Cardiovascular assessment of hyperthyroid patients with multinodular goiter before and after radioiodine treatment preceded by stimulation with recombinant human TSH

Barca, Maria Fernanda; Gruppi, C; Oliveira, Múcio Tavares de; Romão, Rossana; Cardia, M; Rubio, Ileana G.S.; Knobel, Meyer; Medeiros‐Neto, Geraldo

doi:10.1007/s12020-007-9020-3

Cited by 14 publications

(13 citation statements)

References 23 publications

(48 reference statements)

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“…However, 3 (18%) patients presented transient neck pain or tenderness, 1 experienced asymptomatic thyroid enlargement, and 3 became hypothyroid by 3 months (Table 2). [50]. All patients presented a transient surge in serum levels of free T4 and total T3 into the hyperthyroid range following therapy.…”

Section: Increase In Goiter Size Immediately After Ablationmentioning

confidence: 94%

“…A study in which 34 patients with large MNGs were randomized to receive 131 I therapy Details about clinical and laboratory data may be found in Table 1, patient #18 in Ref. [50] (100 lCi/g of thyroid tissue) alone or following a single relatively high dose of rhTSH (0.45 mg) 24 h before 131 I administration, showed that patients who received rhTSH had transient elevations in thyroid hormone levels lasting one week, a greater reduction in goiter size (60% vs. 40%), and a higher incidence of hypothyroidism (65% vs. 21%) (40). In another study, 18 patients received two 0.1 mg doses of rhTSH followed by 30 mCi of 131 I. RAIU increased from 12 to 55%, free T4 increased from 1.3 to 3.2 ng/dL, and goiter size reduced from 97 to 65 cm 3.…”

Section: Transient Hyperthyroidism After 131 I Ablationmentioning

confidence: 99%

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An outline concerning the potential use of recombinant human thyrotropin for improving radioiodine therapy of multinodular goiter

Medeiros‐Neto

Marui

Knobel

2008

Endocr

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Radioiodine ((131)I) treatment for nontoxic and toxic multinodular goiter (MNG) is an alternative therapeutic procedure used especially for patients with contraindication for surgery. Several studies have been conducted in recent years assessing the use of recombinant human TSH (rhTSH) in increasing (131)I uptake in MNGs. This procedure also decreases the activity level of the administered (131)I, changes the distribution of (131)I in the thyroid, lowers the absorption dose, and dramatically reduces the volume of the goiter (50-75% of the baseline volume). A major disadvantage, however, is the induction of hypothyroidism in a relatively large number of patients. A transient increase in thyroid volume and tenderness was noted in the first week of treatment. Also a short period (2-4 weeks) of hyperthyroidism was observed in most patients with potential consequences particularly for the elderly. Still, there has been no evidence to date that the adverse effects outweigh the positive results of using rhTSH. The use of rhTSH in benign goiter disease has not yet been approved worldwide, but its positive activity in MNG is remarkable and promising.

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Section: Increase In Goiter Size Immediately After Ablationmentioning

confidence: 94%

Section: Transient Hyperthyroidism After 131 I Ablationmentioning

confidence: 99%

An outline concerning the potential use of recombinant human thyrotropin for improving radioiodine therapy of multinodular goiter

Medeiros‐Neto

Marui

Knobel

2008

Endocr

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“…With rhTSH doses of 0.01 and 0.03 mg the response is blunted and most patients maintain thyroid hormone levels within the normal range (20). Further reassuring is the observation that pre-treatment with 0.1 mg rhTSH did not affect structural and functional parameters of the heart, despite transient increases in serum levels of thyroid hormones (64). Thus, when limiting rhTSH doses to 0.1 mg or less, the rise in thyroid hormones seems to be of little clinical relevance.…”

