Postgraduation Program, Santa Casa de Belo Horizonte, Minas Gerais, Brazil.
Thyroid. 2010 Nov;20(11):1247-52. doi: 10.1089/thy.2010.0114. Epub 2010 Oct 18.
Most patients with well-differentiated thyroid cancer (WDTC) are first treated by total thyroidectomy followed by remnant ablation (RA) with (131)I. There are less data regarding the efficacy of recombinant human thyrotropin (rhTSH) for patients with WDTC at high risk of relapse than for low-risk patients. This study compared the efficacies of rhTSH and thyroid hormone withdrawal (THW) to prepare patients at high risk of relapse for RA.
Post-thyroidectomy patients with WDTC and complete tumor resection (n = 275) were studied. They were at high risk of recurrence (tumor size >4 cm and/or extrathyroidal extension [pT3] and/or lymph node metastases), and they did not have antithyroglobulin (Tg) antibodies. Group A (n = 77) received 0.9 mg rhTSH for 2 consecutive days followed by RA on day 3. The remaining 198 patients (group B) were prepared by THW for 4 weeks. Patients in groups A and B received 3.7 or 5.5 GBq (131)I.
The groups were similar in terms of gender, age, histology, TNM (tumor-node-metastases) stage, (131)I activity, and frequency of metastases on post-therapy whole-body scanning (RxWBS). Among patients without metastases on RxWBS, RA was successful (stimulated Tg <1 ng/mL and negative diagnostic whole body scan and neck ultrasonography) in 56 of 70 patients in group A (80%) and in 135 of 169 patients in group B (79.9%). Among patients with Tg >1 ng/mL immediately before RA, the comparable success rates were 68.4% and 67.4%, respectively. Among patients with metastases on the first RxWBS, no uptake was observed on the RxWBS 1 year later in 5 of 7 patients in group A (71.4%) and in 17 of 29 patients in group B (58.6%). The rhTSH stimulated serum Tg was <1 ng/mL in 3 of 5 and in 12 of 17 patients with a second negative RxWBS in groups A and B, respectively. Persistent disease (stimulated Tg >1 ng/mL and RxWBS continuing to show ectopic uptake) occurred in 2 of 7 patients in group A (28.5%) and in 12 of 29 patients in group B (41.3%).
rhTSH is as effective as THW for RA in patients with WDTC who are at a high risk of relapse.
大多数分化型甲状腺癌（WDTC）患者首先接受全甲状腺切除术，然后进行放射性碘（RA）残余消融。与低危患者相比，对于高危复发风险的 WDTC 患者，使用重组人促甲状腺激素（rhTSH）的疗效数据较少。本研究比较了 rhTSH 和甲状腺激素停药（THW）在为高危复发患者准备 RA 时的疗效。
对 275 例术后 WDTC 且完全肿瘤切除的患者（n = 275）进行研究。他们有高复发风险（肿瘤大小>4cm 和/或甲状腺外延伸 [pT3] 和/或淋巴结转移），且无抗甲状腺球蛋白（Tg）抗体。A 组（n = 77）连续 2 天接受 0.9mg rhTSH，第 3 天进行 RA。其余 198 例患者（B 组）接受 4 周 THW 准备。A、B 组患者接受 3.7 或 5.5GBq（131）I。
两组患者在性别、年龄、组织学、TNM（肿瘤-淋巴结-转移）分期、（131）I 活性和治疗后全身扫描（RxWBS）转移频率方面无差异。在 RxWBS 无转移的患者中，A 组 70 例患者中有 56 例（80%）和 B 组 169 例患者中有 135 例（79.9%）RA 成功（刺激 Tg<1ng/mL 且诊断全身扫描和颈部超声阴性）。在 RA 前 Tg>1ng/mL 的患者中，相应的成功率分别为 68.4%和 67.4%。在首次 RxWBS 有转移的患者中，A 组 7 例患者中有 5 例（71.4%）和 B 组 29 例患者中有 17 例（58.6%）1 年后 RxWBS 未见摄取。A、B 两组分别有 3 例和 12 例第二次 RxWBS 阴性的患者 rhTSH 刺激血清 Tg<1ng/mL。A 组 7 例患者中有 2 例（28.5%）和 B 组 29 例患者中有 12 例（41.3%）持续疾病（刺激 Tg>1ng/mL，RxWBS 继续显示异位摄取）。
rhTSH 与 THW 对高危复发 WDTC 患者进行 RA 同样有效。
