This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Luster, M. Articles by Reiners, C. Search for Related Content PubMed PubMed Citation Articles by Luster, M. Articles by Reiners, C.

Use of Recombinant Human Thyrotropin before Radioiodine Therapy in Patients with Advanced Differentiated Thyroid Carcinoma

Department of Nuclear Medicine, University of Wuerzburg (M.L., M.L., H.H., U.M., C.R.), D-97080 Wuerzburg, Germany; and Genzyme Europe, 1411 DD Naarden, The Netherlands

Address all correspondence and requests for reprints to: Dr. M. Luster, Department of Nuclear Medicine, University of Wuerzburg, Josef-Schneider-Str. 2, D-97080 Wuerzburg, Germany. E-mail: luster{at}nuklearmedizin.uni-wuerzburg.de

The use of ¹³¹I for radioablative therapy in patients with differentiated thyroid cancer (DTC) requires a sufficient serum concentration of TSH for efficient thyroid tissue uptake of iodine. We describe the use of recombinant human TSH (rhTSH) in conjunction with ablative radioiodine therapy (RIT) in 11 patients (16 total treatments) with advanced and/or recurrent DTC (5 papillary, 6 follicular) for whom withdrawal of thyroid hormone suppression therapy (THST), the standard method to increase serum TSH, was not an option. Indications for rhTSH use in these patients included inability to tolerate withdrawal of thyroid hormones due to very poor physical condition or inability to achieve sufficient serum TSH levels after THST withdrawal. Ten patients had undergone thyroidectomy, and most (9 of 11) had received prior ablative RIT after THST withdrawal. Baseline thyroglobulin levels ranged from 25 to nearly 30,000 ng/mL, reflecting the heterogeneity of the patient population. In 7 cases (5 patients), posttherapy thyroglobulin levels assessed at a mean of 4.3 months (range, 2–10 months) after ¹³¹I therapy were decreased by at least 30% compared to pretherapy levels. In follow-up visits, an additional 3 patients showed marked clinical improvement or decreased or stabilized tumor burden in whole body scans compared to pretherapy scans. Three patients died of progressive disease within 2 months of therapy before follow-up assessments occurred. No adverse events were reported among the 8 surviving patients. The results suggest that rhTSH offers a promising alternative to THST withdrawal to allow ablative RIT after effective TSH stimulation in patients with advanced recurrent DTC who would not otherwise be able to receive this treatment. This therapeutic indication extends the clinical potential of this new agent, already demonstrated to be effective for use with ¹³¹I for diagnostic purposes.

This article has been cited by other articles:

				M. G. Castagna, A. Pinchera, A. Marsili, M. Giannetti, E. Molinaro, P. Fierabracci, L. Grasso, F. Pacini, F. Santini, and R. Elisei Influence of Human Body Composition on Serum Peak Thyrotropin (TSH) after Recombinant Human TSH Administration in Patients with Differentiated Thyroid Carcinoma J. Clin. Endocrinol. Metab., July 1, 2005; 90(7): 4047 - 4050. [Abstract] [Full Text] [PDF]

				M. Luster, F. Lippi, B. Jarzab, P. Perros, M. Lassmann, C. Reiners, and F. Pacini rhTSH-aided radioiodine ablation and treatment of differentiated thyroid carcinoma: a comprehensive review Endocr. Relat. Cancer, March 1, 2005; 12(1): 49 - 64. [Abstract] [Full Text] [PDF]

				B. de Keizer, A. Hoekstra, M. W. Konijnenberg, F. de Vos, B. Lambert, P. P. van Rijk, C. J.M. Lips, and J. M.H. de Klerk Bone Marrow Dosimetry and Safety of High 131I Activities Given After Recombinant Human Thyroid-Stimulating Hormone to Treat Metastatic Differentiated Thyroid Cancer J. Nucl. Med., September 1, 2004; 45(9): 1549 - 1554. [Abstract] [Full Text] [PDF]

				A. A. Driedger and N. Kotowycz Two Cases of Thyroid Carcinoma That Were Not Stimulated by Recombinant Human Thyrotropin J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 585 - 590. [Abstract] [Full Text] [PDF]

				C. Menzel, W. T. Kranert, N. Dobert, M. Diehl, T. Fietz, N. Hamscho, U. Berner, and F. Grunwald rhTSH Stimulation Before Radioiodine Therapy in Thyroid Cancer Reduces the Effective Half-Life of 131I J. Nucl. Med., July 1, 2003; 44(7): 1065 - 1068. [Abstract] [Full Text] [PDF]

				R. J. Robbins and K. S. Pentlow Coming of Age: Recombinant Human Thyroid-Stimulating Hormone as a Preparation for 131I Therapy in Thyroid Cancer J. Nucl. Med., July 1, 2003; 44(7): 1069 - 1071. [Full Text] [PDF]

				R. J. Robbins and A. K. Robbins Recombinant Human Thyrotropin and Thyroid Cancer Management J. Clin. Endocrinol. Metab., May 1, 2003; 88(5): 1933 - 1938. [Full Text] [PDF]

				V. Muller, K. H. Bohuslavizki, S. Klutmann, and M. Clausen Value of Recombinant Human Thyrotropin in High-Dose Radioiodine Therapy: A Case Report J. Nucl. Med. Technol., December 1, 2002; 30(4): 185 - 188. [Abstract] [Full Text] [PDF]

				F. Pacini, E. Molinaro, M. G. Castagna, F. Lippi, C. Ceccarelli, L. Agate, R. Elisei, and A. Pinchera Ablation of Thyroid Residues with 30 mCi 131I: A Comparison in Thyroid Cancer Patients Prepared with Recombinant Human TSH or Thyroid Hormone Withdrawal J. Clin. Endocrinol. Metab., September 1, 2002; 87(9): 4063 - 4068. [Abstract] [Full Text] [PDF]

				M. Braga, M. D. Ringel, and D. S. Cooper Sudden Enlargement of Local Recurrent Thyroid Tumor after Recombinant Human TSH Administration J. Clin. Endocrinol. Metab., November 1, 2001; 86(11): 5148 - 5151. [Abstract] [Full Text] [PDF]