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Radioiodine ablation and therapy in differentiated thyroid cancer under stimulation with recombinant human thyroid-stimulating hormone

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Abstract

We investigated whether recombinant human TSH (rhTSH) safely and effectively induces uptake of high-dose 131-iodine (131I) to ablate thyroid remnant or treat disease, in patients with well-differentiated thyroid carcinoma. Eleven consecutive patients unable to tolerate thyroid hormone withdrawal received one im injection of 0.9 mg rhTSH on 2 consecutive days before receiving 4000 MBq (~108 mCi) radioiodine orally. Eight patients received one, and 3 patients 2 courses. Our series comprised 7 women and 4 men (mean age, 78 yr, range: 56–87 yr). Ten patients had undergone total or near-total thyroid-ectomy up to 19 yr earlier. rhTSH-stimulated single course radioiodine with the intention to ablate thyroid remnant was performed in 3 patients, with following estimation of radioiodine uptake and TG measurements. Of another 8 patients given this treatment palliatively, 5 had radiological, clinical and/or laboratory response, including: 80% decreased pathological uptake between treatment courses; pronounced decrease in bone pain; diminished symptoms; improved physical condition and quality of life; lower serum TG concentration; and/or normalization of TG recovery test. Two patients with small lung metastases on computed tomography had no detectable radioiodine uptake or other response; they also lacked uptake after withdrawal-stimulated radioiodine treatment. Despite being elderly and frail, patients generally tolerated treatment well; rhTSH caused nausea in one patient and transiently increased pain in bone and soft tissue lesions in another. We conclude that rhTSH-stimulated high-dose radioiodine for remnant ablation or tumor treatment is safe, feasible and seemingly effective, enhancing quality of life and offering reasonable palliation in patients with advanced disease.

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Authors and Affiliations

  1. Department of Oncology, Sahlgren University Hospital, SE-413 45, Gothenburg, Sweden

    G. Berg

  2. Departments of Clinical Chemistry and Transfusion Medicine, Sahlgren University Hospital, Gothenburg, Sweden

    G. Lindstedt

  3. Department of Nuclear Medicine, Sahlgren University Hospital, Gothenburg, Sweden

    M. Suurküla

  4. Department of Surgery, Sahlgren University Hospital, Gothenburg, Sweden

    S. Jansson

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  1. G. Berg
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  2. G. Lindstedt
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  3. M. Suurküla
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  4. S. Jansson
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Correspondence to G. Berg.

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Berg, G., Lindstedt, G., Suurküla, M. et al. Radioiodine ablation and therapy in differentiated thyroid cancer under stimulation with recombinant human thyroid-stimulating hormone. J Endocrinol Invest 25, 44–52 (2002). https://doi.org/10.1007/BF03343960

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