Recombinant Human Thyrotropin-Stimulated Radioiodine Therapy of Nodular Goiter Allows Major Reduction of the Radiation Burden with Retained Efficacy

Fast, Søren; Hegedűs, László; Grupe, Peter; Nielsen, Vibeke Lehmann; Bluhme, C.; Bastholt, Lars; Bonnema, Steen Joop

doi:10.1210/jc.2010-0634

Cited by 42 publications

(56 citation statements)

References 23 publications

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“…rhTSH in a low single dose increases 131 I uptake by two-to fourfold, and similar therapeutic effects (in comparison with higher 131 I activities without rhTSH prestimulation), and with lower exposure of extrathyroidal tissues to radiation (23 given (11,14,16,19,24,25). Overall, it has been shown that rhTSH doses lower than 0.1 mg do not cause acute increases in TV or thyroid hormone levels (26).…”

Section: Introductionmentioning

confidence: 84%

“…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%

“…Overall, it has been shown that rhTSH doses lower than 0.1 mg do not cause acute increases in TV or thyroid hormone levels (26). When given 24 h before the administration of fixed or calculated 131 I activities, rhTSH is a safe and efficacious adjunct therapeutic approach that allows for the administration of lower 131 I activities (24).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 84%

Section: Rhtsh and 131 I For Mngmentioning

confidence: 99%

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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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“…The present study was part of a double-blind randomized controlled trial, described in detail elsewhere [16]. In brief, 90 patients suffering from compressive nodular goiter were randomized to either rhTSH-stimulated 131 I therapy, aiming at a thyroid irradiation dose of 50 Gy, or placebo-stimulated 131 I therapy, aiming at a thyroid dose of 100 Gy.…”

Section: Methodsmentioning

confidence: 99%

Systemic Oxidative Stress to Nucleic Acids Is Unaltered Following Radioiodine Therapy of Patients with Benign Nodular Goiter

et al. 2015

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Background: Little is known about the whole body oxidative stress burden following radioactive iodine (¹³¹I) therapy of thyroid diseases. Methods: We studied 17 patients with benign nodular goiter treated with ¹³¹I therapy. The targeted thyroid dose was 50 Gy in 11 patients pretreated with 0.1 mg of recombinant human TSH (rhTSH). In 6 patients, the applied thyroid dose was 100 Gy without rhTSH prestimulation. Well-established biomarkers of oxidative stress to RNA (8-oxo-7,8-dihydroguanosine; 8-oxoGuo) and DNA (8-oxo-7,8-dihydro-2'-deoxyguanosine; 8-oxodG) were measured in freshly voided morning urine (normalized against the creatinine concentration) at baseline, and 7 and 21 days after rhTSH (not followed by ¹³¹I), and 7 and 21 days after ¹³¹I therapy, respectively. Results: The baseline urinary excretions of 8-oxoGuo and 8-oxodG were 2.20 ± 0.84 and 1.63 ± 0.70 nmol/mmol creatinine, respectively. We found no significant changes in the excretion of any of the metabolites, neither after rhTSH stimulation alone nor after ¹³¹I therapy. Also, no significant differences were found between the rhTSH group (low dose, median ¹³¹I: 152 MBq) and the non-rhTSH group (high dose, median ¹³¹I: 419 MBq; 8-oxoGuo: p = 0.66, 8-oxodG: p = 0.71). Conclusion: Systemic oxidative stress, as detected by nucleic acids metabolites in the urine, is not increased after thyroid stimulation with 0.1 mg of rhTSH, or after ¹³¹I therapy. Our method cannot quantify the oxidative stress induced locally in the thyroid gland, but the study supports that ¹³¹I therapy of benign nodular goiter carries no or only a minute risk of developing subsequent malignancies. It remains to be explored whether our findings also apply to hyperthyroid disorders.

