Radioiodine plus recombinant human thyrotropin do not cause acute airway compression and are effective in reducing multinodular goiter

Albino, Cláudio Cordeiro; Graf, Hans; Paz-Filho, Gilberto; Diehl, Leandro Arthur; Olandoski, Márcia; Sabbag, Anwar Fausto Félix; Buchpiguel, Carlos Alberto

doi:10.1590/s0100-879x2010007500001

Cited by 18 publications

(66 citation statements)

References 24 publications

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“…rhTSH in a low single dose increases 131 I uptake by two-to fourfold, and similar therapeutic effects (in comparison with higher 131 I activities without rhTSH prestimulation), and with lower exposure of extrathyroidal tissues to radiation (23 given (11,14,16,19,24,25). Overall, it has been shown that rhTSH doses lower than 0.1 mg do not cause acute increases in TV or thyroid hormone levels (26).…”

Section: Introductionmentioning

confidence: 84%

“…During the last decade, and based on the above observations, rhTSH has been evaluated as an adjuvant to 131 I therapy, in an attempt to improve the efficacy of this treatment for MNG (18,39,40). Different rhTSH doses have been utilized: in some studies 0.2 mg or more (41,42,43,44,45,46,47), while in others 0.1 mg or less (11,16,20,24,31,48). Since the introduction of rhTSH as an aid for 131 I therapy in MNG, nine randomized controlled trials (RCTs) have been published (11,14,15,16,19,24,25,44,45 reduction of the goiter.…”

Section: Rhtsh and 131 I For Mngmentioning

confidence: 99%

“…The administration of recombinant human thyrotropin (rhTSH) before 131 I has been shown to be a potentially valuable therapeutic tool for the management of MNG (11,12,13,14,15,16,17,18,19,20). rhTSH in a low single dose increases 131 I uptake by two-to fourfold, and similar therapeutic effects (in comparison with higher 131 I activities without rhTSH prestimulation), and with lower exposure of extrathyroidal tissues to radiation (23 given (11,14,16,19,24,25).…”

Section: Introductionmentioning

confidence: 99%

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THERAPY OF ENDOCRINE DISEASE: Recombinant human TSH and radioactive iodine therapy in the management of benign multinodular goiter

Graf

2015

European Journal of Endocrinology

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Multinodular goiter (MNG) is a very common thyroid disorder determined by diverse goitrogenic factors, the most important one being iodine deficiency. The clinical presentation of a patient with MNG varies from a completely asymptomatic goiter to a life-threatening disease due to upper airway compression. Patients can develop underlying subclinical or overt hyperthyroidism due to autonomously hyperfunctioning nodules. In the absence of clinical, ultrasonographic, or cytological findings suggestive of malignancy, the best therapeutic approach for a patient with MNG will depend on the size and location of the goiter, the presence and severity of compressive symptoms, and the presence or absence of thyrotoxicosis. There is still no consensus regarding the treatment of atoxic MNGs. Hence, its optimal management remains controversial; possible therapies include levothyroxine (LT 4 ), surgery, and radioactive iodine ( 131 I). Suppressive treatment with LT 4 is discouraged due to the development of sub-clinical or overt hyperthyroidism and to its low efficacy when compared with surgery or 131 I. Total thyroidectomy is effective; however, it is associated with the risk of surgical complications and is often refused by the patient. 131 I therapy is an alternative to thyroid surgery to reduce the size of benign MNGs. Based on the ability of recombinant human TSH (rhTSH) to more than double thyroid 131 I uptake, this compound has been evaluated as an adjuvant to 131 I in the treatment of MNG. Very small doses of rhTSH have been used in patients with MNG and few safety concerns have been observed, but the ideal dose, both effective and safe, is yet to be defined.

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Section: Introductionmentioning

confidence: 84%

Section: Rhtsh and 131 I For Mngmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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THERAPY OF ENDOCRINE DISEASE: Recombinant human TSH and radioactive iodine therapy in the management of benign multinodular goiter

Graf

2015

European Journal of Endocrinology

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“…The concept of rhTSH-stimulated 131 I-therapy of multinodular nontoxic goiter has been thoroughly evaluated in clinical trials during the last decade [46,47,52,[57][58][59][60][61][62][63][64][65][66][67][68], listed in Table 3, and the topic has been discussed in previous reviews [54,[69][70][71][72][73]. Four trials were double-blinded and compared pre-stimulation with either rhTSH or placebo [46,47,66,67].…”

Section: I-therapy Amplification By Rhtsh Stimulationmentioning

confidence: 99%

“…Four trials were double-blinded and compared pre-stimulation with either rhTSH or placebo [46,47,66,67]. Most studies explored whether an rhTSH-mediated increase of the absorbed thyroid dose can improve the goiter reduction.…”

Section: I-therapy Amplification By Rhtsh Stimulationmentioning

confidence: 99%

Non-surgical approach to the benign nodular goiter: new opportunities by recombinant human TSH-stimulated 131I-therapy

Bonnema

Fast

2011

Endocrine

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The optimal treatment strategy in a goiter patient depends--among other factors--on goiter size, the degree of cosmetic or compressive symptoms, the age of the patient, the impact on the upper airways, the wish to maintain normal thyroid function, the ability of the thyroid gland to take up (131)I, and the possibility of thyroid malignancy. When treatment is warranted in a patient with benign goiter, the choice usually stands between surgery and (131)I-therapy. Focal destructive treatment, by ethanol sclerotherapy or interstitial laser photocoagulation, may be considered in patients with a solitary benign nodule. If thyroid hyperfunction due to nodular autonomy is the dominant problem, life-long anti-thyroid drug treatment may be relevant in elderly individuals. With the advent of recombinant human TSH (rhTSH) stimulation the goiter reduction following (131)I-therapy is significantly enhanced and this treatment is of particular benefit, as compared with conventional (131)I-therapy, in patients with a low baseline thyroid (131)I uptake and a large goiter. If the rhTSH dose does not exceed 0.1 mg the risk of temporary hyperthyroidism and acute thyroid swelling is low. Since patient satisfaction seemingly is not improved by the greater goiter reduction obtained by rhTSH-stimulated (131)I-therapy, and permanent hypothyroidism is more frequent, it may be more relevant to reduce the administered radioactivity equivalent to the rhTSH-induced increase in the thyroid (131)I uptake. Future large-scale well-controlled studies should explore this strategy, with focus on cost-benefit and quality of life. A major hindrance of widespread and routine use of rhTSH-stimulated (131)I-therapy is its present status as an off-label treatment.

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Recombinant human thyrotropin (rhTSH)-aided radioiodine treatment for non-toxic multinodular goitre

Huo

Xie

Chen

et al. 2021

Cochrane Database of Systematic Reviews

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Radioiodine plus recombinant human thyrotropin do not cause acute airway compression and are effective in reducing multinodular goiter

Cited by 18 publications

References 24 publications

THERAPY OF ENDOCRINE DISEASE: Recombinant human TSH and radioactive iodine therapy in the management of benign multinodular goiter

THERAPY OF ENDOCRINE DISEASE: Recombinant human TSH and radioactive iodine therapy in the management of benign multinodular goiter

Non-surgical approach to the benign nodular goiter: new opportunities by recombinant human TSH-stimulated 131I-therapy

Recombinant human thyrotropin (rhTSH)-aided radioiodine treatment for non-toxic multinodular goitre

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