Improvement of Goiter Volume Reduction after 0.3 mg Recombinant Human Thyrotropin-Stimulated Radioiodine Therapy in Patients with a Very Large Goiter: A Double-Blinded, Randomized Trial

Bonnema, Steen Joop; Nielsen, Vibeke Lehmann; Boel-Jørgensen, Henrik; Grupe, Peter; Andersen, Peter B.; Bastholt, Lars; Hegedűs, László

doi:10.1210/jc.2007-0501

Cited by 81 publications

(106 citation statements)

References 24 publications

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“…The studies described so far have used doses from 0.005 mg to 0.9 mg. The injections have been performed once, 2-24 hours before the administration of I-131, or twice, at an interval of 24 hours [26,[30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

“…In another paper, a dose of 0.2 mg was administered twice in euthyroid patients, resulting in temporary overt hyperthyroidism lasting 14 days, which is not desirable in elderly patients, particularly ones with concomitant circulatory disorders [25]. Consequently, the authors suggest routine preventive symptomatic treatment [25,31,44]. Studies with patients aged 42-80 years showed that a single dose of 0.1 mg of rhTSH induces hyperthyroidism, which increases the risk of left-sided diastolic heart failure three times [45].…”

Section: Discussionmentioning

confidence: 99%

“…Another factor influencing an increase in the size of the thyroid may be inflammation of the tissue occurring in some patients after the use of I-131, which may also cause temporary pain [17,33,46,47]. Bonnema et al studied 29 patients with goiters 99-440 ml in volume and found significantly more frequent side effects after the administration of 0.3 mg of rhTSH as compared with the control group; only two patients required the use of corticosteroids, which resulted in the expected improvement [31]. In another Italian center, all patients treated with rhTSH received obligatory steroids in order to avoid complications associated with temporary thyroid enlargement [17,26].…”

Section: Discussionmentioning

confidence: 99%

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Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

et al. 2016

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Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter The aim of the study was to assess the influence of a single very low dose (0.03 mg) of rhTSH on RAIU and thyroid function in euthyroid (MNG-EU) and subclinical hyperthyroid (MNG-SC) patients with a large multinodular goiter. MATERIAL AND METHODS:40 patients (14 male, 26 female, age 57-80 yr) with large non-toxic MNG over 80 grams and with baseline RAIU < 40% were included into the double-blind randomized study and divided into two groups: rhTSH-group and control group. First group received the single intramuscular injection of 0.03 mg rhTSH and the second received placebo. The RAIU were measured 24 and 48 hours after the rhTSH and then all the patients were administered therapeutic doses of I-131. TSH and free thyroxine levels were measured at 1 st and 2 nd day after the injection of rhTSH and later, at 4 and 8 weeks after the RIT. RESULTS:The mean RAIU increased significantly from 30.44 ± 7.4% to 77.22 ± 8.7% (p < 0.001). There were no statistically significant differences in RAIU between euthyroid (MNG-EU) and subclinically hyperthyroid (MNG-SC) patients. The peak of serum TSH was noticed 24 hours after rhTSH injection and in MNG-EU patients it has remained within normal range, similarly as fT4. In the MNG-SC group the administration of rhTSH resulted in a significant increase in the TSH values after 24 hours, whose mean level slightly exceeded the upper limit of the normal range with normalization at 48 hours. 8 weeks after the RIT, the TSH and fT4 levels did not exceed the normal range and did not differ in a statistically significant way. Conclusions:Even the single very low dose of rhTSH increases the values of RAIU in significant way, in euthyroid and subclinically hyperthyroid patients. The administration of rhTSH is well-tolerated. Neoadjuvant administration of a low dose (0.03 mg) of rhTSH before I-131 seems to be an optimal method of management which may increase the effectiveness of RIT and decrease the exposure of the patients to absorbed doses of ionizing radiation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

et al. 2016

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“…Interestingly, data from our previous randomized controlled trials (14,15) indicate that mechanisms beyond the increase in the retained thyroid dose may be partially responsible for the beneficial effect of rhTSH in combination with 131 I therapy. In those studies, we found a positive correlation between the relative goiter volume reduction and the retained thyroid dose in the conventional (without rhTSH) 131 I therapy group.…”

