Iodine Biokinetics and Radioiodine Exposure after Recombinant Human Thyrotropin-Assisted Remnant Ablation in Comparison with Thyroid Hormone Withdrawal

Taïeb, David; Sébag, F.; Farman-Ara, Bardia; Portal, T; Baumstarck, Karine; Fortanier, Cécile; Bourrelly, Marc; Mancini, Julien; Micco, C. De; Auquier, Pascal; Conte-Devolx, B.; Henry, Jean François; Mundler, O.

doi:10.1210/jc.2009-2528

Cited by 65 publications

(45 citation statements)

References 25 publications

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“…3 Means and standard deviations of other chemistry profiles (ALP, total bilirubin, and triglyceride) for the group receiving traditional thyroid hormone withdrawal (THW) and the group receiving recombinant human thyroidstimulating hormone (rh-TSH). There were no statistically significant differences between the two groups the body [18], not only patients with metabolic syndrome, but also elderly patients and those with large thyroid remnants can more safely undergo rh-TSH than THW.…”

Section: Discussionmentioning

confidence: 76%

“…Another study on iodine biokinetics showed the effective half-life in the remnant thyroid tissue was significantly longer after rh-TSH than THW, reducing radiation exposure to the rest of the body and to the general public who come in contact with such patients [18]. In these patients, the efficacy of radioiodine treatment is related to the radiation dose delivered to remnant and neoplastic thyroid tissue [19].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Influence on the Liver Function Between Thyroid Hormone Withdrawal and rh-TSH Before High-Dose Radioiodine Therapy in Patients with Well-Differentiated Thyroid Cancer

Han

Lim

Yun

et al. 2012

Nucl Med Mol Imaging

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Purpose An elevated thyroid stimulating hormone level (TSH) is essential to stimulate the uptake of radioiodine into thyroid remnants and metastases of thyroid cancer when a patient undergoes high-dose radioiodine therapy. Nowadays, recombinant human thyroid stimulating hormone (rh-TSH) is increasingly used instead of the classic method of thyroid hormone withdrawal (THW). However, beyond the therapeutic effects, clinical differences between the two methods have not yet been clearly demonstrated. The aim of this work was to investigate the effects of the two methods, especially on liver function. Methods We identified 143 evaluable patients who were further divided into two groups: THW and rh-TSH. We first reviewed the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, which were measured during the admission period for total thyroidectomy. We called these liver enzyme levels "base AST" and "base ALT." We also assessed other chemistry profiles, including AST, ALT, total cholesterol, LDL cholesterol, alkaline phosphatase (ALP), total bilirubin (TB), and triglyceride (TG), which were measured on admission day for high-dose radioiodine therapy. We called these liver enzyme levels "follow-up AST" and "follow-up ALT." We compared the changes in base and follow-up liver enzyme levels and the other chemistry profiles between the two groups. Results The base AST and base ALT levels of the two groups were within normal range, and there was no significant difference between the two groups. In contrast to these base liver enzyme levels, follow-up liver enzyme levels between the two groups showed significant differences. Patients in the THW group had higher follow-up AST and ALT levels than did the rh-TSH group. Patients in the THW group also had higher levels of total cholesterol and LDL cholesterol than did the patients in the rh-TSH group. However there were no statistically significant differences in ALP, total bilirubin, and triglyceride levels between the two groups. Conclusions In this retrospective analysis of liver function, the use of rh-TSH for high-dose radioiodine therapy had less of an effect on liver function and cholesterol levels than dose thyroid hormone withdrawal. This suggests that rh-TSH can be used effectively and safely especially for patients with metabolic syndrome.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Comparison of the Influence on the Liver Function Between Thyroid Hormone Withdrawal and rh-TSH Before High-Dose Radioiodine Therapy in Patients with Well-Differentiated Thyroid Cancer

Han

Lim

Yun

et al. 2012

Nucl Med Mol Imaging

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“…Three trials reported the effects on the blood and bone marrow [10,16,17]. But the study parameters were not identical in these trials.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Adjuvant Interventions for Radioiodine in Patients with Thyroid Cancer

