Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, Japan.
Ann Nucl Med. 2020 Oct;34(10):736-741. doi: 10.1007/s12149-020-01497-0. Epub 2020 Jul 8.
To compare the clinical outcome in patients who received adjuvant therapy with radioactive iodine (RAI) using different preparation methods, namely, thyroid hormone withdrawal (THW) and recombinant human thyroid-stimulating hormone (rhTSH), after undergoing thyroidectomy for intermediate- to high-risk differentiated thyroid carcinoma (DTC) according to the American Thyroid Association criteria.
Between May 2012 and October 2018, 136 patients who underwent adjuvant therapy with high-dose (3700 MBq) RAI for DTC without any metastatic lesions or macroscopic residual lesions after surgical resection were retrospectively selected. Patients were excluded if distant metastasis was confirmed during adjuvant therapy or if the outcome could not be confirmed; thus, 112 patients were finally evaluated. Patients underwent either a 3-week I restriction with thyroxine withdrawal or a 2-week I restriction with rhTSH administration. The serum thyroglobulin (Tg) concentration was measured, and I scintigraphy (370 MBq) was performed 6-12 months after adjuvant therapy. The definition of the initial achievement of adjuvant therapy was the disappearance of the uptake of I at the thyroid bed and serum Tg concentration < 2.0 ng/mL. The results of the adjuvant therapy between the groups were compared using the Fisher's exact test, and the TSH levels and estimated glomerular filtration rate (eGFR) were compared using the Welch's t test.
The THW and rhTSH groups included 47 and 65 patients, respectively, and the intermediate- and high-risk groups included 63 and 49 patients, respectively. No patient was assigned to the low-risk group. In the THW and rhTSH groups, the initial RAI adjuvant therapy goal was achieved in 30/47 (63.8%) and 46/65 patients (70.8%), respectively (p = 0.54); mean ± standard deviation of the TSH levels was 123.8 ± 46.4 µIU/mL and 274.5 ± 97.7 µIU/mL, respectively (p < 0.01), and eGFR (treatment/pre-treatment) was 0.81 and 0.99, respectively (p < 0.01). In the intermediate- and high-risk groups, the initial RAI adjuvant therapy goal was achieved in 43/63 patients (68.3%) and 33/49 (67.3%), respectively (p = 1.0).
No significant differences were observed between the preparation methods in the initial achievement of RAI adjuvant therapy. However, patients in the rhTSH group demonstrated higher TSH levels and retained eGFR.
根据美国甲状腺协会（ATA）标准，比较甲状腺激素（THW）和重组人促甲状腺激素（rhTSH）两种不同准备方法在甲状腺全切术后接受中高危分化型甲状腺癌（DTC）辅助放射性碘（RAI）治疗患者中的临床疗效。
回顾性分析 2012 年 5 月至 2018 年 10 月期间，136 例接受高剂量（3700MBq）RAI 辅助治疗的 DTC 患者，这些患者术后均无远处转移或肉眼残留病灶。如果在辅助治疗期间发现远处转移或无法确认治疗结果，则排除患者，最终有 112 例患者入组。患者接受 3 周的甲状腺素停药碘限制或 2 周的 rhTSH 给药碘限制。治疗后 6-12 个月检测血清甲状腺球蛋白（Tg）浓度和 I 闪烁扫描（370MBq）。辅助治疗初始疗效的定义为甲状腺床 I 摄取消失和血清 Tg 浓度<2.0ng/mL。使用 Fisher 确切检验比较两组之间的辅助治疗结果，使用 Welch's t 检验比较 TSH 水平和估算肾小球滤过率（eGFR）。
THW 组和 rhTSH 组分别有 47 例和 65 例患者，其中中高危组分别有 63 例和 49 例患者。没有患者被归入低危组。THW 组和 rhTSH 组的初始 RAI 辅助治疗目标分别为 30/47（63.8%）和 46/65（70.8%）（p=0.54）；TSH 水平的平均值±标准差分别为 123.8±46.4µIU/mL 和 274.5±97.7µIU/mL（p<0.01），eGFR（治疗前/治疗后）分别为 0.81 和 0.99（p<0.01）。中高危组的初始 RAI 辅助治疗目标分别为 43/63（68.3%）和 33/49（67.3%）（p=1.0）。
两种准备方法在初始 RAI 辅助治疗效果上无显著差异。然而，rhTSH 组患者的 TSH 水平更高，且保留了 eGFR。