Section: Discussionmentioning

confidence: 99%

“…In 3 randomized controlled trials (13)(14)(15), rhTSH has been documented to enhance the goiter volume reduction by 35%256% when standard 131 I activities are used. An alternative strategy is to reduce the administered 131 I activity with a factor corresponding to the rhTSH-induced increase in RAIU.…”

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confidence: 99%

Optimizing ¹³¹I Uptake After rhTSH Stimulation in Patients with Nontoxic Multinodular Goiter: Evidence from a Prospective, Randomized, Double-Blind Study

Fast¹,

Nielsen²,

Grupe³

et al. 2009

J Nucl Med

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Prestimulation with recombinant human thyroid-stimulating hormone (rhTSH) augments radioiodine 131 I therapy for benign nontoxic multinodular goiter. The purpose of this study was to determine the optimal time interval between rhTSH and 131 I administration to enhance thyroid radioactive iodine uptake (RAIU). Methods: Patients were randomized, in a 2-factorial design, to receive either a 0.1-mg dose of rhTSH (n 5 60) or placebo (n 5 30) and to a time interval of 24, 48, or 72 h before 131 I administration. The rhTSH-or placebo-stimulated RAIU study was performed at 4 wk after a baseline RAIU assessment in a tertiary referral center at a university hospital. A total of 90 patients (78 women; median age, 52 y; range, 22-83 y) referred to 131 I therapy for symptomatic nontoxic goiter (median goiter volume, 63 mL; range, 25-464 mL) were included in the study. Change in thyroid RAIU was determined at 24 and 96 h after 131 I tracer administration. Results: In the placebo subgroups, RAIU did not change significantly from baseline. The mean (6SE) 24-h RAIU increased from 33.8% 6 2.3% to 66.0% 6 1.8% (111.2% increase) with a 24-h interval, from 36.8% 6 2.1% to 64.6% 6 2.7% (83.3% increase) with a 48-h interval, and from 33.0% 6 2.7% to 49.6% 6 2.5% (62.4% increase) with a 72-h interval. All within-group changes were highly significant (P , 0.001). The effect was negatively correlated with initial RAIU (r 5 20.703, P , 0.001). The increase in 24-and 96-h RAIU was significantly higher in the rhTSH/24-h group than it was in the rhTSH/72-h group (P 5 0.023 and 0.012, respectively) and insignificantly higher than in the rhTSH/48-h group (P 5 0.37 and 0.26, respectively). Conclusion: The effect of rhTSH on thyroid RAIU is most pronounced when administered 24 h before 131 I administration and declines with longer time intervals. Whether there is a similar time dependency for goiter reduction after rhTSH-stimulated 131 I-therapy remains to be clarified.

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Recombinant human thyrotropin (rhTSH) aided radioiodine treatment for non-toxic multinodular goitre

Xie

Chen

et al. 2013

Cochrane Database of Systematic Reviews

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Improvement of Goiter Volume Reduction after 0.3 mg Recombinant Human Thyrotropin-Stimulated Radioiodine Therapy in Patients with a Very Large Goiter: A Double-Blinded, Randomized Trial

Cited by 81 publications

References 24 publications

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

Optimizing ¹³¹I Uptake After rhTSH Stimulation in Patients with Nontoxic Multinodular Goiter: Evidence from a Prospective, Randomized, Double-Blind Study

Recombinant human thyrotropin (rhTSH) aided radioiodine treatment for non-toxic multinodular goitre

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Improvement of Goiter Volume Reduction after 0.3 mg Recombinant Human Thyrotropin-Stimulated Radioiodine Therapy in Patients with a Very Large Goiter: A Double-Blinded, Randomized Trial

Cited by 81 publications

References 24 publications

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

Optimizing 131I Uptake After rhTSH Stimulation in Patients with Nontoxic Multinodular Goiter: Evidence from a Prospective, Randomized, Double-Blind Study

Recombinant human thyrotropin (rhTSH) aided radioiodine treatment for non-toxic multinodular goitre

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Optimizing ¹³¹I Uptake After rhTSH Stimulation in Patients with Nontoxic Multinodular Goiter: Evidence from a Prospective, Randomized, Double-Blind Study