Management of paediatric thyroid carcinoma: recent experience with recombinant human thyroid stimulating hormone in preparation for radioiodine therapy

Lau, Wcs; Zacharin, Margaret; Waters, Keith; Wheeler, Greg; Johnston, Val; Hicks, Rodney J.

doi:10.1111/j.1445-5994.2006.01149.x

Cited by 32 publications

(20 citation statements)

References 20 publications

(39 reference statements)

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“…In contrast to the large number of studies showing the efficacy of rhTSH preparations for adjuvant radioiodine treatment in adults with DTC, data for children and adolescents are scarce. There are only a few patients described in the literature so far (11,13). To our best knowledge, our retrospective study is the first that evaluated different aspects of the rhTSH-aided radioiodine therapy procedure and its outcomes in children and adolescents with DTC.…”

Section: Discussionmentioning

confidence: 99%

“…We searched for patients who were 18 years of age or younger during 131 I treatment and had no signs of locoregional or distant disease on clinical or imaging examinations, confirming that the radioiodine treatment was an adjunct to the surgical treatment. [6][7][8][9][10][11][12][13][14][15][16][17][18] and the majority of patients were girls. Before radioactive iodine therapy, all patients but one were treated with total/near total thyroidectomy.…”

Section: Patientsmentioning

confidence: 99%

“…However, the potential of rhTSH-aided radioiodine therapy to decrease extra-thyroidal radiation exposure and hypothyroid morbidity is extremely important for the developing organism of young patients. Reports on the effectiveness and safety of 131 I are not numerous, and only a few case reports and one small, retrospective study involving paediatric patients treated with rhTSH-aided adjuvant 131 I have been published so far (10,11,12,13). Beginning in 1999, our centre started to offer rhTSHaided radioiodine treatment as an adjunct to thyroid surgery or treatment of locoregional/metastatic DTC, first during an 'off-label' or 'compassionate use' program and subsequently on a regular basis.…”

Section: Introductionmentioning

confidence: 99%

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Recombinant human thyrotropin preparation for adjuvant radioiodine treatment in children and adolescents with differentiated thyroid cancer

Handkiewicz-Junak

Gawlik

Rozkosz

et al. 2015

European Journal of Endocrinology

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Aim: Although recombinant human thyrotropin (rhTSH) is widely used in treating differentiated thyroid cancer (DTC), almost all clinical investigation has been in adults. The aim of our retrospective study was to evaluate outcomes of adjuvant, rhTSH-aided radioiodine treatment in children/adolescents with DTC and to compare them to 131 I therapy during L-thyroxin withdrawal (THW). Methods: Patients with the diagnosis of DTC who were %18 years of age and had no signs of persistent disease at the time of 131 I treatment were included; 48 patients were treated after rhTSH (rhTSH group) and 82 after THW group. The median time of follow-up after therapy was 67 months and was longer in the THW group (99 vs 43 months, P!0.05).Results: On the day of 131 I administration, all but one patient had TSH levels above 25 mIU/ml. Peak TSH concentration was significantly higher in the rhTSH group (152 mIU/ml vs 91 mIU/ml). Similarly, the thyroglobulin concentration was higher in the rhTSH group (9.7 ng/ml vs 1.8 ng/ml). No side effects requiring medical intervention were recorded after rhTSH administration. The evaluation of disease outcomes during TSH stimulation (6-18 months after 131 I treatment) revealed equal rates of thyroid ablation (71%) in both groups. During subsequent follow-up, five patients showed recurrence (PO0.05). Conclusions: In children/adolescents, rhTSH-aided adjuvant radioiodine treatment is associated with rates of remnant ablation and short-term recurrence similar to THW. As this preparation has several advantages over THW, rhTSH may become the preferred method of TSH stimulation once studies of long-term outcomes show non-inferiority to THW in this age group.

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recombinant human thyrotropin preparation for adjuvant radioiodine treatment in children and adolescents with differentiated thyroid cancer

Handkiewicz-Junak

Gawlik

Rozkosz

et al. 2015

European Journal of Endocrinology

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“…However, data regarding the use of rhTSH in children are limited (235,236). Experience in children would suggest that the typical adult dose of rhTSH (two doses of 0.9 mg given 24 hours apart) appears to be safe and generates sufficient TSH levels (169,236,237).…”

Section: And Recommendation 17mentioning

confidence: 99%

Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer

Francis

Waguespack

Bauer

et al. 2015

Thyroid

973

1,365

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Background: Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. Methods: A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects £ 18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. Results: These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided.

