhanced benefit from using MRrhTSH. At three years, the prevalence of permanent hypothyroidism was 13%, 33%, and 45% in the placebo, 0.01 mg, and 0.03 mg MRrhTSH groups respectively. The overall safety profile of the study was favorable.
CONCLUSIONS
When used as adjuvant to (131)I, enhanced MNG reduction could not be demonstrated with MRrhTSH doses ≤ 0.03 mg, indicating that the lower threshold for efficacy is around this level.
Topics: Aged; Chemotherapy, Adjuvant; Delayed-Action Preparations; Female; Goiter, Nodular; Humans; Iodine Radioisotopes; Male; Middle Aged; Organ Size; Recombinant Proteins; Single-Blind Method; Thyroid Function Tests; Thyrotropin Alfa; Treatment Outcome
PubMed: 24341527
DOI: 10.1089/thy.2013.0370 -
The British Journal of Radiology Oct 2012The aim of this study was to assess the accuracy of recombinant thyroid-stimulating hormone (rTSH)-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose ((18)F-FDG) positron...
Increasing the yield of recombinant thyroid-stimulating hormone-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose positron emission tomography-CT in patients with differentiated thyroid carcinoma.
OBJECTIVE
The aim of this study was to assess the accuracy of recombinant thyroid-stimulating hormone (rTSH)-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography (PET)-CT in detecting recurrence in patients with differentiated thyroid cancer.
METHODS
Consecutive (18)F-FDG PET-CT scans performed with rTSH stimulation between 2007 and 2010 in patients with a history of papillary or follicular thyroid carcinoma were reviewed. PET-CT findings were correlated with thyroglobulin levels, and histological, clinical and radiological follow-up.
RESULTS
58 rTSH PET-CT scans were performed in 47 patients with a previous thyroidectomy and radioiodine ablation. The only indication for PET-CT was a raised thyroglobulin level in 46 of 58 scans, with the remainder for characterisation of equivocal radiology or staging. 25 (43%) of PET-CT scans were positive for recurrent disease. Histological correlation was available for 21 (36%) scans. The overall sensitivity, specificity, positive predictive value and negative predictive value were 69%, 76%, 72% and 73%, respectively. Median unstimulated thyroglobulin in true-positive scans was 33 µg l(-1) and 2.2 µg l(-1) in the remainder (p=0.12). 4 of 35 (11%) patients with unstimulated thyroglobulin levels <10 µg l(-1) had true-positive scans. Median stimulated thyroglobulin in true-positive scans was 320 µg l(-1), and 10 µg l(-1) in the remainder (p=0.046), with no positive scans with a stimulated thyroglobulin <8 µg l(-1). PET-CT directly influenced patient management in 17/58 (29%) scans.
CONCLUSION
rTSH PET-CT is a useful imaging technique for detecting disease recurrence in patients with iodine-resistant differentiated thyroid cancer. Low stimulated thyroglobulin levels are potentially useful in identifying patients unlikely to benefit from a PET-CT scan.
Topics: Adenocarcinoma, Follicular; Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma; Carcinoma, Papillary; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasm Recurrence, Local; Positron-Emission Tomography; Radiopharmaceuticals; Recombinant Proteins; Retrospective Studies; Sensitivity and Specificity; Thyroglobulin; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyrotropin Alfa; Tomography, X-Ray Computed; Young Adult
PubMed: 22972977
DOI: 10.1259/bjr/26733491 -
Endocrinology and Metabolism (Seoul,... Dec 2015Previous studies have suggested that recombinant human thyroid stimulating hormone (rhTSH) stimulation is an acceptable alternative to thyroid hormone withdrawal (THW)...
Economic Evaluation of Recombinant Human Thyroid Stimulating Hormone Stimulation vs. Thyroid Hormone Withdrawal Prior to Radioiodine Ablation for Thyroid Cancer: The Korean Perspective.
BACKGROUND
Previous studies have suggested that recombinant human thyroid stimulating hormone (rhTSH) stimulation is an acceptable alternative to thyroid hormone withdrawal (THW) when radioiodine remnant ablation is planned for thyroid cancer treatment, based on superior short-term quality of life with non-inferior remnant ablation efficacy. This study evaluated the cost-effectiveness of radioiodine remnant ablation using rhTSH, compared with the traditional preparation method which renders patients hypothyroid by THW, in Korean perspective.
