Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
Thyroid. 2010 Feb;20(2):173-9. doi: 10.1089/thy.2009.0187.
Few reports have examined the use of recombinant human thyroid-stimulating hormone (rhTSH) for ablation of postsurgical thyroid remnants after low-dose radioactive iodine (RI) therapy, compared with conventional thyroid hormone withdrawal. We investigated whether patient preparation using rhTSH was comparable to conventional thyroid hormone withdrawal with respect to efficacy of postsurgical remnant ablation in low-risk patients receiving a 30 mCi RI. In addition, we also evaluated the impact of rhTSH (rhTSH vs. conventional thyroid hormone withdrawal) on quality of life (QoL) of thyroid cancer patients undergoing RI ablation.
This study included three groups of patients, enrolled consecutively. From February 2006 to March 2007, 291 patients were enrolled and randomized, after total thyroidectomy: (1) withdrawal of levothyroxine (LT4) for 4 weeks (T4-WD Group, n = 89), (2) withdrawal of LT4 for 4 weeks plus 2 weeks on and then 2 weeks off liothyronine (LT3) (T3-WD Group, n = 133), and (3) rhTSH administration (rhTSH Group, n = 69). QoL was determined at the time of ablation.
Patients in the three groups did not differ significantly in baseline characteristics or tumor, node and metastasis (TNM) staging. In all study groups, serum TSH levels showed very good stimulation (mean, 82.24 +/- 18.21 mU/L), without significant between-group differences (p = 0.5213). Follow-up examinations were performed 12 months after ablation to assess ablation outcome in each group by 131 whole body scans (WBSs), serum thyroglobulin measurement after TSH stimulation, and neck ultrasonography. The successful ablation rate was 91.0% in T4-WD Group, 91.7% in T3-WD Group, and 91.3% in rhTSH Group, without significant between-preparation differences (p = 0.2061). QoL was better preserved in rhTSH Group than in T4-WD and T3-WD Groups (p < 0.0001). However, there was no QoL difference at the time of ablation between T4-WD and T3-WD Groups.
Our study indicates that use of rhTSH preserves QoL in patients undergoing RI ablation and affords an ablation success rate comparable to that seen after thyroid hormone withdrawal. Notably, ablation preparation using withdrawal of LT3 for 2 weeks did not prevent development of profound hypothyroidism, as also occurred when LT4 alone was withdrawn for 4 weeks.
与传统甲状腺激素停药相比，很少有报道研究重组人促甲状腺激素（rhTSH）在低剂量放射性碘（RI）治疗后用于消融术后甲状腺残留的作用。我们研究了在接受 30mCi RI 的低危患者中，rhTSH 患者准备与传统甲状腺激素停药相比，对术后残留消融的疗效是否相当。此外，我们还评估了 rhTSH（rhTSH 与传统甲状腺激素停药）对接受 RI 消融的甲状腺癌患者生活质量（QoL）的影响。
这项研究包括连续纳入的三组患者。从 2006 年 2 月至 2007 年 3 月，对 291 例甲状腺全切除术后患者进行了随机分组：（1）停用左旋甲状腺素（LT4）4 周（T4-WD 组，n=89）；（2）LT4 停药 4 周，加用左旋甲状腺素 2 周，停药 2 周（T3-WD 组，n=133）；（3）rhTSH 给药（rhTSH 组，n=69）。在消融时测定 QoL。
三组患者的基线特征或肿瘤、淋巴结和转移（TNM）分期无显著差异。在所有研究组中，血清 TSH 水平均显示出很好的刺激（平均，82.24±18.21mU/L），组间无显著差异（p=0.5213）。消融后 12 个月进行随访检查，通过 131 全身扫描（WBS）、TSH 刺激后血清甲状腺球蛋白测定和颈部超声检查评估每组的消融结果。T4-WD 组、T3-WD 组和 rhTSH 组的成功消融率分别为 91.0%、91.7%和 91.3%，组间无显著差异（p=0.2061）。rhTSH 组比 T4-WD 组和 T3-WD 组保留 QoL 更好（p<0.0001）。然而，T4-WD 组和 T3-WD 组在消融时的 QoL 没有差异。
我们的研究表明，rhTSH 的使用在接受 RI 消融的患者中保留了 QoL，并提供了与甲状腺激素停药后相当的消融成功率。值得注意的是，与单独停用 LT4 4 周一样，LT3 停用 2 周也不能预防严重甲状腺功能减退的发生。
