Taïeb D, Lussato D, Guedj E, Roux F, Mundler O
Service central de Biophysique et de Médecine Nucléaire, Centre hospitalo-universitaire de la Timone, Marseille, France.
Thyroid. 2006 Feb;16(2):177-9. doi: 10.1089/thy.2006.16.177.
TNM status and posttherapy whole-body scan findings aid in risk stratification of patients with thyroid cancer during initial therapy. Recently, the thyroglobulin (Tg) value measured during hypothyroidism just before 131I therapy (preablation Tg) has proved to be effective for predicting persistent/recurrent disease. In this study, we assessed the changes in serum Tg 48 hours after radioiodine ablative therapy performed in the hypothyroid state in order to evaluate if this parameter could be used in recombinant human thyrotropin (rhTSH)-treated patients. Because rhTSH-stimulated TG is traditionally measured 72 hours after the second injection of rhTSH corresponding to 48 hours post-131I therapy, the time course of serum Tg after radioiodine administration is an important clinical issue. To address this issue, we performed a prospective evaluation of 26 consecutive patients with low-risk differentiated thyroid cancer hypothyroidism for radioiodine ablation (3.7 GBq of 131I). Baseline Tg values were compared to posttherapy Tg values (at 24 and 48 hours). We found that Tg increased after 131I therapy because of the acute radiation effects on residual thyroid cells. Median values at each of the three time points were 1.8 ng/mL (baseline), 3 ng/mL (Tg-24), and 11.3 ng/mL (Tg-48) (Brahms Tg Kryptor assay, Brahms AG, Berlin, Germany). Tg-48 values were not statistically correlated with initial Tg values. Tg-48 remained below 15 ng/mL in 14 of 26 patients. In conclusion, the increase in Tg during the early post-131I therapy period means that first rhTSH-stimulated Tg cannot be used as a corresponding value for preablative hypo-Tg. We discussed whether rhTSH-stimulated Tg value might be useful in a subset of patients. In our opinion, this drawback does not outweight the expected benefits of rhTSH-aided therapy on quality of life of patients and overall cost of the therapy.
TNM分期和治疗后全身扫描结果有助于对甲状腺癌患者初始治疗期间进行风险分层。最近，在131I治疗前甲状腺功能减退期间测得的甲状腺球蛋白（Tg）值（消融前Tg）已被证明对预测持续性/复发性疾病有效。在本研究中，我们评估了甲状腺功能减退状态下进行放射性碘消融治疗48小时后血清Tg的变化，以评估该参数是否可用于重组人促甲状腺素（rhTSH）治疗的患者。由于传统上在第二次注射rhTSH后72小时（相当于131I治疗后48小时）测量rhTSH刺激后的Tg，放射性碘给药后血清Tg的时间进程是一个重要的临床问题。为解决这一问题，我们对26例连续的低风险分化型甲状腺癌甲状腺功能减退患者进行放射性碘消融（3.7GBq的131I）进行了前瞻性评估。将基线Tg值与治疗后Tg值（24小时和48小时）进行比较。我们发现，由于对残余甲状腺细胞的急性辐射效应，131I治疗后Tg升高。三个时间点各自的中位数分别为1.8ng/mL（基线）、3ng/mL（Tg-24）和11.3ng/mL（Tg-48）（德国柏林Brahms公司的Brahms Tg Kryptor检测法）。Tg-48值与初始Tg值无统计学相关性。26例患者中有14例的Tg-48低于15ng/mL。总之，131I治疗后早期Tg升高意味着首次rhTSH刺激后的Tg不能用作消融前低Tg的对应值。我们讨论了rhTSH刺激后的Tg值在部分患者中是否有用。我们认为，这一缺点并不超过rhTSH辅助治疗对患者生活质量和治疗总成本的预期益处。
