Recombinant human thyrotropin stimulation prior to I-131 therapy in toxic multinodular goitre with low radioactive iodine uptake
Por:
Azorín Belda MJ, Martínez Caballero A, Figueroa Ardila GC, Martínez Ramírez M, Gómez Jaramillo CA, Dolado Ardit JI and Verdú Rico J
Publicada:
1 ene 2017
Categoría:
Radiology, nuclear medicine and imaging
Resumen:
Aim: Stimulation with recombinant human thyrotropin (rhTSH) increases thyroid radioiodine uptake, and is an aid to 1311 therapy in non-toxic multinodular goitre (MNG). However, there are not many studies using rhTSH prior to 1311 in toxic multinodular goitre to improve hyperthyroidism and compressive symptoms.
Material and method: A prospective study was conducted on patients with MNG and hyperthyroidism. Patients were recruited consecutively and divided into group I, stimulated with 0.3 mg of rhTSH before radioiodine therapy, and a control group or group II, without stimulation. Thyroid function, radioiodine thyroid uptake, thyroid weight, and compressive symptoms were measured, and patients were followed up for 9 months.
Results: Group I consisted of 16 patients (14 women), with a mean age 69.7 years, and group II with 16 patients (12 women), with a mean age 70.7 years. After stimulation with 0.3 mg rhTSH in group I, 1311 uptake (RAIU) at 24h increased by 78.4%, and the estimated absorbed dose by 89.3%. In group II, the estimated absorbed dose was lower than group I after stimulation with rhTSH (29.8 Gy vs. 56.4 Gy; P=0.001).
At 9 months of follow-up, hyperthyroidism was controlled in 87.5% of patients in group I, and 56.2% in group II (P=0.049). The mean reduction in thyroid weight was higher in group I than in group II (39.3% vs. 26.9%; P=0.017), with a tendency towards subjective improvement of compressive symptoms in group I, although non-significant. Only 2 patients described tachycardias after rhTSH administration, which were resolved with beta-blockers.
Conclusion: Stimulation with 0.3 mg of recombinant human thyrotropin prior to radioiodine therapy achieves a reduction in thyroid weight and functional improvement in patients with hyperthyroidism and multinodular goitre with low uptake, and with no need for hospital admission. (C) 2016 Elsevier Espana, S.L.U. y SEMNIM. All rights reserved.
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