METHODS
This economic evaluation considered the costs and benefits to the Korean public healthcare system. Clinical experts were surveyed regarding the current practice of radioiodine ablation in Korea and their responses helped inform assumptions used in a cost effectiveness model. Markov modelling with 17 weekly cycles was used to assess the incremental costs per quality-adjusted life year (QALY) associated with rhTSH. Clinical inputs were based on a multi-center, randomized controlled trial comparing remnant ablation success after rhTSH preparation with THW. The additional costs associated with rhTSH were considered relative to the clinical benefits and cost offsets.
RESULTS
The additional benefits of rhTSH (0.036 QALY) are achieved with an additional cost of Korean won W961,105, equating to cost per QALY of W26,697,361. Sensitivity analyses had only a modest impact upon cost-effectiveness, with one-way sensitivity results of approximately W33,000,000/QALY.
CONCLUSION
The use of rhTSH is a cost-effective alternative to endogenous hypothyroid stimulation prior to radioiodine ablation for patients who have undergone thyroidectomy in Korea.
PubMed: 26394733
DOI: 10.3803/EnM.2015.30.4.531 -
Internal Medicine (Tokyo, Japan) 2008A 58-year-old woman with chronic hepatitis C was admitted to our hospital to receive interferon (IFN) therapy. Twenty years earlier she had received blood transfusion...
A 58-year-old woman with chronic hepatitis C was admitted to our hospital to receive interferon (IFN) therapy. Twenty years earlier she had received blood transfusion because of obstetric hemorrhage. Blood test showed mild hypothyroidism and a relatively elevated eosinophil count. Therapy with pegylated IFNalpha-2a was started, and two days later she complained of nausea and severe malaise. Blood test showed hyponatremia, and plasma prolactin, growth hormone and cortisol levels were all decreased. A simultaneous administration test of lutenizing hormone releasing-, corticotrophin releasing-, growth hormone releasing- and thyrotropin releasing-hormones revealed that only adrenocorticotropic hormone was responsive. Magnetic resonance imaging showed atrophy of anterior lobe of pituitary gland. We diagnosed that IFN therapy disclosed latent Sheehan's syndrome due to previous obstetric hemorrhage. Following supplementation of thyroid and adrenal cortical hormones, we were able to complete IFN therapy. Thus, before IFN therapy for woman patients it is important to suspect latent Sheehan's syndrome when the patient had a history of obstetric hemorrhage.
Topics: Adrenocorticotropic Hormone; Antiviral Agents; Female; Hepatitis C, Chronic; Hormones; Humans; Hypopituitarism; Interferon alpha-2; Interferon-alpha; Middle Aged; Polyethylene Glycols; Postpartum Hemorrhage; Recombinant Proteins; Thyroxine; Time Factors
PubMed: 18480578
DOI: 10.2169/internalmedicine.47.0990 -
Journal of Radiology Case Reports Jun 2015Salivary dysfunction and sialadenitis are well known complications of radioiodine treatment for thyroid cancer. The parotid gland is more frequently affected and the...
Salivary dysfunction and sialadenitis are well known complications of radioiodine treatment for thyroid cancer. The parotid gland is more frequently affected and the salivary gland injury is dose related. The symptoms may develop shortly after therapeutic Iodine 131(I-131) administration or months later and progress with time. The development of unilateral parotiditis following a low dose, diagnostic I-131 scan performed following Thyrogen stimulation in a patient without prior history of sialadenitis is rare in our experience, and has not been reported in the medical literature.
Topics: Aged; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Radiation Dosage; Radionuclide Imaging; Sialadenitis; Thyroid Gland; Thyroid Neoplasms; Thyrotropin Alfa
PubMed: 26622936
DOI: 10.3941/jrcr.v9i6.2220 -
Serial measurements of serum thyroglobulin in response to recombinant human thyrotropin stimulation.Thyroid : Official Journal of the... Jun 2015
Topics: Biomarkers, Tumor; Humans; Radioimmunoassay; Thyroglobulin; Thyroid Neoplasms; Thyroidectomy; Thyrotropin Alfa
PubMed: 25850337
DOI: 10.1089/thy.2014.0586