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Recombinant Human Thyrotropin Markedly Changes the ¹³¹I Kinetics during ¹³¹I Therapy of Patients with Nodular Goiter: An Evaluation by a Randomized Double-Blinded Trial

Departments of Endocrinology and Metabolism (V.E.N., S.J.B., L.H.) and Nuclear Medicine (H.B.-J., A.V.), Odense University Hospital, DK-5000 Odense, Denmark

Address all correspondence and requests for reprints to: Viveque Egsgaard Nielsen, M.D., Department of Endocrinology and Metabolism, Odense University Hospital, DK-5000 Odense C, Denmark. E-mail: viveque.egsgaard{at}ouh.fyns-amt.dk.

The present study compares, in a randomized double-blinded design, the expected and the actual absorbed thyroid radioactive dose in response to 0.3 mg recombinant human (rh)TSH (n = 35) or placebo (n = 28) given 24 h before ¹³¹I therapy in patients with nodular goiter (median volume, 69 ml; range, 20–440 ml). The ¹³¹I activity calculation was based on thyroid ¹³¹I uptake (RAIU) at 24 and 96 h after a tracer dose of 0.5 MBq ¹³¹I. After ¹³¹I therapy, 24- and 96-h RAIU were repeated allowing a more exact assessment of the actual absorbed thyroid dose. The median ¹³¹I activity was 617 and 632 MBq, respectively, in the rhTSH and the placebo group. At baseline, the 24- and 96-h RAIU and the expected thyroid dose were 32.8 ± 9.1%, 32.1 ± 8.2%, and 96.3 ± 16.3 Gy, respectively, in the rhTSH group and 35.7 ± 11.8%, 35.2 ± 11.3%, and 94.1 ± 18.5 Gy, respectively, in the placebo group (P value not significant between groups). After ¹³¹I therapy, the 24- and 96-h RAIU and the actual absorbed thyroid dose were 46.9 ± 11.7%, 45.0 ± 12.1%, and 136.7 ± 47.9 Gy, respectively, in the rhTSH group and 33.0 ± 11.4%, 31.0 ± 11.3%, and 76.9 ± 27.5 Gy, respectively, in the placebo group (P < 0.001 between groups). Comparing the expected with the actual absorbed thyroid dose, this corresponds to a mean increase of 36.4% (95% confidence interval, 21.3–53.4) in the rhTSH group and a decrease of 21.5% (95% confidence interval, –33.9 to –6.6) in the placebo group (P < 0.001), equivalent to an increase of 73.8% in the absorbed thyroid dose in the rhTSH-treated group. We have thus for the first time shown that stimulation with rhTSH before ¹³¹I therapy not only hinders the decrease in the thyroid RAIU observed with conventional ¹³¹I therapy but in fact also significantly enhances the absorbed thyroid dose. Whether this also leads to a significant increase in goiter size reduction needs additional study.

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