Recombinant Human TSH for Thyroid Remnant Ablation with ¹³¹I in Children and Adolescents with Papillary Carcinoma

Abstract

Background: The objective of this study was to report the results of a series of 12 patients with papillary carcinoma aged 16 years or younger, who were prepared with recombinant human TSH (rhTSH) for remnant ablation with ¹³¹I. The TSH levels achieved and the safety of 24 cycles of rhTSH administration (ablation and control assessment) are reported. Methods: All patients were prepared using the same protocol as recommended for adults. Eight to 12 months after initial therapy, the patients were submitted to neck ultrasound, measurement of stimulated Tg and anti-Tg antibodies (TgAb), and diagnostic whole-body scanning (DxWBS). Results: TSH levels >50 mIU/l were achieved in all patients. An adverse reaction (mild nausea and headache) was observed in 1/24 cycles (4.1%). Eight (88.8%) of 9 patients with uptake in the thyroid bed in post-therapy whole-body scanning (RxWBS) achieved complete remission. One patient presented TgAb in the absence of apparent disease. In addition, imaging methods showed no apparent disease in the 2 patients with lymph node metastases in RxWBS. Elevated Tg persisted in 1 patient with pulmonary micrometastases. Conclusion: The present results demonstrate the efficacy and safety of rhTSH in children and adolescents.

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

“…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.…”

“…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.…”

“…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.…”

Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

“…In the remainder of patients (incomplete tumor resection or persistent metastases), discontinuation of T4 over 3 or 4 weeks is still the most proper indication in the absence of clinical contraindications. The latter recommendation also applies to children and adolescents because although the use of recombinant TSH is safe and apparently efficacious in them (114), further studies are required.…”

Timing of Hormone Withdrawal in Children Undergoing ¹³¹I Whole-Body Scans for Thyroid Cancer

“…TSH levels ≥ 25 μIU/mL were obtained in 95.9% of patients [15] . Similarly, Rosario et al [16] had less than 5% adverse events and TSH levels ≥ 50 μIU/mL prior to 131 I thyroid remnant ablation. In a study by Handkiewicz-Junak et al [17] , TSH levels were higher at day 3 post rhTSH (median 152 μIU/mL) when compared to hormonal withdrawal (median 91 μIU/mL) in a cohort of children referred for 131 I treatment ( p < 0.05).…”