Section: Acute Adverse-effectsmentioning

confidence: 99%

Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy

Fast¹,

Nielsen²,

Bonnema³

et al. 2009

European Journal of Endocrinology

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The treatment of benign multinodular goitre (MNG) is controversial, but surgery is recommended in large compressive goitres. While some patients decline surgery others may have contraindications due to comorbidity, since MNG is prevalent in the elderly. Therefore, non-surgical treatment alternatives are needed. Until recently, levothyroxine therapy was the preferred non-surgical alternative, but due to low efficacy and potential side-effects, it is not recommended for routine use in recent international guidelines. Conventional radioiodine ( 131 I) therapy has been used for two decades as an effective and safe alternative to surgery in the treatment of symptomatic non-toxic MNG. Since much higher activities of 131 I are employed when treating non-toxic rather than toxic MNG, there has been reluctance in many countries to use this treatment modality. Frequently, the 131 I -uptake in a non-toxic MNG is low, which makes 131 I therapy less feasible. Another challenge is the negative correlation between the initial goitre size and goitre volume reduction (GVR). With its ability to more than double the thyroid 131 I-uptake, recombinant human TSH (rhTSH) increases the absorbed radiation dose and thus enhances the GVR by 35-56% at the expense of up to fivefold higher rate of permanent hypothyroidism. An alternative strategy is to reduce the administered 131 I-activity with a factor corresponding to the rhTSH induced increase in 131 I-uptake. Hereby, the extrathyroidal irradiation can be reduced without compromising efficacy. Thus, although in its infancy, and still experimental, rhTSH-augmented 131 I therapy may profoundly alter the non-surgical treatment of benign non-toxic MNG.

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“…The mean therapeutic activity of I-131 was 715.79 ± 101. 45 MBq in the rhTSH-group and 768.42 ± 74.93 MBq in the control group. The therapeutic doses of I-131 used in both groups did not differ in a statistically significant way.…”

Section: Methodsmentioning

confidence: 87%

“…Consequently, the authors suggest routine preventive symptomatic treatment [25,31,44]. Studies with patients aged 42-80 years showed that a single dose of 0.1 mg of rhTSH induces hyperthyroidism, which increases the risk of left-sided diastolic heart failure three times [45]. In another group, a dose of 0.1 mg administered twice caused tachyarrhythmia in two patients [17].…”

Section: Discussionmentioning

confidence: 99%

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

et al. 2016

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Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter The aim of the study was to assess the influence of a single very low dose (0.03 mg) of rhTSH on RAIU and thyroid function in euthyroid (MNG-EU) and subclinical hyperthyroid (MNG-SC) patients with a large multinodular goiter. MATERIAL AND METHODS:40 patients (14 male, 26 female, age 57-80 yr) with large non-toxic MNG over 80 grams and with baseline RAIU < 40% were included into the double-blind randomized study and divided into two groups: rhTSH-group and control group. First group received the single intramuscular injection of 0.03 mg rhTSH and the second received placebo. The RAIU were measured 24 and 48 hours after the rhTSH and then all the patients were administered therapeutic doses of I-131. TSH and free thyroxine levels were measured at 1 st and 2 nd day after the injection of rhTSH and later, at 4 and 8 weeks after the RIT. RESULTS:The mean RAIU increased significantly from 30.44 ± 7.4% to 77.22 ± 8.7% (p < 0.001). There were no statistically significant differences in RAIU between euthyroid (MNG-EU) and subclinically hyperthyroid (MNG-SC) patients. The peak of serum TSH was noticed 24 hours after rhTSH injection and in MNG-EU patients it has remained within normal range, similarly as fT4. In the MNG-SC group the administration of rhTSH resulted in a significant increase in the TSH values after 24 hours, whose mean level slightly exceeded the upper limit of the normal range with normalization at 48 hours. 8 weeks after the RIT, the TSH and fT4 levels did not exceed the normal range and did not differ in a statistically significant way. Conclusions:Even the single very low dose of rhTSH increases the values of RAIU in significant way, in euthyroid and subclinically hyperthyroid patients. The administration of rhTSH is well-tolerated. Neoadjuvant administration of a low dose (0.03 mg) of rhTSH before I-131 seems to be an optimal method of management which may increase the effectiveness of RIT and decrease the exposure of the patients to absorbed doses of ionizing radiation.

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Cardiovascular assessment of hyperthyroid patients with multinodular goiter before and after radioiodine treatment preceded by stimulation with recombinant human TSH

Cited by 14 publications

References 23 publications

An outline concerning the potential use of recombinant human thyrotropin for improving radioiodine therapy of multinodular goiter

An outline concerning the potential use of recombinant human thyrotropin for improving radioiodine therapy of multinodular goiter

Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

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