Comparison of Therapeutic Efficacy and Clinical Parameters Between Recombinant Human Thyroid Stimulating Hormone and Thyroid Hormone Withdrawal in High-Dose Radioiodine Treatment with Differentiated Thyroid Cancer

Sw, Choi; Na, Chang Ju; Kim, Jeonghun; Han, Young Jin; Jeong, Byung‐Hoon; Jeong, Hwan-Jeong; Sohn, Myung‐Hee; Lim, Sungjoon

doi:10.1007/s13139-014-0308-y

Cited by 4 publications

(6 citation statements)

References 16 publications

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“…Recombinant human thyroid-stimulating hormone is generally associated with good tolerability, including shorter hospital stay, with the majority of reported adverse effects being manageable through symptomatic treatment, even in patients with metastases. 28,[41][42][43][44][45][46] Despite initial reports of severe adverse effects including death resulting from myocardial infarction, these incidents were limited to cases involving nontotal thyroidectomized patients. 42 Quality of life, which is inherently subjective and was assessed through questionnaires, was reported to be superior in the rhTSH group compared with the THW group in all studies (Supplemental Digital Content, Table S5, http://links.lww.com/CNM/A457).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Recombinant Human Thyroid-Stimulating Hormone and Thyroid Hormone Withdrawal for 131I Therapy in Patients With Intermediate- to High-Risk Thyroid Cancer

Park,

Bang,

Kim

et al. 2024

Clin Nucl Med

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Background This meta-analysis and systematic review aimed to evaluate the therapeutic efficacy and advantages associated with the use of recombinant human thyroid-stimulating hormone (rhTSH) for radioactive iodine (RAI) therapy in patients with intermediate- to high-risk differentiated thyroid cancer. Patients and Methods MEDLINE, EMBASE, and Cochrane databases were searched to identify relevant articles reporting clinical outcomes of rhTSH compared with thyroid hormone withdrawal (THW) in patients with intermediate- to high-risk differentiated thyroid cancer published between January 2012 and June 2023. Meta-analyses were performed (PROSPERO registration number: CRD42022340915) to assess the success rate of radioiodine remnant ablation (RRA) in patients with intermediate to high risk and determine the disease control rate among patients with distant metastases, evaluated using the RECIST criteria. Results Thirteen studies involving 1858 patients were included in the meta-analysis. Pooled analyses revealed significantly higher overall RRA success rate in the rhTSH group compared with the THW group, with a risk ratio (RR) of 1.12 (95% confidence interval [CI], 1.01–1.25). However, in the subgroup analysis of high-risk patients, pooled analyses showed no significant differences in RRA success rate between the rhTSH group compared with the THW group with a pooled RR of 1.05 (95% CI, 0.88–1.24). In patients with distant metastases, there were no significant differences in the disease control rate between groups, with a pooled RR of 1.06 (95% CI, 0.78–1.44). Conclusions rhTSH for RAI therapy is a practical option for RAI therapy in patients with intermediate- to high-risk thyroid cancer, including those with distant metastases.

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Section: Discussionmentioning

confidence: 99%

Comparison of Recombinant Human Thyroid-Stimulating Hormone and Thyroid Hormone Withdrawal for 131I Therapy in Patients With Intermediate- to High-Risk Thyroid Cancer

Park,

Bang,

Kim

et al. 2024

Clin Nucl Med

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“…Moreover, Yap et al [ 29 ] discovered that the median RAI uptake in remnant thyroid tissue was less than 2% in patients with thyroidectomy performed by specialized surgeons. Of note, approximately half of our study population used rhTSH, which prevents delayed excretion of RAI in extrathyroidal components from hypothyroid state [ 30 ], while it may cause higher uptake of RAI in remnant thyroid tissue. Although the potential effect of rhTSH is not considered in effective half-life and thyroidal fraction, our model based on EDR R is more predictive of necessary required radiation precautions compared with the model based on administered radioactivities.…”

Section: Discussionmentioning

confidence: 99%

“…rhTSH, which prevents delayed excretion of RAI in extrathyroidal components from hypothyroid state [30], while it may cause higher uptake of RAI in remnant thyroid tissue. Although the potential effect of rhTSH is not considered in effective half-life and thyroidal fraction, our model based on EDR R is more predictive of necessary required radiation precautions compared with the model based on administered radioactivities.…”