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“…A atividade de 131 I pode ser administrada empiricamente ou calculada por dosimetria, não havendo dados que permitam avaliar a superioridade de um método sobre o outro. O uso do rhTSH na doença metastática ainda não está aprovado, embora existam evidências clínicas de boa resposta da radioioterapia pós-rhTSH, especialmente em crianças (24,41). Não há estudos randomizados que avaliem o papel do rhTSH no tratamento do CDT recorrente ou metastático, tampouco há uma padronização dos parâmetros de resposta descritos na literatura.…”

Section: Tratamento Do Cdt Recorrente Ou Metastático Com Rhtshunclassified

Uso do TSH humano recombinante no câncer diferenciado de tireóide

Graf

Paz-Filho

2007

Arq Bras Endocrinol Metab

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RESUMOO seguimento imediato após tireoidectomia total (TT), em pacientes com câncer diferenciado de tireóide (CDT), tradicionalmente é feito com a ablação de remanescentes tireoidianos (RT) com 131 I, na vigência de hipotireoidismo. O seguimento tardio do CDT inclui o uso de doses supressivas de T4, dosagem seriada da tireoglobulina (Tg), pesquisa de corpo inteiro (PCI) com 131 I e ultrasonografia (US) cervical. Nos últimos anos, tem-se mostrado que a ablação de RT com a ajuda do TSH recombinante humano (rhTSH) tem a mesma eficácia que a ablação de RT observada com a elevação endógena do TSH, mas sem os sintomas e piora de qualidade de vida descritos no hipotireoidismo. A dosagem da Tg estimulada com TSH endógeno ou exógeno, 9 a 12 meses após o tratamento inicial do CDT, associado à US cervical, pode identificar pacientes de baixo risco potencialmente curados de sua doença e nos quais a supressão do TSH não necessita ser tão intensa, evitando as complicações cardíacas e ósseas da tireotoxicose exógena prolongada. Finalmente, apesar de não existirem estudos randomizados que avaliem o papel do rhTSH no tratamento do CDT metastático, os resultados do tratamento combinado do rhTSH e 131 I mostram um benefício clínico na maioria dos pacientes tratados. Traditionally, the immediate treatment of patients with differentiated thyroid carcinoma (DTC) after total thyroidectomy (TT) is thyroid remnant ablation (TRA) with 131 I, during hypothyroidism. Late follow-up of DCT includes suppressive doses of T4, serial measurements of thyroglobulin (Tg), whole body scan (WBS) with 131 I and cervical ultrasound (US). In the last years, TRA with the aid of recombinant human TSH (rhTSH) has shown not only to avoid symptoms of hypothyroidism and a lower quality of life, but also to have the same efficacy as TRA during endogenous TSH elevation. Stimulated Tg with endogenous or exogenous TSH, 9 to 12 months after the initial treatment of DTC, associated with cervical US, is able to identify low-risk patients virtually cured of their disease, in whom TSH suppression does not need to be so strict, avoiding the heart and bone complications of prolonged exogenous thyrotoxicosis. Finally, in spite of the absence of randomized studies designed to evaluate the role of rhTSH in metastatic DTC disease, results of the combined treatment of rhTSH and 131 I show a clinical benefit in the majority of treated patients. CÂNCER DE TIREÓIDE é a lesão endócrina maligna mais comum, sendo responsável por cerca de 90% das malignidades endócrinas. A incidên-cia de nódulos tireoidianos também é bastante significativa na população geral, detectados em 19% a 67% de indivíduos selecionados randomicamente, através de US de alta resolução (1). Apesar da elevada incidência de nódulos tireoidianos, o câncer de tireóide ocorre em apenas 5 a 10% dos pacientes, dependendo da população avaliada (2). A grande maioria das lesões tireoidianas malignas tem origem nas células foliculares, cujo tipo revisão

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Management of paediatric thyroid carcinoma: recent experience with recombinant human thyroid stimulating hormone in preparation for radioiodine therapy

Abstract: Optimal management of paediatric thyroid carcinoma necessitates a multidisciplinary approach. Radioiodine therapy under rhTSH is an effective and safe adjuvant treatment in this special subgroup.

Cited by 32 publications

References 20 publications

Recombinant human thyrotropin preparation for adjuvant radioiodine treatment in children and adolescents with differentiated thyroid cancer

Recombinant human thyrotropin preparation for adjuvant radioiodine treatment in children and adolescents with differentiated thyroid cancer

Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer

Uso do TSH humano recombinante no câncer diferenciado de tireóide

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