PMID- 12213846
OWN - NLM
STAT- MEDLINE
DCOM- 20021003
LR  - 20061115
IS  - 0021-972X (Print)
IS  - 0021-972X (Linking)
VI  - 87
IP  - 9
DP  - 2002 Sep
TI  - Ablation of thyroid residues with 30 mCi (131)I: a comparison in thyroid cancer 
      patients prepared with recombinant human TSH or thyroid hormone withdrawal.
PG  - 4063-8
AB  - The aim of the study was to assess whether stimulation by recombinant human TSH 
      (rhTSH) may be used in patients with differentiated thyroid carcinoma for 
      postsurgical ablation of thyroid remnants using a 30-mCi standard dose of (131)I 
      during thyroid hormone therapy. The rate of ablation was prospectively compared 
      in three groups of patients consecutively assigned to one of three treatment 
      arms: in the first arm, patients (n = 50) were treated while hypothyroid (HYPO); 
      in the second arm, patients (n = 42) were treated while HYPO and stimulated in 
      addition with rhTSH (HYPO + rhTSH); in the third arm, patients (n = 70) were 
      treated while euthyroid (EU) on thyroid hormone therapy and stimulated with rhTSH 
      (EU + rhTSH). The outcome of thyroid ablation was assessed by conventional HYPO 
      (131)I scan performed in HYPO state 6-10 months after ablation. Basal serum TSH 
      was elevated in the HYPO and HYPO + rhTSH groups. In the EU + rhTSH group, basal 
      serum TSH was 1.3 +/- 2.5 micro U/ml (range, <0.005-11.9 micro U/ml). After 
      rhTSH, serum TSH significantly increased in the HYPO + rhTSH group and the EU + 
      rhTSH group. Basal 24-h radioiodine thyroid bed uptake was 5.8 +/- 5.7% (range, 
      0.2-21%) and 5.4 +/- 5.7% (range, 0.2-26%) in the HYPO and HYPO + rhTSH groups, 
      respectively. In the HYPO + rhTSH group, mean 24-h thyroid bed uptake rose to 9.4 
      +/- 9.5% (range, 0.2-46%) after rhTSH (P < 0.0001). The 24-h uptake after rhTSH 
      in the EU + rhTSH group was 2.5 +/- 4.3% (range, 0.1-32%), significantly lower (P 
      < 0.0001) than that found in the HYPO and HYPO + rhTSH groups. The rate of 
      successful ablation was similar in the HYPO and HYPO + rhTSH groups (84% and 
      78.5%, respectively). A significantly lower rate of ablation (54%) was achieved 
      in the EU + rhTSH group. Mean initial dose rate (the radiation dose delivered 
      during the first hour after treatment) was significantly lower in the EU + rhTSH 
      group (10.7 +/- 12.6 Gy/h) compared with the HYPO + rhTSH group (48.5 +/- 43 
      Gy/h) and the HYPO group (27.1 +/- 42.5 Gy/h). In conclusion, our study indicates 
      that by using stimulation with rhTSH, a 30-mCi standard dose of radioiodine is 
      not sufficient for a satisfactory thyroid ablation rate. Possible reasons for 
      this failure may be the low 24-h radioiodine uptake, the low initial dose rate 
      delivered to the residues, and the accelerated iodine clearance observed in EU 
      patients. Possible alternatives for obtaining a satisfactory rate of thyroid 
      ablation with rhTSH may consist of increasing the dose of radioiodine or using 
      different protocols of rhTSH administration producing more prolonged thyroid 
      cells stimulation.
FAU - Pacini, Furio
AU  - Pacini F
AD  - Department of Endocrinology and Metabolism, University of Pisa, 56124 Pisa, 
      Italy.
FAU - Molinaro, Eleonora
AU  - Molinaro E
FAU - Castagna, Maria Grazia
AU  - Castagna MG
FAU - Lippi, Francesco
AU  - Lippi F
FAU - Ceccarelli, Claudia
AU  - Ceccarelli C
FAU - Agate, Laura
AU  - Agate L
FAU - Elisei, Rossella
AU  - Elisei R
FAU - Pinchera, Aldo
AU  - Pinchera A
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Controlled Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Clin Endocrinol Metab
JT  - The Journal of clinical endocrinology and metabolism
JID - 0375362
RN  - 0 (Iodine Radioisotopes)
RN  - 0 (Recombinant Proteins)
RN  - 9002-71-5 (Thyrotropin)
SB  - IM
CIN - J Clin Endocrinol Metab. 2002 Sep;87(9):4059-62. PMID: 12213844
MH  - Adenocarcinoma, Follicular/drug therapy/pathology/radiotherapy/surgery
MH  - Adult
MH  - Biological Transport
MH  - Carcinoma, Papillary/drug therapy/pathology/radiotherapy/surgery
MH  - Female
MH  - Humans
MH  - Iodine Radioisotopes/pharmacokinetics/*therapeutic use
MH  - Male
MH  - Neoplasm Staging
MH  - Recombinant Proteins/therapeutic use
MH  - Thyroid Gland/drug effects/*radiation effects
MH  - Thyroid Neoplasms/*drug therapy/pathology/*radiotherapy/surgery
MH  - Thyrotropin/*therapeutic use
MH  - Treatment Outcome
EDAT- 2002/09/06 10:00
MHDA- 2002/10/04 04:00
CRDT- 2002/09/06 10:00
PHST- 2002/09/06 10:00 [pubmed]
PHST- 2002/10/04 04:00 [medline]
PHST- 2002/09/06 10:00 [entrez]
AID - 10.1210/jc.2001-011918 [doi]
PST - ppublish
SO  - J Clin Endocrinol Metab. 2002 Sep;87(9):4063-8. doi: 10.1210/jc.2001-011918.