TY - JOUR
T1 - Recombinant human thyrotropin-stimulated radioiodine therapy of nodular goiter allows major reduction of the radiation burden with retained efficacy
AU - Fast, Søren
AU - Hegedüs, Laszlo
AU - Grupe, Peter
AU - Nielsen, Viveque Egsgaard
AU - Bluhme, Christa
AU - Bastholt, Lars
AU - Bonnema, Steen Joop
PY - 2010/8/1
Y1 - 2010/8/1
N2 - Context and Objective: Stimulation with recombinant human TSH (rhTSH) before radioiodine ((131)I) therapy augments goiter volume reduction (GVR). Observations indicate that rhTSH has a preconditioning effect beyond increasing thyroid (131)I uptake. We test the hypothesis that an equivalent GVR might be obtained by an absorbed thyroid dose well below what has been used previously. Patients and Design: In a double-blinded setup, 90 patients (78 women; median age, 52 yr; range, 22-83) with a nontoxic nodular goiter (median size, 63 ml; range, 25-379 ml) were randomized to either 0.1 mg rhTSH (n = 60) followed by a thyroid dose of 50 Gy or placebo followed by 100 Gy (n = 30). Results: At 12 months, the mean relative GVR in the placebo and the rhTSH group was identical (35 +/- 3%; P = 0.81). The median administered (131)I-activity was 170 MBq (45-1269) in the rhTSH group and 559 MBq (245-3530) in the placebo group (70% reduction, P < 0.0001). According to the official radiation regulation, hospitalization was required in 14 patients in the placebo group vs. one patient in the rhTSH group (P < 0.0001). In both groups, goiter-related symptoms were effectively relieved in the majority of patients. The prevalence of myxedema (10%) did not differ among groups. Conclusions: This is the first study to demonstrate that rhTSH not only increases the thyroid (131)I uptake, but per se potentiates the effect of (131)I-therapy, allowing a major reduction of the (131)I-activity without compromising efficacy. This approach is attractive in terms of minimizing posttherapeutic restrictions and in reducing the potential risk of radiation-induced malignancy.
AB - Context and Objective: Stimulation with recombinant human TSH (rhTSH) before radioiodine ((131)I) therapy augments goiter volume reduction (GVR). Observations indicate that rhTSH has a preconditioning effect beyond increasing thyroid (131)I uptake. We test the hypothesis that an equivalent GVR might be obtained by an absorbed thyroid dose well below what has been used previously. Patients and Design: In a double-blinded setup, 90 patients (78 women; median age, 52 yr; range, 22-83) with a nontoxic nodular goiter (median size, 63 ml; range, 25-379 ml) were randomized to either 0.1 mg rhTSH (n = 60) followed by a thyroid dose of 50 Gy or placebo followed by 100 Gy (n = 30). Results: At 12 months, the mean relative GVR in the placebo and the rhTSH group was identical (35 +/- 3%; P = 0.81). The median administered (131)I-activity was 170 MBq (45-1269) in the rhTSH group and 559 MBq (245-3530) in the placebo group (70% reduction, P < 0.0001). According to the official radiation regulation, hospitalization was required in 14 patients in the placebo group vs. one patient in the rhTSH group (P < 0.0001). In both groups, goiter-related symptoms were effectively relieved in the majority of patients. The prevalence of myxedema (10%) did not differ among groups. Conclusions: This is the first study to demonstrate that rhTSH not only increases the thyroid (131)I uptake, but per se potentiates the effect of (131)I-therapy, allowing a major reduction of the (131)I-activity without compromising efficacy. This approach is attractive in terms of minimizing posttherapeutic restrictions and in reducing the potential risk of radiation-induced malignancy.
U2 - 10.1210/jc.2010-0634
DO - 10.1210/jc.2010-0634
M3 - Journal article
C2 - 20519346
SN - 0021-972X
VL - 95
SP - 3719
EP - 3725
JO - The Journal of Clinical Endocrinology & Metabolism
JF - The Journal of Clinical Endocrinology & Metabolism
IS - 8
ER -