Müller Vika, Bohuslavizki Karl H, Klutmann Susanne, Clausen Malte
Department of Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany.
J Nucl Med Technol. 2002 Dec;30(4):185-8.
We report on a high-dose radioiodine therapy after injection of recombinant human thyrotropin (rhTSH) in a 61-y-old woman with compression of the spinal cord caused by metastasis of a follicular thyroid carcinoma. Fourteen years ago, the patient underwent subtotal thyroidectomy because of multinodular goiter without any histologic evidence for malignant disease, and the patient was put on thyroxine substitution (100 micro g/d). In April 2000, she developed paralysis of the right leg. Morphologic imaging revealed spinal compression caused by a space-occupying lesion within the thoracic spine. Subsequent biopsy and histology demonstrated metastasis of a follicular thyroid carcinoma. Therefore, high-dose radioiodine therapy was scheduled after 4 wk of hormone withdrawal. Within a few days of being off thyroxine, the patient's paralytic symptoms worsened rapidly. The patient was again put on thyroxine, 100 micro g/d, and high-dose radioiodine therapy under stimulation with rhTSH was performed without any side effects. The second high-dose radioiodine therapy 3 mo later, again performed under stimulation with rhTSH, showed significantly less iodine avidity, and thyroglobulin levels fell from 1,024 micro g/L to 361 micro g/L, thereby demonstrating therapeutic efficacy. Thus, rhTSH might be used as a tool not only in the diagnostic application but also in the therapeutic application of (131)I.
我们报告了一例61岁女性滤泡状甲状腺癌转移导致脊髓受压患者，在注射重组人促甲状腺素（rhTSH）后接受大剂量放射性碘治疗的病例。14年前，该患者因结节性甲状腺肿接受了甲状腺次全切除术，当时无任何恶性疾病的组织学证据，术后患者接受甲状腺素替代治疗（100μg/d）。2000年4月，她出现右腿麻痹。形态学影像显示胸椎内占位性病变导致脊髓受压。随后的活检及组织学检查证实为滤泡状甲状腺癌转移。因此，在激素停用4周后安排了大剂量放射性碘治疗。在停用甲状腺素的几天内，患者的麻痹症状迅速恶化。患者再次接受100μg/d的甲状腺素治疗，并在rhTSH刺激下进行大剂量放射性碘治疗，未出现任何副作用。3个月后在rhTSH刺激下再次进行第二次大剂量放射性碘治疗，结果显示碘摄取明显减少，甲状腺球蛋白水平从1024μg/L降至361μg/L，从而证明了治疗效果。因此，rhTSH不仅可作为一种工具用于（131）I的诊断应用，也可用于治疗应用。