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“…Fokozza a mirigy radioszenzitivitását. 100 Gy besugárzási dózissal végzett terá-pia eredménye azonos volt azzal, ha 50 Gy-t adtak rhTSH-előkészítéssel [31]. Előnyösen változik a jódki-netika, emiatt az extrathyreoidealis sugárterhelés csök-ken.…”

Section: Göbös Strúmák Radiojódkezeléseunclassified

Változások a pajzsmirigybetegségek radiojódkezelésében

Konrády

2016

Orvosi Hetilap

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A benignus és malignus pajzsmirigybetegségek radiojódkezelését körülbelül 70 éve vezették be, mindemellett a kezelés az indikáció, a dózis és az eljárás tekintetében a konszenzus hiányával jellemezhető. Az összefoglaló foglalkozik az immunogén hyperthyreosis kezelésének eredményeivel, beleértve az endokrin orbitopathia problémáját. Tárgyalja a toxikus és nem toxikus multinodularis strúma radiojódkezelését, hangsúlyozva a jódfelvétel növelésének jelentősé-gét. Ebben a vonatkozásban a rekombináns humán tireotropin alkalmazását szükséges említeni. A pajzsmirigyrák kezelési protokollja is változott, a kis kockázatú betegeken a kezelés ineffektív, szükségtelen. Több figyelmet érdemel a radiojód carcinogen hatása. Számos említett probléma jól megtervezett, prospektív tanulmányokat igényel, hogy az alapvető problémák tisztázódjanak. A szerző hangsúlyozza: a radiojódterápia megválasztásánál a még megfelelően hatékony, legalacsonyabb dózisra kell törekedni. Orv. Hetil., 2016, 157(3), 83-88. Kulcsszavak: jóindulatú pajzsmirigybetegségek, pajzsmirigyrák, radiojódterápia változásai Changes in radioiodine therapy for thyroid disordersRadioiodine therapy for benign and malignant thyroid diseases was introduced about 70 years ago, however, there is still a lack of consensus regarding indications, doses and procedure. This review covers treatment results in immunogenic hyperthyroidism including the problem of orbitopathy. Radioiodine therapy for toxic and non-toxic multinodular goiter is also discussed with striking possibility of enhanching the radioiodine uptake. In this respect the recombinant human thyrotropin should be mentioned. Thyroid cancer treatment protocol has changed, too, due to ineffectivity in low-risk patients. More attention is needed to the carcinogenecity of radioiodine. The numerous problems mentioned above require large and well-designed prospective trials to resolve the fundamental questions. The author emphasizes that radioiodine dose should be administered in doses as low as reasonably achievable. Keywords: benign thyroid diseases, thyroid cancer, changes of radioiodine therapyKonrády, A. [Changes in radioiodine therapy for thyroid disorders]. Orv. Hetil., 2016, 157(3), 83-88. (Beérkezett: 2015. október 6.; elfogadva: 2015. november 5.) ÖSSZEFOGLALÓ KÖZLEMÉNYRövidítések aTPO = peroxidáz elleni antitest; BG-kór = Basedow-Gravesbetegség; DTC = differenciált pajzsmirigyrák; EOP = endokrin orbitopathia; hTG = humán tireoglobulin; NIS = nátrium-jodid-szimporter; rhTSH = rekombináns humán tireotropin; TRAb = tireotropinreceptor-antitest A pajzsmirigybetegségek jódizotópos kezelésének törté-nete csaknem háromnegyed százados, 1942-ben kezdő-dött [1]. Először a jód 130-as izotópját alkalmazták, majd uralkodóvá vált a béta-és gamma-sugárzó 131-es izotóp ( 131 I). A múlt század '70-es éveiben kísérletek történtek a 125 I alkalmazásával is, amelynek kedvező fizikai tulajdonságai alapján jó eredményeket vártunk, de a klinikai gyakorlat a várakozásokat nem igazolta. Ma már csak a jód 131-es izotópját használjuk.Év...

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Recombinant Human Thyrotropin-Stimulated Radioiodine Therapy of Nodular Goiter Allows Major Reduction of the Radiation Burden with Retained Efficacy

Cited by 42 publications

References 23 publications

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

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

Systemic Oxidative Stress to Nucleic Acids Is Unaltered Following Radioiodine Therapy of Patients with Benign Nodular Goiter

Változások a pajzsmirigybetegségek radiojódkezelésében

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