Recombinant Human Thyrotropin in Thyroid Remnant Ablation with 131-Iodine in High-Risk Patients

Rosário, Pedro Weslley; Xavier, Arthur Cezar Malard; Calsolari, Maria Regina

doi:10.1089/thy.2010.0114

Cited by 16 publications

(20 citation statements)

References 33 publications

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“…In contrast to the large number of studies showing the efficacy of rhTSH for remnant ablation with 131 I in adults [1,2,3], data for children and adolescents are scarce [12]. The results of the treatment of already known distant metastases with 131 I after rhTSH administration have been reported for 8 children and adolescents in four publications [4,8,9,12].…”

Section: Discussionmentioning

confidence: 99%

“…Since this preparation has several advantages over L-T4 withdrawal [5], rhTSH may become the preparation of choice for this age group as it is for adults [1,2,3]. …”

Section: Discussionmentioning

confidence: 99%

“…Recombinant human TSH (rhTSH) has been widely used for the preparation of adult patients with differentiated thyroid carcinoma for ablation of thyroid remnants with 131 I [1,2,3]. Data regarding its use in children and adolescents for this purpose are desired since 10-15% of cases of differentiated thyroid carcinoma are diagnosed before the age of 18 and ablation with 131 I is frequently indicated for this age group after thyroidectomy [4].…”

Section: Introductionmentioning

confidence: 99%

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Recombinant Human TSH for Thyroid Remnant Ablation with <sup>131</sup>I in Children and Adolescents with Papillary Carcinoma

Rosário

Filho²,

Lacerda³

et al. 2012

Horm Res Paediatr

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Background: The objective of this study was to report the results of a series of 12 patients with papillary carcinoma aged 16 years or younger, who were prepared with recombinant human TSH (rhTSH) for remnant ablation with ¹³¹I. The TSH levels achieved and the safety of 24 cycles of rhTSH administration (ablation and control assessment) are reported. Methods: All patients were prepared using the same protocol as recommended for adults. Eight to 12 months after initial therapy, the patients were submitted to neck ultrasound, measurement of stimulated Tg and anti-Tg antibodies (TgAb), and diagnostic whole-body scanning (DxWBS). Results: TSH levels >50 mIU/l were achieved in all patients. An adverse reaction (mild nausea and headache) was observed in 1/24 cycles (4.1%). Eight (88.8%) of 9 patients with uptake in the thyroid bed in post-therapy whole-body scanning (RxWBS) achieved complete remission. One patient presented TgAb in the absence of apparent disease. In addition, imaging methods showed no apparent disease in the 2 patients with lymph node metastases in RxWBS. Elevated Tg persisted in 1 patient with pulmonary micrometastases. Conclusion: The present results demonstrate the efficacy and safety of rhTSH in children and adolescents.

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Section: Discussionmentioning

confidence: 99%

“…Since this preparation has several advantages over L-T4 withdrawal [5], rhTSH may become the preparation of choice for this age group as it is for adults [1,2,3]. …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recombinant Human TSH for Thyroid Remnant Ablation with <sup>131</sup>I in Children and Adolescents with Papillary Carcinoma

Rosário

Filho²,

Lacerda³

et al. 2012

Horm Res Paediatr

Self Cite

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“…Even when none such condition is present, recombinant TSH is preferable when it is available in patients with complete tumor resection and no apparent metastasis after thyroidectomy because it is known to be efficacious in such cases (108)(109)(110)(111)(112). Furthermore, recombinant TSH exhibits advantages over discontinuation of T4: the quality of life of the patients is not affected; it eliminates the symptoms and eventual risk of hypothyroidism; and it is associated with shorter leaves of absence, less extrathyroidal radiation, and shorter exposure to high TSH levels (103,108,109,111,113). In the remainder of patients (incomplete tumor resection or persistent metastases), discontinuation of T4 over 3 or 4 weeks is still the most proper indication in the absence of clinical contraindications.…”

