RESUMEN
BACKGROUND: To prevent the unwarranted effects of post-thyroidectomy hypothyroidism prior to radiodine (RAI) ablation, patients with well-differentiated thyroid cancer can currently undergo this treatment while in a euthyroid state. This is achieved with the use of recombinant human thyroid-stimulating hormone (rhTSH) injections prior to the ablation. OBJECTIVES: To demonstrate the efficacy of rhTSH in radioiodine thyroid ablation in patients with differentiated thyroid cancer. METHODS: We conducted a retrospective study of patients who underwent total thyroidectomy for well-differentiated thyroid cancer with different levels of risk, treated with rhTSH prior to remnant ablation with radioiodine. RESULTS: Seventeen patients with thyroid cancer were studied and followed fora median of 25 months (range 8-49 months). Ablation (defined as stimulated thyroglobulin < 1 mg/ml and negative neck ultrasonography) was successful in 15 patients (88.2%). One of the patients was lost to follow-up. CONCLUSIONS: The use of rhTSH with postoperative radioiodine ablation may be an efficient tool for sufficient thyroid remnant ablation, avoiding hypothyroidal state in the management of thyroid cancer patients.
Asunto(s)
Técnicas de Ablación/métodos , Hipotiroidismo , Complicaciones Posoperatorias/prevención & control , Glándula Tiroides , Neoplasias de la Tiroides , Tirotropina Alfa/uso terapéutico , Adulto , Anciano , Femenino , Humanos , Hipotiroidismo/etiología , Hipotiroidismo/prevención & control , Radioisótopos de Yodo/uso terapéutico , Israel , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Clasificación del Tumor , Estadificación de Neoplasias , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/terapia , Tiroidectomía/métodos , Resultado del Tratamiento , UltrasonografíaRESUMEN
OBJECTIVE: We aimed to assess low-dose recombinant human thyroid-stimulating hormone (rhTSH)-aided, fixed-activity radioiodine therapy of large, multinodular goiters (MNGs) in elderly patients with comorbidities. DESIGN: This was a short-term, observational study. METHODS: We measured 24-h thyroid radioiodine uptake (RAIU) of 2 microCi 131-iodine at baseline and 24 h after intramuscular injection of 0.03 mg rhTSH in 17 patients (aged 60-86 years, 12 women), who subsequently received 30 mCi 131-iodine 24 h after an identical rhTSH injection. TSH and free thyroxine (FT4) were measured at baseline and days 10, 30 and 90 after therapy. Thyroid volume was assessed by computed tomography at baseline and day 180. RESULTS: rhTSH, 0.03 mg, significantly increased mean 24-h thyroid RAIU from 25.8% +/- 10.3% to 43.3% +/- 8.4% (68% relative increase; t(16) = -8.43, P < 0.001). The proportion of patients overtly or subclinically hyperthyroid (TSH < 0.5 mU/l) decreased from 71% (12/17) at baseline to 19% (3/16) at 3 months. Mean serum FT4 peaked at slightly above normal range, 25.9 +/- 7.7 pmol/l (46% over baseline) and was 21% under baseline levels at 3 months. Mean estimated thyroid volume fell 34% from baseline to 6 months (170.0 +/- 112.8 to 113.1 +/- 97.5 ml; P < 0.01). Symptomatic relief, improved well-being, and/or reduction or elimination of antihyperthyroid medication were seen in 76% of patients. Three (18%) patients had transient neck pain or tenderness, or palpitations; one had transient asymptomatic thyroid enlargement; and three (18%) became hypothyroid by 3 months. CONCLUSIONS: Intramuscular rhTSH, 0.03 mg, followed 24 h later by 30 mCi 131-iodine, is a safe, effective and convenient treatment for MNG in elderly patients with comorbidities.