Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.
Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy.
Endocrine. 2019 Jul;65(1):132-137. doi: 10.1007/s12020-019-01897-x. Epub 2019 Mar 14.
In DTC patients, 131-radioiodine therapy has routinely been used for many years for thyroid remnant ablation after thyroid surgery. To date, two different strategies can be used to achieve sufficient TSH stimulation on thyroid remnant: (I) Levo-thyroxine withdrawal or (II) rhTSH stimulation. The aim of our study was to compare the abdominal absorbed dose ratio between differentiated thyroid cancer patients who underwent thyroid remnant ablation after either L-T4 withdrawal or rhTSH stimulation.
We reviewed the records of 63 patients affected by differentiated thyroid cancer. All patients underwent thyroid remnant ablation after either L-T4 withdrawal or rhTSH stimulation. A post-therapy whole-body scan was obtained 5 days after 131-radioiodine therapy. Qualitative and quantitative image analysis was performed. Quantitative analysis was performed by drawing seven regions of interest on the abdomen (anterior and posterior views) to estimate both the activity ratio (AR) and absorbed dose ratio (DR) obtained in patients treated in hypothyroidism or after rhTSH stimulation.
The values of the activity and absorbed dose ratios obtained on each abdomen region (liver, stomach, ascending colon, transverse colon, descending colon, rectum, and small intestine) were always higher in patients treated after L-T4 withdrawal than after rhTSH stimulation with p-values of 0.000, 0.000, 0.001, 0.000, 0.022, 0.007, and 0.002, respectively.
DTC patients treated with 131-radioiodine after rhTSH stimulation have lower abdominal radioiodine activity than hypothyroid patients. Our data could be of practical relevance in terms of patient management. The potential impact on rare radioiodine-related gastrointestinal side effects is to be established in specifically designed prospective studies.
在 DTC 患者中，131 碘放射性碘治疗已常规用于甲状腺手术后甲状腺残余物消融多年。迄今为止，有两种不同的策略可用于实现甲状腺残余物的充分 TSH 刺激：（I）左甲状腺素停药或（II）rhTSH 刺激。我们研究的目的是比较甲状腺残余物消融后接受 L-T4 停药或 rhTSH 刺激的分化型甲状腺癌患者之间的腹部吸收剂量比。
我们回顾了 63 例分化型甲状腺癌患者的记录。所有患者均在 L-T4 停药或 rhTSH 刺激后进行甲状腺残余物消融。在 131 碘放射性碘治疗后 5 天获得治疗后全身扫描。进行定性和定量图像分析。通过在前视图和后视图上绘制七个腹部感兴趣区（ROI）来进行定量分析，以评估甲状腺功能减退或 rhTSH 刺激后治疗的患者获得的活性比（AR）和吸收剂量比（DR）。
在每个腹部区域（肝脏、胃、升结肠、横结肠、降结肠、直肠和小肠）获得的活性和吸收剂量比的值在 L-T4 停药后治疗的患者中始终高于 rhTSH 刺激后治疗的患者，p 值分别为 0.000、0.000、0.001、0.000、0.022、0.007 和 0.002。
接受 rhTSH 刺激后用 131 碘治疗的 DTC 患者的腹部放射性碘活性低于甲状腺功能减退患者。我们的数据在患者管理方面可能具有实际意义。在专门设计的前瞻性研究中确定对罕见放射性碘相关胃肠道副作用的潜在影响。