Section: Ablation/therapy?mentioning

confidence: 99%

Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

Rosário

Ward

Carvalho

et al. 2013

Arq Bras Endocrinol Metab

123

147

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Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature. Arq Bras Endocrinol Metab. 2013;57(4):240-64 Keywords Thyroid nodules; thyroid cancer; Brazilian consensus; update RESUMO Nódulos tireoidianos são muito frequentes, sobretudo quando se empregam métodos sensí-veis de imagem. Embora o câncer seja proporcionalmente raro, sua incidência vem aumentando, especialmente de tumores pequenos, cuja evolução clínica é incerta. A maioria dos pacientes com carcinoma diferenciado de tireoide evolui bem quando adequadamente tratada, com índices de mortalidade similares à população geral. Por outro lado, um percentual não desprezível apresenta recidivas e alguns eventualmente não respondem às terapias convencionais, evoluindo para óbito. Assim, o desafio é distinguir os pacientes merecedores de condutas mais agressivas e, ao mesmo tempo e não menos importante, poupar a maioria de tratamentos e procedimentos desnecessários. Atualizamos o Consenso Brasileiro publicado em 2007, ressaltando os avanços diagnósticos e terapêuticos que os participantes, de diferentes Centros Universitários do Brasil, consideram mais relevantes para prática clínica. A elaboração dessas diretrizes foi baseada na experiência dos participantes e revisão da literatura pertinente. Arq Bras Endocrinol Metab. 2013;57(4):240-64 Descritores

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“…Numerous studies have confirmed that administration of radioiodine for remnant ablation after recombinant human thyroid-stimulating hormone (rhTSH) therapy achieves results that are good and by no means inferior to the traditional way of preparing patients, i.e. by thyroid hormone withdrawal (THW) [3,4,5,6,7,8,9,10,11]. For this reason, most national and society guidelines do not distinguish between rhTSH or THW for the preparation of DTC patients for ablation, except for those with proven distant metastatic disease [2,12,13].…”

Section: Introductionmentioning

confidence: 99%

Recombinant Human Thyroid-Stimulating Hormone-Aided Remnant Ablation Achieves a Response to Treatment Comparable to That with Thyroid Hormone Withdrawal in Patients with Clinically Relevant Lymph Node Metastases

2014

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It has already been shown that remnant ablation in patients with thyroid cancer and lymph node (LN) metastases has similar results when patients are prepared after recombinant human thyroid-stimulating hormone (rhTSH) therapy or thyroid hormone withdrawal (THW). Due to the current changes in the risk-of-recurrence classifications, we decided to evaluate the initial response to treatment and the outcome at medium-term follow-up in 40 consecutive patients with clinically relevant lymph nodes who received radioiodine remnant ablation after rhTSH therapy (n = 20) or THW (n = 20). Each patient received either 100 or 150 mCi 131-I for ablation based on TNM status, and the mean amounts of 131-I used in the 2 groups were not significantly different. An excellent response to treatment was observed in 45% of the patients prepared after rhTSH therapy compared to 20% of those prepared after THW (p = 0.08). Three patients (2 in the THW group and 1 in the rhTSH group) who had N1a in the initial surgery presented with structural persistence as an initial response to treatment. One patient in the THW group had a follow-up of the persistent disease with no surgical treatment, and 2 others received a lateral LN dissection. When the status at final follow-up was considered (median follow-up 3.3 years, range 3-4.2), 60% of the patients ablated after rhTSH therapy were considered with no evidence of disease, compared to 30% of those who underwent THW. The frequency of structural persistence (metastatic LN) was similar in the 2 groups (15 vs. 25%), and the distribution of the responses at final follow-up was not statistically significantly different (p = 0.12). We conclude that preparation after rhTSH therapy seems to be as effective as after THW for patients with clinically relevant LN metastases.

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Recombinant Human Thyrotropin in Thyroid Remnant Ablation with 131-Iodine in High-Risk Patients

Abstract: rhTSH is as effective as THW for RA in patients with WDTC who are at a high risk of relapse.

Cited by 16 publications

References 33 publications

Recombinant Human TSH for Thyroid Remnant Ablation with <sup>131</sup>I in Children and Adolescents with Papillary Carcinoma

Recombinant Human TSH for Thyroid Remnant Ablation with <sup>131</sup>I in Children and Adolescents with Papillary Carcinoma

Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

Recombinant Human Thyroid-Stimulating Hormone-Aided Remnant Ablation Achieves a Response to Treatment Comparable to That with Thyroid Hormone Withdrawal in Patients with Clinically Relevant Lymph Node Metastases

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