Azorín Belda M J, Martínez Caballero A, Figueroa Ardila G C, Martínez Ramírez M, Gómez Jaramillo C A, Dolado Ardit J I, Verdú Rico J
Hospital Universitario de San Juan de Alicante, San Juan de Alicante, España.
Hospital Universitario de San Juan de Alicante, San Juan de Alicante, España.
Rev Esp Med Nucl Imagen Mol. 2017 Jan-Feb;36(1):7-12. doi: 10.1016/j.remn.2016.05.009. Epub 2016 Jul 12.
Stimulation with recombinant human thyrotropin (rhTSH) increases thyroid radioiodine uptake, and is an aid to I therapy in non-toxic multinodular goitre (MNG). However, there are not many studies using rhTSH prior to I in toxic multinodular goitre to improve hyperthyroidism and compressive symptoms.
A prospective study was conducted on patients with MNG and hyperthyroidism. Patients were recruited consecutively and divided into group I, stimulated with 0.3mg of rhTSH before radioiodine therapy, and a control group or group II, without stimulation. Thyroid function, radioiodine thyroid uptake, thyroid weight, and compressive symptoms were measured, and patients were followed-up for 9 months.
Group I consisted of 16 patients (14 women), with a mean age 69.7 years, and group II with 16 patients (12 women), with a mean age 70.7 years. After stimulation with 0.3mg rhTSH in group I, I uptake (RAIU) at 24h increased by 78.4%, and the estimated absorbed dose by 89.3%. In group II, the estimated absorbed dose was lower than group I after stimulation with rhTSH (29.8Gy vs. 56.4Gy; P=0.001). At 9 months of follow-up, hyperthyroidism was controlled in 87.5% of patients in group I, and 56.2% in group II (P=0.049). The mean reduction in thyroid weight was higher in group I than in group II (39.3% vs. 26.9%; P=0.017), with a tendency towards subjective improvement of compressive symptoms in group I, although non-significant. Only 2 patients described tachycardias after rhTSH administration, which were resolved with beta-blockers.
Stimulation with 0.3mg of recombinant human thyrotropin prior to radioiodine therapy achieves a reduction in thyroid weight and functional improvement in patients with hyperthyroidism and multinodular goitre with low uptake, and with no need for hospital admission.
重组人促甲状腺素（rhTSH）刺激可增加甲状腺对放射性碘的摄取，有助于非毒性多结节性甲状腺肿（MNG）的碘治疗。然而，在毒性多结节性甲状腺肿患者进行碘治疗前使用rhTSH以改善甲亢和压迫症状的研究并不多。
对MNG合并甲亢患者进行前瞻性研究。连续招募患者并分为I组，在放射性碘治疗前用0.3mg rhTSH刺激，以及对照组或II组，不进行刺激。测量甲状腺功能、放射性碘甲状腺摄取、甲状腺重量和压迫症状，并对患者进行9个月的随访。
I组有16例患者（14名女性），平均年龄69.7岁，II组有16例患者（12名女性），平均年龄70.7岁。I组用0.3mg rhTSH刺激后，24小时碘摄取（RAIU）增加78.4%，估计吸收剂量增加89.3%。II组在用rhTSH刺激后估计吸收剂量低于I组（29.8Gy对56.4Gy；P = 0.001）。随访9个月时，I组87.5%的患者甲亢得到控制，II组为56.2%（P = 0.049）。I组甲状腺重量的平均减轻高于II组（39.3%对26.9%；P = 0.017），I组压迫症状有主观改善的趋势，尽管不显著。rhTSH给药后只有2例患者出现心动过速，用β受体阻滞剂后缓解。
放射性碘治疗前用0.3mg重组人促甲状腺素刺激可减轻甲亢和低摄取多结节性甲状腺肿患者的甲状腺重量并改善功能，且无需住院。
