Kohlfuerst Susanne, Igerc Isabelle, Lind Peter
Department of Nuclear Medicine and Endocrinology, PET Center, LKH Klagenfurt, St. Veiterstrase 47, 9020 Klagenfurt, Austria.
Thyroid. 2005 Apr;15(4):371-6. doi: 10.1089/thy.2005.15.371.
There is no doubt that the availability of recombinant human thyrotropin (rhTSH) is one of the milestones in the management of patients with differentiated thyroid cancer (DTC). It offers the opportunity to obtain representative serum thyroglobulin (Tg) levels and diagnostic whole-body scanning (Dx WBS) with 131I under adequate TSH elevation, while the patient continues to receive thyroid hormone. But rhTSH is also used with success in the treatment of local recurrences and distant metastases. In this retrospective analysis we were able to show that our excellent clinical experiences with the use of rhTSH (rare side effects and high compliance) could also be demonstrated by sufficiently elevated TSH levels and representative stimulated Tg measurements. Since April 2001 most of the patients with thyroid cancer in our hospital have undergone diagnostic examination (205 patients underwent 319 examinations) and 131I therapy (a total of 68 treatments) with rhTSH stimulation excluding the first radioiodine ablation of remnants after initial thyroidectomy. Our results show that under rhTSH stimulation 83.5% (diagnostic group) and 88% (therapy group) of our patients with DTC obtained a TSH level of greater than 80 mU/L after two injections of rhTSH (Thyrogen, Genzyme Corp., Cambridge, MA) 0.9 mg intramuscularly 24 hours and 48 hours before the administration of 131I. Only 2.3% (diagnostic group) and 0% (therapy group) demonstrated TSH levels less than 50 mU/L. Serum Tg levels under rhTSH-stimulated conditions showed that in 81.2% the serum Tg maximum was obtained on day 5. Because of the costs associated with periodically rhTSH-assisted Tg testing and based on the data of other studies we are now testing mainly on day 5 to identify residual tumor mass and to compare these Tg levels in the follow-up. Our experience demonstrates that the administration of rhTSH is a safe, effective, and-from an economic point of view- valuable tool in the management of patients with DTC.
毫无疑问，重组人促甲状腺素（rhTSH）的出现是分化型甲状腺癌（DTC）患者管理中的里程碑之一。它提供了在患者持续接受甲状腺激素治疗的情况下，在促甲状腺素充分升高时获得代表性血清甲状腺球蛋白（Tg）水平以及进行131I诊断性全身扫描（Dx WBS）的机会。但rhTSH在局部复发和远处转移的治疗中也取得了成功。在这项回顾性分析中，我们能够表明，我们使用rhTSH的出色临床经验（罕见的副作用和高依从性）也可以通过充分升高的促甲状腺素水平和具有代表性的刺激后Tg测量结果得到证明。自2001年4月以来，我院大多数甲状腺癌患者在不包括初次甲状腺切除术后首次放射性碘清除残余甲状腺组织的情况下，接受了rhTSH刺激下的诊断性检查（205例患者接受了319次检查）和131I治疗（共68次治疗）。我们的结果表明，在rhTSH刺激下，我们的DTC患者中有83.5%（诊断组）和88%（治疗组）在注射两次rhTSH（Thyrogen，Genzyme公司，马萨诸塞州剑桥）0.9mg肌肉注射，在给予131I前24小时和48小时后，促甲状腺素水平大于80mU/L。只有2.3%（诊断组）和0%（治疗组）的促甲状腺素水平低于50mU/L。rhTSH刺激条件下的血清Tg水平显示，81.2%的患者在第5天达到血清Tg最大值。由于与rhTSH辅助的定期Tg检测相关的成本，并基于其他研究的数据，我们现在主要在第5天进行检测，以识别残留肿瘤肿块并在随访中比较这些Tg水平。我们的经验表明，rhTSH的给药在DTC患者的管理中是一种安全有效且从经济角度来看有价值的工具。
