Stimulation With 0.3-mg Recombinant Human Thyrotropin Prior to Iodine 131 Therapy to Improve the Size Reduction of Benign Nontoxic Nodular Goiter

Nielsen, Vibeke Lehmann; Bonnema, Steen Joop; Boel-Jørgensen, Henrik; Grupe, Peter; Hegedűs, László

doi:10.1001/archinte.166.14.1476

Cited by 87 publications

(91 citation statements)

References 26 publications

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“…Combined with 131 I therapy rhTSH increases the GVR in MNG patients by 35-56%. This effect has been documented in three randomized controlled trials (RCT) depicted in Table 2 (17)(18)(19). In small-to-medium sized goitres (median goitre volume 51 ml, range 20-99 ml), we demonstrated that 0.3 mg of rhTSH improved the mean GVR by 33% at 1 year follow-up (Fig.…”

Section: Effect On Gvrsupporting

confidence: 68%

“…One study did not address this issue at all (19), whereas the other two studies (17,18) relied on a visual analogue scale (VAS). Before rhTSH-augmented 131 I therapy is implemented this issue deserves further attention.…”

Section: Effect On Gvrmentioning

confidence: 99%

“…In combination with 131 I therapy rhTSH enhances the goitre volume reduction (GVR) by 35-56% (17-19) at the expense of up to fivefold higher rate of permanent hypothyroidism (18). Alternatively, the administered 131 I-activity can be reduced by a factor corresponding to the rhTSH induced 131 I-uptake increase, without compromising efficacy (20).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Effect On Gvrsupporting

confidence: 68%

Section: Effect On Gvrmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Interestingly, data from our previous randomized controlled trials (14,15) indicate that mechanisms beyond the increase in the retained thyroid dose may be partially responsible for the beneficial effect of rhTSH in combination with 131 I therapy. In those studies, we found a positive correlation between the relative goiter volume reduction and the retained thyroid dose in the conventional (without rhTSH) 131 I therapy group.…”

Section: Discussionmentioning

confidence: 99%

“…In 3 randomized controlled trials (13)(14)(15), rhTSH has been documented to enhance the goiter volume reduction by 35%256% when standard 131 I activities are used. An alternative strategy is to reduce the administered 131 I activity with a factor corresponding to the rhTSH-induced increase in RAIU.…”

mentioning

confidence: 99%

Optimizing ¹³¹I Uptake After rhTSH Stimulation in Patients with Nontoxic Multinodular Goiter: Evidence from a Prospective, Randomized, Double-Blind Study

Fast¹,

Nielsen²,

Grupe³

et al. 2009

J Nucl Med

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Prestimulation with recombinant human thyroid-stimulating hormone (rhTSH) augments radioiodine 131 I therapy for benign nontoxic multinodular goiter. The purpose of this study was to determine the optimal time interval between rhTSH and 131 I administration to enhance thyroid radioactive iodine uptake (RAIU). Methods: Patients were randomized, in a 2-factorial design, to receive either a 0.1-mg dose of rhTSH (n 5 60) or placebo (n 5 30) and to a time interval of 24, 48, or 72 h before 131 I administration. The rhTSH-or placebo-stimulated RAIU study was performed at 4 wk after a baseline RAIU assessment in a tertiary referral center at a university hospital. A total of 90 patients (78 women; median age, 52 y; range, 22-83 y) referred to 131 I therapy for symptomatic nontoxic goiter (median goiter volume, 63 mL; range, 25-464 mL) were included in the study. Change in thyroid RAIU was determined at 24 and 96 h after 131 I tracer administration. Results: In the placebo subgroups, RAIU did not change significantly from baseline. The mean (6SE) 24-h RAIU increased from 33.8% 6 2.3% to 66.0% 6 1.8% (111.2% increase) with a 24-h interval, from 36.8% 6 2.1% to 64.6% 6 2.7% (83.3% increase) with a 48-h interval, and from 33.0% 6 2.7% to 49.6% 6 2.5% (62.4% increase) with a 72-h interval. All within-group changes were highly significant (P , 0.001). The effect was negatively correlated with initial RAIU (r 5 20.703, P , 0.001). The increase in 24-and 96-h RAIU was significantly higher in the rhTSH/24-h group than it was in the rhTSH/72-h group (P 5 0.023 and 0.012, respectively) and insignificantly higher than in the rhTSH/48-h group (P 5 0.37 and 0.26, respectively). Conclusion: The effect of rhTSH on thyroid RAIU is most pronounced when administered 24 h before 131 I administration and declines with longer time intervals. Whether there is a similar time dependency for goiter reduction after rhTSH-stimulated 131 I-therapy remains to be clarified.

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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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Stimulation With 0.3-mg Recombinant Human Thyrotropin Prior to Iodine 131 Therapy to Improve the Size Reduction of Benign Nontoxic Nodular Goiter

Cited by 87 publications

References 26 publications

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

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

Optimizing ¹³¹I Uptake After rhTSH Stimulation in Patients with Nontoxic Multinodular Goiter: Evidence from a Prospective, Randomized, Double-Blind Study

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

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Stimulation With 0.3-mg Recombinant Human Thyrotropin Prior to Iodine 131 Therapy to Improve the Size Reduction of Benign Nontoxic Nodular Goiter

Cited by 87 publications

References 26 publications

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

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

Optimizing 131I Uptake After rhTSH Stimulation in Patients with Nontoxic Multinodular Goiter: Evidence from a Prospective, Randomized, Double-Blind Study

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

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Optimizing ¹³¹I Uptake After rhTSH Stimulation in Patients with Nontoxic Multinodular Goiter: Evidence from a Prospective, Randomized, Double-Blind Study