The use of recombinant human TSH in the follow‐up of differentiated thyroid cancer: experience from a large patient cohort in a single centre

Mantovani, Giovanna; Arianna, Lupoli Gelsy; Ciccarelli, Andrea; Fonderico, Francesco; Klain, Michele; Squame, G; Mastrangelo, Salvatore; Lupoli, Giovanni

doi:10.1046/j.0300-0664.2001.01425.x

Cited by 52 publications

(21 citation statements)

References 43 publications

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“…Likewise, tumour swelling and pain from metastases, resulting from repeated injections of 0.9 mg rhTSH have been reported in patients with differentiated thyroid carcinoma (65). Thus, 0.9 mg of rhTSH administered to nine healthy individuals resulted in a 35% increase in mean thyroid volume at 48 h (62).…”

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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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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“…Moreover, no adverse effects have been reported when testing similar or lower doses of rhTSH in subjects with an intact benign thyroid gland (Huysmans et al, 2000;Lawrence et al, 2001;Torres et al, 2001). Nevertheless, there have been recent reports of more serious reactions such as tumour swelling and pain from metastases, resulting from repeated injections of 0·9 mg rhTSH in patients with DTC (Vargas et al, 1999;Robbins et al, 2000;Braga et al, 2001;Giovanni et al, 2002;Goffman et al, 2003).…”

Section: Adverse Effects Of Rhtshmentioning

confidence: 99%

The effects of recombinant human thyrotropin, in normal subjects and patients with goitre

Nielsen

Bonnema

2004

Clinical Endocrinology

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“…No DxWBS was performed in the present series and we directly administered a therapeutic dose of 131 I (followed by RxWBS) to patients with negative US and CT. DxWBS showed ectopic uptake in only 5 to 33% of patients with detectable Tg on T4 in other series (13)(14)(15)(16). We therefore considered DxWBS to be of little value in this situation.…”

Section: Discussionmentioning

confidence: 99%

“…Direct administration of a therapeutic 131 I dose to these patients would permit the detection of most cases of metastases, with a sensitivity of 75 to 93% (13)(14)(15). However, empirical therapy with radioiodine in all patients with detectable Tg on T4 (1,2) deserves further discussion.…”

Section: Discussionmentioning

confidence: 99%

Management of low-risk patients with thyroid carcinoma and detectable thyroglobulin on T4 after thyroidectomy and ablation with iodine-131

Rosario

Borges

Costa

et al. 2007

Arq Bras Endocrinol Metab

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Objective: To evaluate the positive predictive value of detectable Tg during T4 therapy (Tg on T4) in patients with thyroid cancer after total thyroidectomy and remnant ablation, discussing the work-up in this situation and the empirical indication of 131 I. Patients and methods: Initially, 234 low-risk patients [tumor ≤ 5cm, completely resected, no extensive extrathyroid invasion (pT4)] submitted to total thyroidectomy and ablation with 131 I (3.7-5.5 GBq) who presented no ectopic uptake on RxWBS were studied. Of these, 23 patients with detectable Tg on T4 (> 1ng/ml) during the first year after initial therapy were selected. Results: Metastases were detected by neck US in 7 patients, by chest CT in 2 and by US and CT in 3. Four of five patients with lung metastases upon CT had a positive RxWBS. Eleven patients with negative US and CT received a new 131 I dose (without DxWBS), and RxWBS showed ectopic uptake in 3 patients. Among the patients with negative RxWBS, 7 remained free of apparent disease and Tg was declining (5 with undetectable Tg on T4 at the end of the study). One patient presented an increase in Tg and FDG-PET was positive for lymph node and bone metastases. Conclusions: All patients with Tg on T4 > 5ng/ml presented apparent disease. In these cases, even when US and CT are negative, the administration of a therapeutic dose of 131 I (without DxWBS) and FDG-PET are recommended. Among patients with detectable Tg on T4 ≤ 5ng/ml and negative US and CT, only 12% presented ectopic uptake on RxWBS. These cases could be followed up by monitoring Tg on T4, and RxWBS and FDG-PET should only be performed if this marker does not decrease after 1-2 years. Objetivo: Avaliar o valor preditivo positivo da Tg detectável durante terapia com T4 (Tg sob T4) em pacientes com câncer de tireóide após tireoidectomia total e ablação dos remanescentes, discutindo o manuseio dessa situação e a indicação empírica de 131 I. Pacientes e métodos: Inicialmente, foram estudados 234 pacientes de baixo risco [tumor ≤ 5cm, completamente ressecado, sem invasão extratireoideana extensa (pT4)] submetidos à tireoidectomia total e ablação com 131 I (3,7-5,5 GBq) que não apresentaram captação ectópica com RxWBS. Desses, foram selecionados 23 pacientes com Tg detectável com T4 (> 1ng/ml) durante o primeiro ano após a terapia inicial. Resultados: Metástases foram detectadas em 7 pacientes pelo US cervical, em 2 pela TC de tórax e em 3 pela US e TC. Quatro de 5 pacientes com metástases pulmonares à TC tiveram um RxWBS positivo; 11 pacientes com US e TC negativos receberam uma nova dose de 131 I (sem DxWBS), e a RxWBS mostrou captação ectópica em 3 pacientes. Entre os pacientes com RxWBS negativo, 7 permaneceram livres de doença aparente e a Tg estava em declínio (5 com Tg indetectável sob T4 ao final do estudo). Um paciente apresentou aumento da Tg e o FDG-PET foi positivo para linfonodos e metástases ósseas. Conclusões: Todos os patients com Tg sob T4 > 5ng/ml apresentaram doença aparente. Nesses casos, mesmo quando a US e a TC são ne...

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The use of recombinant human TSH in the follow‐up of differentiated thyroid cancer: experience from a large patient cohort in a single centre

Cited by 52 publications

References 43 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

The effects of recombinant human thyrotropin, in normal subjects and patients with goitre

Management of low-risk patients with thyroid carcinoma and detectable thyroglobulin on T4 after thyroidectomy and ablation with iodine-131

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