Section: Plos Onementioning

confidence: 99%

A practical individualized radiation precaution based on the dose rate at release time after inpatient 131I ablation therapy

et al. 2021

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Introduction Retained radioactivity of 131I after ablation therapy largely differs in each patient according to factors including the amount of remnant thyroid tissue, renal function, and use of recombinant human thyroid-stimulating hormone. To reduce unnecessary restriction of patient’s daily life after inpatient 131I ablation therapy, we propose a practical individualized method for radiation precaution based on dose rate at release time. Methods We evaluated 215 patients with differentiated thyroid cancer who underwent inpatient 131I ablation therapy following total thyroidectomy. Effective dose equivalent rates at 1-m distance were measured upon release (EDRR) on day 2 and during delayed whole-body scan (EDRD) visits on day 6‒8 after 131I administration. The biexponential model was designed to estimate total effective dose equivalent to others. To assess conservativeness of our model, EDRD estimated by our model was compared with measured EDRD. EDRR-based periods of precaution not to receiving 1 mSv of radiation exposure were estimated and compared with those based on administered radioactivities on American Thyroid Association (ATA) recommendations. Results The EDRR ranged from 1.0–48.9 μSv/hr. The measured EDRD were equal to or lower than estimated EDRD in all patients, except for one, indicating that our model is sufficiently conservative. According to our model, no subjects needed additional daytime restriction after release. The maximum permissible times for public transportation use were longer in all patients compared with those based on administered radioactivities. Nighttime restriction periods were significantly shorter than those based on administered radioactivity; median periods requiring sleeping apart were 0 (range, 0‒5), 4 (range, 1‒14), and 3 (range, 2‒13) days after release in patients treated with radioactivity doses of 2.96, 5.50, and 7.40 GBq, respectively, needing 8, 16, and 19 additional days, respectively, based on administered radioactivity. Conclusions Radiation safety instructions using proposed method based on EDRR of individual patient could safely reduce the burden of radiation precaution.

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“…Recent international multicenter trials have shown that complete radioiodine ablation has equivalent efficacy in patients receiving rhTSH and those with elevated TSH due to THW (26)(27)(28)(29). The general use of rhTSH is constrained by economic reasons and lack of availability in some areas; therefore, there is general interest in identifying patients who may benefit more from rhTSH stimulation than THW.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Cardiovascular Risk and Myocardial Perfusion in Patients with Radically Treated Differentiated Thyroid Carcinoma and Repeated Episodes of Iatrogenic Hypothyroidism

et al. 2016

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Context. Patients with radically treated differentiated thyroid carcinoma (DTC) undergo multiple episodes of iatrogenously-acquired hypothyroidism for the oncological follow-up. In some patients, this elevates high-sensitive C-reactive protein (hsCRP), a cardiovascular risk biomarker.Objective. We wanted to determine if there is any correlation between repeated hypothyroidism episodes, elevated hsCRP and an increased cardiovascular risk as stated through myocardial perfusion.Design. Between July 2014-January 2015, we analyzed serological levels of hsCRP for identifying our patients' cardiovascular risk; we performed a myocardial perfusion scintigraphy to observe the alterations.Subjects and methods. We included 27 patients (n=27), mean age of 52±10: CI (95%),14 female, all diseasefree after thyroidectomy, radioiodine ablation and chronic thyroid hormone treatment. We assigned the cardiovascular risk category for each patient according to hsCRP levels; all patients underwent a myocardial perfusion scintigraphy in order to determine the cardiac perfusion index (CPI).Results. hsCRP has been higher in > 65 years old male patients with more than 5 thyroid hormone withholdings. hsCRP is significantly associated with CPI (p=0.001). Spearman's rank correlation indicates a strongly positive linear correlation between these two parameters (r=0.745). Conclusions.Repeated thyroid hormonal withdrawals in patients with DTC during the long-term follow-up elevated hsCRP at cardiovascular risk levels, having an impact on myocardial perfusion.

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Comparison of Therapeutic Efficacy and Clinical Parameters Between Recombinant Human Thyroid Stimulating Hormone and Thyroid Hormone Withdrawal in High-Dose Radioiodine Treatment with Differentiated Thyroid Cancer

Cited by 4 publications

References 16 publications

Comparison of Recombinant Human Thyroid-Stimulating Hormone and Thyroid Hormone Withdrawal for 131I Therapy in Patients With Intermediate- to High-Risk Thyroid Cancer

Comparison of Recombinant Human Thyroid-Stimulating Hormone and Thyroid Hormone Withdrawal for 131I Therapy in Patients With Intermediate- to High-Risk Thyroid Cancer

A practical individualized radiation precaution based on the dose rate at release time after inpatient 131I ablation therapy

Evaluation of Cardiovascular Risk and Myocardial Perfusion in Patients with Radically Treated Differentiated Thyroid Carcinoma and Repeated Episodes of Iatrogenic Hypothyroidism

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