Current trends in treatment and follow-up of patients with differentiated thyroid carcinoma – experience with the use of recombinant human thyrotropin

Czech version

Authors: M. Macková; P. Vlček
Authors‘ workplace: Klinika nukleární medicíny a endokrinologie 2. lékařské fakulty UK a FN Motol Praha, přednosta prof. MUDr. Petr Vlček, CSc.
Published in: Vnitř Lék 2013; 59(2): 106-112
Category: Review

Overview

Differentiated thyroid carcinoma is the most common endocrine malignancy with an excellent prognosis in the case of its early detection. Radioiodine ¹³¹I and thyroid hormones continue to be the pivotal drugs in treatment and follow-up for more than 50 years. The therapeutical and diagnostic options were recently expanded by the use of recombinant human thyrotropin (rhTSH). Our experience with the diagnostic administration of rhTSH confirms the outcomes of official trials and also indicates that the effect of rational therapy with ¹³¹I after rhTSH is similar to the outcome after standard regime using long-term thyroid hormone withdrawal.

Key words:
differentiated thyroid carcinoma – radioiodine ¹³¹I – thyrotropin (TSH) – TSH stimulation – rhTSH – thyroid hormone withdrawal – hypothyroidism – thyroxine (T₄) – TSH suppression

Sources

1. Vlček P. Endokrinologicko-nukleárně medicínské aspekty v léčbě nádorů štítné žlázy. Vnitř Lék 2007; 53: 807–811.

2. Luster M, Clarke SE, Dietlein M et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol imaging 2008; 35: 1941–1959.

3. Tuttle RM, Brokhin M, Omry G et al. Recombinant human TSH-assisted radioactive iodine remnant ablation achieves short-term clinical recurrence rates similar to those of traditional thyroid hormone withdrawal. J Nucl Med 2008; 49: 764–770.

4. Elisei R, Schlumberger M, Driedger A et al. Follow-up of low-risk differentiated thyroid cancer patients who underwent radioiodine ablation of postsurgical thyroid remnants after either recombinant human thyrotropin of thyroid hormone withdrawal. J Clin Endocrinol Metab 2009; 94: 4171–4179.

5. Lee J, Yun MJ, Nam KH et al. Quality of life and effectiveness comparisons of thyroxine withdrawal, triiodothyronine withdrawal, and recombinant human thyroid-stimulating hormone administration for low-dose radioiodine remnant ablation of differentiated thyroid carcinoma. Thyroid 2010; 20: 173–179.

6. Rosario PW, Xavier AC, Calsolari MR Recombinant human thyrotropin in thyroid remnant ablation with 131I-iodine in high-risk patients. Thyroid 2010; 20: 1247–1252.

7. Robbins RJ, Driedger A, Magner J et al. Recombinant human thyrotropin-assisted radioiodine therapy for patients with metastatic thyroid cancer who could not elevace endogenous thyrotropin or be withdrawn from thyroxine. Thyroid 2006; 16: 1121–1130.

8. Molinaro E, Viola D, Passannanti P et al. Recombinant human TSH (rhTSH) in 2009: new perspectives in diagnosis and therapy. Q J Nucl Med Mol Imaging. 2009; 53: 490–502.

9. Klubo-Gwiezdzinska J, Burman KD, Van Nostrand D et al. Radioiodine treatment of metastatic thyroid cancer: relative efficacy and side effect profile after preparation by thyroid hormone withdrawal vs. recombinant human thyrotropin. Thyroid 2012; 22: 310–317.

10. Tala H, Robbins R, Fagin JA et al. Five-year survival is similar in thyroid cancer patients with distant metastases prepared for radioactive iodine therapy with either thyroid hormone withdrawal or recombinant human TSH. J Clin Endocrinol Metab 2011; 96: 2105–2111.

11. Frigo A, Dardano A, Danese E et al. Chromosome translocation frequency after radioiodine thyroid remnant ablation: a comparison between recombinant human thyrotropin stimulation and prolonged levothyroxine withdrawal. J Clin Endocrinol Metab 2009; 94: 3472–3476.

12. Rosario PW, Salles DS, Purisch S Area under the curve of TSH after levothyroxine withdrawal versus administration of recombinant human TSH (rhTSH): possible implications for tumor growth. Arq Bras Endocrinol Metabol 2009; 53: 767–770.

13. Menzel C, Kranert WT, Döbert N et al. rhTSH Stimulation Before Radioiodine Therapy in Thyroid Cancer Reduces the Effective Half-Life of 131I. J Nucl Med 2003; 44: 1065–1068.

14. Vaiano A, Claudio Traino A et al. Comparison between remnant and red-marrow absorbed dose in thyroid cancer patients submitted to 131I ablative therapy after rh-TSH stimulation versus hypothyroidism induced by L-thyroxine withdrawal. Nucl Med Commun 2007; 28: 215–223.

15. Rosário PW, Borges MA, Purisch S. Preparation with recombinant human thyroid-stimulating hormone for thyroid remnant ablation with 131I is associated with lowered radiotixicity. J Nucl Med 2008; 49: 1776–1782.

16. Taïeb D, Sebag F, Farman-Ara B et al. Iodine biokinetics and radiodine exposure after recombinant human thyrotropin-assisted remnant ablation in comparison with thyroid hormone withdrawal. J Clin Endocrinol Metab 2010; 95: 3283–3290.

17. Borget I, Remy H, Chevalier J et al. Lenght and cost of hospital stay of radioiodine ablation in thyroid cancer patients: comparison between preparation with thyroid hormone withdrawal and thyrogen. Eur J Nucl Med Mol Imaging 2008; 35: 1457–1463.

18. Klubo-Gwiezdzinska J, Burman KD, Van Nostrand D et al. Does an undetectable rhTSH-stimulated Tg level 12 month after initial treatment of thyroid cancer indicate remission? Clin Endocrinol (Oxf) 2011; 74: 111–117.

19. Kloos RT. Thyroid cancer recurrence in patients clinically free of disease with undetectable or very low serum thyroglobulin values. J Clin Endocrinol Metab 2010; 95: 5241–5248.

20. Molinaro E, Viola D, Passannanti P et al. Recombinant human TSH (rhTSH) in 2009: new perspectives in diagnosis and therapy. Q J Nucl Med Mol Imaging 2009; 53: 490–502.

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Article was published in

Internal Medicine

2013 Issue 2