La TSH humana recombinante en el seguimiento de pacientes con cáncer diferenciado de tiroides

Camarero, P. Gómez; Brocca, MA Martínez; Rodríguez, JR Rodríguez; González, E Navarro; Hospital, JL Tirado; Duarte, Dawn; Albertino, R. Vázquez; Jimenez, R Astorga

doi:10.1157/13052230

Cited by 4 publications

(2 citation statements)

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“…In publications to date, rhTSH has been used for a variety of reasons (Table 2) to aid radioiodine treatment in a total of 217 patients, aged 14 to 87 years (108 female, 90 male, 18 sex unreported or not clearly reported; histology: papillary in 69, follicular in 64, Hu¨rthle cell in 1, unreported or not clearly reported in 83) (Chiu et al 1997, Adler et al 1998, Rudavsky & Freeman 1998, Colleran & Burge 1999, Perros 1999, Masiukiewicz et al 1999, Vargas et al 1999, Jarzab et al 2000a, Lippi et al 2000, Mariani et al 2000, Mazzaferri & Kloos 2000, Robbins et al 2000, Rotman-Pikielny et al 2000, Aslam & Daly 2001, Checrallah et al 2001, McDougall & Weigel 2001, Pellegritti et al 2001, Berg et al 2002, Mu¨ller et al 2002, Robeson et al 2002, Goffman et al 2003, Go´mez Camarero et al 2003, de Keizer et al 2003, Menzel et al 2003, Driedger & Kotowycz 2004, Kovatcheva et al 2004, Taı¨eb et al 2004. The published experience has encompassed at least 266 courses of rhTSH-aided radioiodine treatment, with up to six courses given per patient (Driedger & Kotowycz 2004).…”

Section: Rhtsh-aided Treatmentmentioning

confidence: 99%

“…By the end of August 2004, open-label experience with rhTSH-aided ablation or treatment involving a total of 394 patients had been published by some 29 medical centres worldwide (Chiu et al 1997, Adler et al 1998, Rudavsky & Freeman 1998, Colleran & Burge 1999, Perros 1999, Masiukiewicz et al 1999, Vargas et al 1999, Jarzab et al 2000a, Lippi et al 2000, Luster et al 2000a,b, Mariani et al 2000, Mazzaferri & Kloos 2000, Robbins et al 2000, Rotman-Pikielny et al 2000, Aslam & Daly 2001, Checrallah et al 2001, McDougall & Weigel 2001, Pellegritti et al 2001, Berg et al 2002, Mu¨ller et al 2002, Pacini et al 2002, Robeson et al 2002, Barbaro et al 2003, Goffman et al 2003, Go´mez Camarero et al 2003, de Keizer et al 2003, Menzel et al 2003, Driedger & Kotowycz 2004, Kovatcheva et al 2004, Taieb et al 2004. All but two of these studies (Pacini et al 2002, Barbaro et al 2003 have utilized the rhTSH regimen most investigated and now approved in the diagnostic setting: one intramuscular injection of 0.9 mg on each of two consecutive days given during THST, with administration of 131 I on the third day.…”

Section: Introductionmentioning

confidence: 99%

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rhTSH-aided radioiodine ablation and treatment of differentiated thyroid carcinoma: a comprehensive review

Luster¹,

Lippi²,

Jarząb³

et al. 2005

Endocr Relat Cancer

164

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Traditionally, withdrawal of thyroid hormone has been used to attain the increase in serum TSH concentrations that are believed to optimize the trapping and retention of radioiodine for diagnostic procedures, thyroid remnant ablation and treatment of patients with differentiated thyroid cancer (DTC). However, withdrawal frequently causes clinical hypothyroidism, with resultant cognitive impairment, emotional dysfunction, physical discomfort, health risks in patients who are elderly, frail or have concomitant illness, and impaired quality of life and ability to work. Recombinant human TSH (rhTSH) was developed to provide TSH stimulation without withdrawal of thyroid hormone and the associated morbidity. rhTSH has been approved as an adjunct for diagnostic procedures in patients with DTC, but is currently an experimental aid in thyroid remnant ablation and the treatment of thyroid tumours. In the period 1997-2004, nearly 30 medical centres worldwide have reported on almost 400 patients with DTC who were given rhTSH in preparation for radioiodine ablation of thyroid remnants or treatment of local tumours of metastatic disease. We have analysed and summarized the findings reported in this literature. Ablation aided by the standard course of rhTSH, two consecutive daily injections of 0.9 mg, had success rates better than 84% in 90 patients given radioiodine activities in excess of 4000 MBq. However, when 1110 MBq was administered, success rates were 81.2% in 16 patients given the standard course of rhTSH and 4-day withdrawal of thyroid hormone around the time of radioiodine administration in one study, but 54% in 70 patients in another study. rhTSH-aided treatment of persistent or recurrent local or metastatic cancer, or both, with from one to six courses of radioiodine 1000-19055 MBq, achieved 2% complete remission, 36% partial response and 27% disease stabilization rates, for a 65% clinical benefit rate, in 115 primarily elderly, late-stage patients for whom responses were reported. Twelve of these patients died as a result of progressive disease or were discharged from hospital into hospice care. Generally, rhTSH was very well tolerated. However, in a minority of patients with central nervous system, spinal or bone metastases, or bulky thyroid remnant or neck lesions with or without poor pulmonary reserve, administration of rhTSH, like thyroid hormone withdrawal, was found to stimulate expansion of the tumour, with ensuing compression of key anatomical structures and neurological, respiratory or other clinical complications. The rapid onset, response to glucocorticoids and radiological findings of peritumoural oedema or, less commonly, haemorrhage in the published cases, strongly suggest that the tumour expansion was the result of swelling rather than growth. As in the case of thyroid hormone withdrawal, special attention and glucocorticoid premedication are thus warranted when rhTSH is given to patients known or suspected to have the above characteristics. Dosimetric data suggest that whole-body and whole-blood ra...

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