Prestimulation with Recombinant Human Thyrotropin (rhTSH) Improves the Long-Term Outcome of Radioiodine Therapy for Multinodular Nontoxic Goiter

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

doi:10.1210/jc.2011-3335

Cited by 37 publications

(30 citation statements)

References 29 publications

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“…Second, patients with toxic nodular disease who receive 131 I in the presence of detectable levels of TSH show higher rates of hypothyroidism than those with undetectable TSH at the time of treatment (3,4). Finally, the administration of rhTSH before 131 I therapy to patients with nodular disease, which increases the tissue area that takes up iodine, notably increases the risk of hypothyroidism (16). Thus, normalization of TSH with ATDs before radioiodine, restoring the uptake by normal thyroid tissue, increases the risk of hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to non-voluminous nodular goiter and its effect on bone metabolism

Rosário¹

2013

Arq Bras Endocrinol Metab

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Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to nonvoluminous nodular goiter and its effect on bone metabolism I therapy in elderly patients with subclinical hyperthyroidism (SCH) due to nodular disease and who did not receive antithyroid drugs (ATDs), and the effect of the treatment on bone metabolism. Subjects and methods: Thirty-six patients with TSH ≤ 0.1 mIU/L and non-voluminous goiter (< 60 cm 3 ) were studied. Bone mineral density (BMD) was assessed in 17 women with osteopenia. Results: Mean 24-h 131 I uptake was 17.5%. Symptoms of thyrotoxicosis were reported by two (5.5%) patients in the first week after therapy. One year after radioiodine treatment, SCH was resolved in 30 (83.3%) patients, and hypothyroidism was detected in one (2.7%). In the patients in whom TSH returned to normal, femoral and lumbar spine BMD increased by 1.9% and 1.6%, respectively, in average. I em 24 h foi 17,5%. Sintomas de tireotoxicose foram reportados por dois pacientes (5,5%) na primeira semana após a terapia. Um ano após o radioiodo, HSC foi resolvido em 30 pacientes (83,3%) e hipotireoidismo ocorreu em 1 (2,7%). Nas pacientes que normalizaram o TSH, DMO em fêmur e coluna lombar incrementou em média 1,9% e 1,6%, respectivamente. Conclusões: Em idosos com HSC e bócio não volumoso, radioiodo, não precedido de DATs, é uma alternativa terapêutica segura e eficaz. Resolução do HSC tem benefício na DMO em mulheres menopausadas com osteopenia. Arq Bras Endocrinol Metab. 2013;57(2):144-7 Descritores Hipertireoidismo subclínico; radioiodo; doença nodular

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Section: Discussionmentioning

confidence: 99%

Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to non-voluminous nodular goiter and its effect on bone metabolism

Rosário¹

2013

Arq Bras Endocrinol Metab

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“…It is unclear whether rhTSH-stimulated radioiodine therapy increases the risk of thyroidal and extrathyroidal malignancy. Long-term efficacy is retained (323 In one series, thyroid nodules were diagnosed in 34 of 221 pregnant patients who were monitored for 3 months after delivery (346 [EL 2]). The volume of the single or dominant thyroid nodule increased from a mean of 60 mm 3 at the beginning of pregnancy to 65 mm 3 at the third trimester and 103 mm 3 at 6 weeks after delivery.…”

Section: Management and Therapymentioning

confidence: 99%

American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules - 2016 Update Appendix

et al. 2016

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“…During the last decade, and based on the above observations, rhTSH has been evaluated as an adjuvant to 131 I therapy, in an attempt to improve the efficacy of this treatment for MNG (18,39,40). Different rhTSH doses have been utilized: in some studies 0.2 mg or more (41,42,43,44,45,46,47), while in others 0.1 mg or less (11,16,20,24,31,48). Since the introduction of rhTSH as an aid for 131 I therapy in MNG, nine randomized controlled trials (RCTs) have been published (11,14,15,16,19,24,25,44,45 reduction of the goiter.…”

Section: Rhtsh and 131 I For Mngmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Recombinant human TSH and radioactive iodine therapy in the management of benign multinodular goiter

Graf

2015

European Journal of Endocrinology

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Multinodular goiter (MNG) is a very common thyroid disorder determined by diverse goitrogenic factors, the most important one being iodine deficiency. The clinical presentation of a patient with MNG varies from a completely asymptomatic goiter to a life-threatening disease due to upper airway compression. Patients can develop underlying subclinical or overt hyperthyroidism due to autonomously hyperfunctioning nodules. In the absence of clinical, ultrasonographic, or cytological findings suggestive of malignancy, the best therapeutic approach for a patient with MNG will depend on the size and location of the goiter, the presence and severity of compressive symptoms, and the presence or absence of thyrotoxicosis. There is still no consensus regarding the treatment of atoxic MNGs. Hence, its optimal management remains controversial; possible therapies include levothyroxine (LT 4 ), surgery, and radioactive iodine ( 131 I). Suppressive treatment with LT 4 is discouraged due to the development of sub-clinical or overt hyperthyroidism and to its low efficacy when compared with surgery or 131 I. Total thyroidectomy is effective; however, it is associated with the risk of surgical complications and is often refused by the patient. 131 I therapy is an alternative to thyroid surgery to reduce the size of benign MNGs. Based on the ability of recombinant human TSH (rhTSH) to more than double thyroid 131 I uptake, this compound has been evaluated as an adjuvant to 131 I in the treatment of MNG. Very small doses of rhTSH have been used in patients with MNG and few safety concerns have been observed, but the ideal dose, both effective and safe, is yet to be defined.

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Prestimulation with Recombinant Human Thyrotropin (rhTSH) Improves the Long-Term Outcome of Radioiodine Therapy for Multinodular Nontoxic Goiter

Cited by 37 publications

References 29 publications

Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to non-voluminous nodular goiter and its effect on bone metabolism

Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to non-voluminous nodular goiter and its effect on bone metabolism

American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules - 2016 Update Appendix

THERAPY OF ENDOCRINE DISEASE: Recombinant human TSH and radioactive iodine therapy in the management of benign multinodular goiter

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