Drozd Valentina, Leonova Tatjana, Mitjukova Tatjana, Lushchik Maxim, Koritko Sergey, Magner James A, Biko Johannes, Reiners Christoph
Arnica International Fund Help for Patients with Radiation-Induced Thyroid Cancer, Minsk, Belarus.
Nucl Med Rev Cent East Eur. 2012 Aug 28;15(2):108-12.
Women with a history of differentiated thyroid carcinoma who are contemplating pregnancy may wish reassurance regarding apparent remission. However, the thyroid hormone withdrawal needed to obtain serum thyroglobulin testing (Tg) results in weeks-long biochemical and clinical hypothyroidism, which could increase miscarriage and fetal death rates if pregnancy occurred during withdrawal of thyroxine or soon thereafter. Recombinant human thyrotropin (rhTSH) elevates thyrotropin exogenously, allowing uninterrupted thyroid hormone therapy and avoids hypothyroidism.
Thirty female radiation-induced papillary thyroid carcinoma survivors who had undergone total- or near-total thyroidectomy and who were now seeking pregnancy (mean age 23.9 ± 1.8 years), and who were considered cancer-free by local standards, underwent rhTSH-aided Tg testing to help confirm remission. At the time of rhTSH testing, mean follow-up after primary surgical treatment was 11.1 ± 3.9 years, and all patients had negative neck ultrasonography, undetectable unstimulated serum Tg (< 0.2 ng/mL) and no interfering anti-Tg antibodies. However, based on T3, N1 or M1 status, 28/30 (93.3%) patients had high recurrence risk.
rhTSH produced no serum Tg increase in 27/30 women (90.0%). Serum Tg increases to 0.4-0.9 ng/ml were observed in 3 women, but careful neck ultrasonography found no lymphadenopathy. Reassured about their remission, 14/30 women (46%) have become pregnant and delivered healthy children in the 3 years since rhTSH-aided testing.
rhTSH-aided Tg testing is useful in confirming absence of tumor in female patients with a history of radiation-induced thyroid cancer who are seeking pregnancy, but who also have a high risk of thyroid cancer recurrence.
有分化型甲状腺癌病史且打算怀孕的女性可能希望得到关于明显缓解的保证。然而，为获得血清甲状腺球蛋白检测（Tg）结果而进行的甲状腺激素撤药会导致长达数周的生化性和临床性甲状腺功能减退，如果在甲状腺素撤药期间或之后不久怀孕，可能会增加流产和胎儿死亡率。重组人促甲状腺素（rhTSH）可外源性升高促甲状腺素，允许不间断的甲状腺激素治疗并避免甲状腺功能减退。
30名接受过甲状腺全切术或近全切术的女性放射性诱导乳头状甲状腺癌幸存者，她们现在正在备孕（平均年龄23.9±1.8岁），根据当地标准被认为无癌，接受了rhTSH辅助的Tg检测以帮助确认缓解情况。在进行rhTSH检测时，初次手术治疗后的平均随访时间为11.1±3.9年，所有患者颈部超声检查均为阴性，未刺激血清Tg检测不到（<0.2 ng/mL）且无干扰性抗Tg抗体。然而，根据T3、N1或M1状态，28/30（93.3%）患者具有高复发风险。
27/30名女性（90.0%）的rhTSH未引起血清Tg升高。3名女性血清Tg升高至0.4 - 0.9 ng/ml，但仔细的颈部超声检查未发现淋巴结病。自rhTSH辅助检测后的3年里，14/30名女性（46%）因对缓解情况放心而怀孕并产下健康婴儿。
rhTSH辅助的Tg检测对于确认有放射性诱导甲状腺癌病史且备孕但甲状腺癌复发风险高的女性患者无肿瘤情况很有用。
