Ladenson P W, Braverman L E, Mazzaferri E L, Brucker-Davis F, Cooper D S, Garber J R, Wondisford F E, Davies T F, DeGroot L J, Daniels G H, Ross D S, Weintraub B D
Division of Endocrinology and Metabolism and the Thyroid Tumor Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287-4904, USA.
N Engl J Med. 1997 Sep 25;337(13):888-96. doi: 10.1056/NEJM199709253371304.
To detect recurrent disease in patients who have had differentiated thyroid cancer, periodic withdrawal of thyroid hormone therapy may be required to raise serum thyrotropin concentrations to stimulate thyroid tissue so that radioiodine (iodine-131) scanning can be performed. However, withdrawal of thyroid hormone therapy causes hypothyroidism. Administration of recombinant human thyrotropin stimulates thyroid tissue without requiring the discontinuation of thyroid hormone therapy.
One hundred twenty-seven patients with thyroid cancer underwent whole-body radioiodine scanning by two techniques: first after receiving two doses of thyrotropin while thyroid hormone therapy was continued, and second after the withdrawal of thyroid hormone therapy. The scans were evaluated by reviewers unaware of the conditions of scanning. The serum thyroglobulin concentrations and the prevalence of symptoms of hypothyroidism and mood disorders were also determined.
Sixty-two of the 127 patients had positive whole-body radioiodine scans by one or both techniques. The scans obtained after stimulation with thyrotropin were equivalent to the scans obtained after withdrawal of thyroid hormone in 41 of these patients (66 percent), superior in 3 (5 percent), and inferior in 18 (29 percent). When the 65 patients with concordant negative scans were included, the two scans were equivalent in 106 patients (83 percent). Eight patients (13 percent of those with at least one positive scan) were treated with radioiodine on the basis of superior scans done after withdrawal of thyroid hormone. Serum thyroglobulin concentrations increased in 15 of 35 tested patients: 14 after withdrawal of thyroid hormone and 13 after administration of thyrotropin. Patients had more symptoms of hypothyroidism (P<0.001) and dysphoric mood states (P<0.001) after withdrawal of thyroid hormone than after administration of thyrotropin.
Thyrotropin stimulates radioiodine uptake for scanning in patients with thyroid cancer, but the sensitivity of scanning after the administration of thyrotropin is less than that after the withdrawal of thyroid hormone. Thyrotropin scanning is associated with fewer symptoms and dysphoric mood states.
为了检测分化型甲状腺癌患者的疾病复发情况，可能需要定期停用甲状腺激素治疗，以提高血清促甲状腺素浓度，刺激甲状腺组织，从而进行放射性碘（碘 - 131）扫描。然而，停用甲状腺激素治疗会导致甲状腺功能减退。给予重组人促甲状腺素可刺激甲状腺组织，而无需中断甲状腺激素治疗。
127例甲状腺癌患者通过两种技术进行全身放射性碘扫描：第一种是在继续甲状腺激素治疗的同时接受两剂促甲状腺素后进行扫描，第二种是在停用甲状腺激素治疗后进行扫描。由不知道扫描情况的评估者对扫描结果进行评估。还测定了血清甲状腺球蛋白浓度以及甲状腺功能减退和情绪障碍症状的发生率。
127例患者中有62例通过一种或两种技术进行的全身放射性碘扫描呈阳性。在这些患者中，41例（66%）促甲状腺素刺激后获得的扫描结果与停用甲状腺激素后获得的扫描结果相当，3例（5%）更好，18例（29%）更差。当纳入65例扫描结果均为阴性的患者时，两种扫描结果在106例患者（83%）中相当。8例患者（至少有一次阳性扫描结果的患者中的13%）基于停用甲状腺激素后更好的扫描结果接受了放射性碘治疗。35例接受检测的患者中有15例血清甲状腺球蛋白浓度升高：14例在停用甲状腺激素后升高，13例在给予促甲状腺素后升高。与给予促甲状腺素后相比，患者在停用甲状腺激素后出现更多甲状腺功能减退症状（P<0.001）和烦躁情绪状态（P<0.001）。
促甲状腺素可刺激甲状腺癌患者摄取放射性碘进行扫描，但给予促甲状腺素后扫描的敏感性低于停用甲状腺激素后。促甲状腺素扫描相关的症状和烦躁情绪状态较少。
