The effects of recombinant human thyrotropin, in normal subjects and patients with goitre

Nielsen, Vibeke Lehmann; Bonnema, Steen Joop

doi:10.1111/j.1365-2265.2004.02134.x

Cited by 31 publications

(28 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In patients with MNG, it has been shown Treatment of goiter with rhTSH and 131 I www.bjournal.com.br that rhTSH increases 131 I uptake, changing the 131 I uptake pattern from heterogeneous to homogeneous (17,18). Also, rhTSH transiently increases thyroid hormone levels and TV (22). Another recent study suggested that rhTSH could influence the 131 I kinetics, hindering the decrease in thyroid uptake and enhancing the absorbed activity (23).…”

Section: Discussionmentioning

confidence: 99%

Effect of 30 mCi radioiodine on multinodular goiter previously treated with recombinant human thyroid-stimulating hormone

Paz-Filho

Mesa-Junior

Olandoski

et al. 2007

Braz J Med Biol Res

View full text Add to dashboard Cite

Recombinant human thyroid-stimulating hormone (rhTSH) enhances 131 I uptake, permitting a decrease in radiation for the treatment of multinodular goiter (MNG). Our objective was to evaluate the safety and efficacy of a single 0.1-mg dose of rhTSH, followed by 30 mCi 131 I, in patients with MNG. Seventeen patients (15 females, 59.0 ± 13.1 years), who had never been submitted to 131 I therapy, received a single 0.1-mg injection of rhTSH followed by 30 mCi 131 I on the next day. Mean basal thyroid volume measured by computed tomography was 106.1 ± 64.4 mL. 131 I 24-h uptake, TSH, free-T4, T3, thyroglobulin, anti-thyroid antibodies, and thyroid volume were evaluated at regular intervals of 12 months. Mean 131 I 24-h uptake increased from 18.1 ± 9.7 to 49.6 ± 13.4% (P < 0.001), a median 2.6-fold increase (1.2 to 9.2). Peak hormonal levels were 10.86 ± 5.44 mU/L for TSH (a median 15.5-fold increase), 1.80 ± 0.48 ng/dL for free-T4, 204.61 ± 58.37 ng/dL for T3, and a median of 557.0 ng/mL for thyroglobulin. The adverse effects observed were hyperthyroidism (17.6%), painful thyroiditis (29.4%) and hypothyroidism (52.9%). Thyroid volume was reduced by 34.3 ± 14.3% after 6 months (P < 0.001) and by 46.0 ± 14.6% after 1 year (P < 0.001). Treatment of MNG with a single 0.1-mg dose of rhTSH, followed by a fixed amount of radioactivity of 131 I, leads to an efficacious decrease in thyroid volume for the majority of the patients, with a moderate incidence of non-serious and readily treatable adverse effects.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of 30 mCi radioiodine on multinodular goiter previously treated with recombinant human thyroid-stimulating hormone

Paz-Filho

Mesa-Junior

Olandoski

et al. 2007

Braz J Med Biol Res

View full text Add to dashboard Cite

show abstract

“…Although rhTSH amplifies the GVR considerably, the three RCTs have failed to demonstrate an effect on patient satisfaction or QoL (16). One study did not address this issue at all (19), whereas the other two studies (17,18) relied on a visual analogue scale (VAS).…”

Section: Effect On Gvrmentioning

confidence: 99%

“…Although rhTSH amplifies the GVR, the failure to demonstrate an effect on patient satisfaction or QoL is problematic (16). This issue deserves further attention to clarify whether it is due to lack of sensitivity of the method for QoL determination.…”

Section: Therapymentioning

confidence: 99%

“…The recent advent of recombinant human TSH (rhTSH) has opened new avenues for 131 I therapy of MNG since it can double the thyroid RAIU even using minute quantities (16). In combination with 131 I therapy rhTSH enhances the goitre volume reduction (GVR) by 35-56% (17-19) at the expense of up to fivefold higher rate of permanent hypothyroidism (18).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy

Fast¹,

Nielsen²,

Bonnema³

et al. 2009

European Journal of Endocrinology

Self Cite

View full text Add to dashboard Cite

The treatment of benign multinodular goitre (MNG) is controversial, but surgery is recommended in large compressive goitres. While some patients decline surgery others may have contraindications due to comorbidity, since MNG is prevalent in the elderly. Therefore, non-surgical treatment alternatives are needed. Until recently, levothyroxine therapy was the preferred non-surgical alternative, but due to low efficacy and potential side-effects, it is not recommended for routine use in recent international guidelines. Conventional radioiodine ( 131 I) therapy has been used for two decades as an effective and safe alternative to surgery in the treatment of symptomatic non-toxic MNG. Since much higher activities of 131 I are employed when treating non-toxic rather than toxic MNG, there has been reluctance in many countries to use this treatment modality. Frequently, the 131 I -uptake in a non-toxic MNG is low, which makes 131 I therapy less feasible. Another challenge is the negative correlation between the initial goitre size and goitre volume reduction (GVR). With its ability to more than double the thyroid 131 I-uptake, recombinant human TSH (rhTSH) increases the absorbed radiation dose and thus enhances the GVR by 35-56% at the expense of up to fivefold higher rate of permanent hypothyroidism. An alternative strategy is to reduce the administered 131 I-activity with a factor corresponding to the rhTSH induced increase in 131 I-uptake. Hereby, the extrathyroidal irradiation can be reduced without compromising efficacy. Thus, although in its infancy, and still experimental, rhTSH-augmented 131 I therapy may profoundly alter the non-surgical treatment of benign non-toxic MNG.

show abstract

“…Only one of these was randomized [53]. Some conclusions, as described in a recent review [54], can be drawn from these studies. Pre-treatment with small amounts of rhTSH allows a reduction of the 131 I activity while still achieving a mean goitre reduction of approximately 40% within the first 12 months.…”

Section: Radioiodine Therapy With Recombinant Human Tsh Pre-stimulationmentioning

confidence: 99%

Radioiodine therapy in non-toxic multinodular goitre. The possibility of effect-amplification with recombinant human TSH (rhTSH)

Bonnema

Nielsen

2006

Acta Oncologica

View full text Add to dashboard Cite

The effects of recombinant human thyrotropin, in normal subjects and patients with goitre

Cited by 31 publications

References 55 publications

Effect of 30 mCi radioiodine on multinodular goiter previously treated with recombinant human thyroid-stimulating hormone

Effect of 30 mCi radioiodine on multinodular goiter previously treated with recombinant human thyroid-stimulating hormone

Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy

Radioiodine therapy in non-toxic multinodular goitre. The possibility of effect-amplification with recombinant human TSH (rhTSH)

Contact Info

Product

Resources

About