Barbaro Daniele, Boni Giuseppe, Meucci Giuseppe, Simi Umberto, Lapi Paola, Orsini Paola, Pasquini Cristina, Turco Anna, Mariani Giuliano
Spedali Riuniti di Livorno, Italy.
Nucl Med Commun. 2006 Aug;27(8):627-32. doi: 10.1097/00006231-200608000-00005.
To investigate whether recombinant human thyroid-stimulating factor (rhTSH) is effective for the radiometabolic ablation of post-surgery thyroid remnants, using low doses of (131)I.
The study included two groups of patients enrolled consecutively: group 1 consisted of 52 patients with papillary cancer or minimally invasive follicular cancer (stage I and II), and group 2 consisted of 41 patients with the same stage of disease. All patients underwent a total thyroidectomy. Group 1 received 1.11 GBq (30 mCi) (131)I for post-surgical remnants ablation with the aid of rhTSH, while group 2, in the hypothyroid state, received the same amount of radioiodine. To minimize iodine interference, all patients remained on a low iodine diet for 2 weeks and L-thyroxine (L-T4) was stopped for 4 days in the group of patients treated with the aid of rhTSH. To investigate (131)I uptake in this group, a tracer dose was administered 3 h after the second injection of rhTSH and the uptake was evaluated at 24 h just before administration of the therapeutic dose. I was also measured in the patients treated in the hypothyroid state just before the therapeutic dose was given.
After 1 year both groups were studied by using whole-body scintigraphy (WBS) and measuring thyroglobulin after rhTSH. In group 1, WBS was negative in 76.9% (40 patients), while thyroglobulin-stimulated levels were <1.0 ng . ml(-1) in 86.5% (45 patients). In Group 2, WBS was negative in 75.6% (31 patients), while thyroglobulin-stimulated levels were <1 ng . ml(-1) in 78.0% (32 patients). (131)I uptake was 2.29+/-0.45 in the group treated with the aid of rhTSH, and 3.30+/-0.7 in the group treated in the hypothyroid state (P=0.2). No patients treated with the aid of rhTSH and with the short stoppage of L-T4 experienced symptoms of hypothyroidism, and free thyroxine (FT4) and thyroid-stimulating hormone levels remained normal.
Our data confirm that, when the interference of iodine is minimized, rhTSH is highly effective for the treatment of post-surgical thyroid remnants using a low dose of (131)I.
探讨重组人促甲状腺素（rhTSH）联合低剂量（131）I对手术后甲状腺残留组织进行放射性代谢消融是否有效。
本研究连续纳入两组患者：第1组由52例乳头状癌或微小浸润性滤泡癌（I期和II期）患者组成，第2组由41例处于相同疾病分期的患者组成。所有患者均接受了甲状腺全切除术。第1组在rhTSH辅助下接受1.11 GBq（30 mCi）（131）I用于手术后残留组织消融，而第2组处于甲状腺功能减退状态，接受相同剂量的放射性碘。为尽量减少碘干扰，所有患者均维持低碘饮食2周，且在rhTSH辅助治疗组中，患者停用左旋甲状腺素（L-T4）4天。为研究该组患者的（131）I摄取情况，在第二次注射rhTSH后3小时给予示踪剂量，并在给予治疗剂量前24小时评估摄取情况。在给予治疗剂量前，也对处于甲状腺功能减退状态治疗的患者进行了碘测量。
1年后，对两组患者均采用全身闪烁扫描（WBS）并在rhTSH刺激后测量甲状腺球蛋白。在第1组中，WBS阴性者占76.9%（40例患者），而甲状腺球蛋白刺激水平<1.0 ng·ml-1者占86.5%（45例患者）。在第2组中，WBS阴性者占75.6%（31例患者），而甲状腺球蛋白刺激水平<1 ng·ml-1者占78.0%（32例患者）。rhTSH辅助治疗组的（131）I摄取率为2.29±0.45，甲状腺功能减退状态治疗组为3.30±0.7（P = 0.2）。接受rhTSH辅助治疗且短期停用L-T4的患者均未出现甲状腺功能减退症状，游离甲状腺素（FT4）和促甲状腺激素水平保持正常。
我们的数据证实，当碘干扰降至最低时，rhTSH联合低剂量（131）I对治疗手术后甲状腺残留组织非常有效。
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