Higuchi Cynara Rena Salmont, Fernanda Paula, Jurnior Paulo Alonso, Andrade Fernanda Accioly, Corbo Rossana, Vaisman Mario, Vaisman Fernanda, Bulzico Daniel
Endocrinology Service, Instituto Nacional do Cancer do Rio de Janeiro, Rio de Janeiro, Brazil.
Endocrinology Service, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Front Nucl Med. 2021 Nov 30;1:785768. doi: 10.3389/fnume.2021.785768. eCollection 2021.
To effectively treat differentiated thyroid carcinoma (DTC) with radioiodine therapy (RAI), it is necessary to raise serum thyrotropin levels, either by thyroid hormone withdrawal (THW) or by administration of recombinant human TSH (rhTSH). The use of rh-TSH is controversial in DTC patients at intermediate to high risk of recurrence. Even more controversial is the question of whether is alters progression-free survival rates and overall survival in more aggressive patients. The primary objective of this study was comparing clinical outcomes according to the method of preparation of RAI in intermediate to high DTC patients who presented progression of structural disease. This retrospective study included 81 patients with initial intermediate to high DTC and progression of structural disease at the end of follow-up. In 21 patients, all RAI treatments were done with only rhTSH stimulation. In 11, RAI treatments were done either with thyroid hormone withdrawal (THW) or rhTSH. In 49 patients, all RAI treatments were done only THW. After a median follow-up time of 83 months, there were no statistical differences in the clinical outcomes (status of structural disease at the end of the follow-up, death rate, overall survival curve, and progression-free survival curve). Preparation for RAI therapy using either rhTSH stimulation or THW was associated with no inferiority in the clinical outcomes in progressive DTC patients at higher risk of recurrence.
为了通过放射性碘治疗（RAI）有效治疗分化型甲状腺癌（DTC），有必要通过甲状腺激素撤减（THW）或给予重组人促甲状腺素（rhTSH）来提高血清促甲状腺素水平。在复发风险为中到高的DTC患者中，rhTSH的使用存在争议。在侵袭性更强的患者中，它是否会改变无进展生存率和总生存率的问题甚至更具争议性。本研究的主要目的是比较在结构性疾病出现进展的中到高风险DTC患者中，根据RAI准备方法得出的临床结果。这项回顾性研究纳入了81例初始为中到高风险DTC且在随访结束时出现结构性疾病进展的患者。21例患者的所有RAI治疗仅在rhTSH刺激下进行。11例患者的RAI治疗通过甲状腺激素撤减（THW）或rhTSH进行。49例患者的所有RAI治疗仅通过THW进行。中位随访时间83个月后，临床结果（随访结束时的结构性疾病状态、死亡率、总生存曲线和无进展生存曲线）无统计学差异。在复发风险较高的进展期DTC患者中，使用rhTSH刺激或THW进行RAI治疗准备，其临床结果并无劣势。
