Department of Diabetes and Endocrinology, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Diabetes and Endocrinology, Kobe City Medical Center General Hospital, Kobe, Japan.
Endocr Pract. 2021 Oct;27(10):1022-1027. doi: 10.1016/j.eprac.2021.03.012. Epub 2021 Apr 6.
Stimulation with recombinant human thyroid-stimulating hormone (rhTSH) before radioactive iodine administration for patients with thyroid cancer may increase the body iodine pool in the presence of continued levothyroxine; however, the precise significance of its influence remains unclear.
This was a prospective observational study conducted between March 2017 and August 2020. We measured the 24-hour urinary iodine excretion and urinary iodine-to-creatinine ratio in patients with thyroid cancer stimulated by rhTSH or thyroid hormone withdrawal (THW) before radioactive iodine administration. Oral iodine intake was controlled by a 7-day self-managed low iodine diet, followed by a strict 3-day low iodine diet while in the hospital.
Overall, 343 subjects were included (rhTSH: n = 181; THW: n = 162). The mean levothyroxine dose in the rhTSH group was 115.2 μg daily. The median 24-hour urinary iodine and urinary iodine-to-creatinine ratio in the rhTSH group (71.0 [interquartile range, 57.5-88.0] μg/day and 80.0 [59.0-97.5] μg/gCr, respectively) were significantly higher than those in the THW group (42.0 [30.0-59.0] μg/day and 39.0 [28.0-61.3] μg/gCr, respectively; both P < .001). After propensity score matching by age, sex, body weight, and renal function (rhTSH: n = 106; THW: n = 106), consistent results for both values were observed for both methods. The increase in urinary iodine with the rhTSH method was smaller than the expected value calculated from the amount of levothyroxine.
Urinary iodine excretion was significantly higher among patients with rhTSH stimulation than those with THW, indicating that the rhTSH method slightly increases the body iodine pool.
甲状腺癌患者在放射性碘治疗前使用重组人促甲状腺激素（rhTSH）刺激可能会在持续服用左甲状腺素的情况下增加体内碘池；然而，其影响的确切意义仍不清楚。
这是一项于 2017 年 3 月至 2020 年 8 月期间进行的前瞻性观察性研究。我们测量了 rhTSH 或甲状腺激素停药（THW）刺激下准备接受放射性碘治疗的甲状腺癌患者的 24 小时尿碘排泄量和尿碘/肌酐比值。通过 7 天的自我管理低碘饮食控制口服碘摄入量，然后在住院期间严格进行 3 天的低碘饮食。
总体而言，共纳入 343 例受试者（rhTSH 组：n=181；THW 组：n=162）。rhTSH 组左甲状腺素的平均剂量为 115.2μg/天。rhTSH 组 24 小时尿碘和尿碘/肌酐中位数分别为 71.0[四分位距（IQR）：57.5-88.0]μg/天和 80.0[IQR：59.0-97.5]μg/gCr，明显高于 THW 组（42.0[30.0-59.0]μg/天和 39.0[28.0-61.3]μg/gCr；均 P<.001）。通过年龄、性别、体重和肾功能进行倾向评分匹配（rhTSH 组：n=106；THW 组：n=106）后，两种方法均观察到两种值的一致结果。rhTSH 法尿碘增加量小于从左甲状腺素剂量计算出的预期值。
rhTSH 刺激组患者的尿碘排泄量明显高于 THW 组，表明 rhTSH 法略微增加了体内碘池。