Ge³

et al. 2015

Oncol Res Treat

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Aims: The purpose of this study was to assess the effects of adjuvant interventions for radioiodine in patients with thyroid cancer. Materials and Methods: A systematic search was undertaken on July 9, 2014. RevMan 5 software was used to synthesize data. Results: 13 randomized controlled trials were included. The pooled risk ratio of 0.99 (95% confidence interval (CI): 0.96-1.02, p = 0.58) indicated no significant difference in successful thyroid remnant ablation between recombinant human thyroid-stimulating hormone (rhTSH) and thyroid hormone withdrawal in 7 trials. The percentage of patients who had successful ablation was significantly higher in the oral-lithium group than in the control group (p = 0.017). A computerized decision aid improves informed decision-making in patients with early-stage papillary thyroid cancer (PTC) who are considering adjuvant radioiodine treatment (p < 0.001). Amifostine pretreatment did not prevent parenchymal damage to the major salivary gland function after radioiodine treatment (p = 0.2461). Conclusions: The present systematic review suggests that rhTSH, lithium, and computerized decision aids maybe act as beneficial adjuvant interventions for radioiodine in patients with thyroid cancer; however, amifostine does not exhibit helpful effects in thyroid cancer patients treated with radioiodine.

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“…Alternatively, preparation for radioiodine treatment with rhTSH instead of THW has been proposed to induce less bone marrow toxicity. rhTSH preparation is associated with a lower red marrow absorbed dose [31], and in a study performed in 15 elderly DTC patients no clinically relevant bone marrow toxicity was observed after radioiodine therapy [32]. However, no differences in peripheral blood counts were found between patients prepared with THW and rhTSH in a larger-scale study [33].…”

Section: Radioiodine Therapymentioning

confidence: 99%

Radioiodine Treatment and Thyroid Hormone Suppression Therapy for Differentiated Thyroid Carcinoma: Adverse Effects Support the Trend toward Less Aggressive Treatment for Low-Risk Patients

Hesselink¹,

Links²

2015

Eur Thyroid J

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Over the past decades, the incidence of differentiated thyroid carcinoma (DTC) has steadily increased, with especially a growing number of low-risk patients. Whereas DTC used to be treated rather aggressively, it is now acknowledged that aggressive treatment does not affect outcome for low-risk patients and that it can induce adverse effects. In this review an overview of the most clinically relevant adverse effects of radioiodine treatment and thyroid hormone suppression therapy (THST) is presented, and the trend toward less aggressive treatment for low-risk patients is outlined. Salivary gland dysfunction occurs in roughly 30% of patients, and is probably due to the concentration of radioiodine in the salivary glands by the sodium/iodide symporter. Beta radiation from radioiodine can result in sialoadenitis and eventually fibrosis and loss of salivary function. Furthermore, patients can experience bone marrow dysfunction following radioiodine treatment. Although this is in general subclinical and transient, patients that receive very high cumulative radioiodine doses may be at risk for more severe bone marrow dysfunction. THST can induce adverse cardiovascular effects in patients with DTC, such as diastolic and systolic dysfunction, and also adverse vascular and prothrombotic effects have been described. Finally, the effects of THST on bone formation and resorption are outlined; especially postmenopausal women with DTC on THST seem to be at risk of bone loss. In the past years, advances have been made in preventing low-risk patients from being overtreated. Improved biomarkers are still needed to further optimize risk stratification and personalize medicine.

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Iodine Biokinetics and Radioiodine Exposure after Recombinant Human Thyrotropin-Assisted Remnant Ablation in Comparison with Thyroid Hormone Withdrawal

Abstract: In comparison with thyroid hormone withdrawal, rhTSH is associated with longer remnant half-life of radioactive iodine while also reducing radiation exposure to the rest of the body and also to the general public who come in contact with such patients.

Cited by 65 publications

References 25 publications

Comparison of the Influence on the Liver Function Between Thyroid Hormone Withdrawal and rh-TSH Before High-Dose Radioiodine Therapy in Patients with Well-Differentiated Thyroid Cancer

Comparison of the Influence on the Liver Function Between Thyroid Hormone Withdrawal and rh-TSH Before High-Dose Radioiodine Therapy in Patients with Well-Differentiated Thyroid Cancer

A Systematic Review of Adjuvant Interventions for Radioiodine in Patients with Thyroid Cancer

Radioiodine Treatment and Thyroid Hormone Suppression Therapy for Differentiated Thyroid Carcinoma: Adverse Effects Support the Trend toward Less Aggressive Treatment for Low-Risk Patients

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