Skip to main content

Advertisement

SpringerLink
Log in

Tumour dosimetry and response in patients with metastatic differentiated thyroid cancer using recombinant human thyrotropin before radioiodine therapy

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

The development of recombinant human thyrotropin (rhTSH) has given clinicians new options for diagnostic follow-up and treatment of patients with differentiated thyroid cancer (DTC). This paper evaluates the tumour dosimetry and response following -iodine-131 treatment of metastatic thyroid cancer patients after rhTSH stimulation instead of classical hormone withdrawal-induced hypothyroidism. Nineteen consecutive 131I treatments in 16 patients were performed after rhTSH stimulation. All patients had undergone a near-total thyroidectomy followed by an ablative dosage of 131I. They all suffered from metastatic or recurrent disease showing tumoral 131I uptake on previous post-treatment scintigraphy. Dosimetric calculations were performed using 131I tumour uptake measurements from post-treatment 131I scintigrams and tumour volume estimations from radiological images. Response was assessed by comparing pre-treatment serum thyroglobulin (Tg) level with the Tg level 3 months post treatment. In 18 out of 19 treatments, uptake of 131I in metastatic or recurrent lesions was seen. The median tumour radiation dose was 26.3 Gy (range 1.3–368 Gy), and the median effective half-life was 2.7 days (range 0.5–6.5 days). Eleven of 19 treatments (10/16 patients) were evaluable for response after 3 months. 131I therapy with rhTSH resulted in a biochemical partial response in 3/11 or 27% of treatments (two patients), biochemical stable disease in 2/11 or 18% of treatments and biochemical progressive disease in 6/11 or 55% of treatments. Our study showed that although tumour doses in DTC patients treated with 131I after rhTSH were highly variable, 45% of treatments led to disease stabilisation or partial remission when using rhTSH in conjunction with 131I therapy, without serious side-effects and with minimal impact on quality of life. RhTSH is therefore adequately satisfactory as an adjuvant tool in therapeutic settings and is especially suitable in advanced recurrent or metastatic DTC patients who may be intolerant to TSH stimulation by levothyroxine withdrawal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1. A

Similar content being viewed by others

References

  1. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med 1998; 338:297–306.

    CAS  PubMed  Google Scholar 

  2. Mazzaferri EL, Kloos RT. Using recombinant human TSH in the management of well-differentiated thyroid cancer: current strategies and future directions. Thyroid 2000; 10:767–778.

    CAS  PubMed  Google Scholar 

  3. Dow KH, Ferrell BR, Anello C. Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid 1997; 7:613–619.

    CAS  PubMed  Google Scholar 

  4. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001; 344:501–509.

    CAS  PubMed  Google Scholar 

  5. Rudavsky AZ, Freeman LM. Treatment of scan-negative, thyroglobulin-positive metastatic thyroid cancer using radioiodine 131I and recombinant human thyroid stimulating hormone. J Clin Endocrinol Metab 1997; 82:11–14.

    CAS  PubMed  Google Scholar 

  6. Kaplan MM. Progress in thyroid cancer. Endocrinol Metab Clin North Am 1990; 19:469–478.

    CAS  Google Scholar 

  7. Meier CA, Braverman LE, Ebner SA, Veronikis I, Daniels GH, Ross DS, Deraska DJ, Davies TF, Valentine M, DeGroot LJ. Diagnostic use of recombinant human thyrotropin in patients with thyroid carcinoma (phase I/II study). J Clin Endocrinol Metab 1994; 78:188–196.

    CAS  PubMed  Google Scholar 

  8. Robbins RJ, Tuttle RM, Sharaf RN, Larson SM, Robbins HK, Ghossein RA, Smith A, Drucker WD. Preparation by recombinant human thyrotropin or thyroid hormone withdrawal are comparable for the detection of residual differentiated thyroid carcinoma. J Clin Endocrinol Metab 2001; 86:619–625.

    CAS  PubMed  Google Scholar 

  9. Lippi F, Capezzone M, Angelini F, Taddei D, Molinaro E, Pinchera A, Pacini F. Radioiodine treatment of metastatic differentiated thyroid cancer in patients on l-thyroxine, using recombinant human TSH. Eur J Endocrinol 2001; 144:5–11.

    CAS  PubMed  Google Scholar 

  10. Luster M, Lassmann M, Haenscheid H, Michalowski U, Incerti C, Reiners C. Use of recombinant human thyrotropin before radioiodine therapy in patients with advanced differentiated thyroid carcinoma. J Clin Endocrinol Metab 2000; 85:3640–3645.

    CAS  PubMed  Google Scholar 

  11. Rotman-Pikielny P, Reynolds JC, Barker WC, Yen PM, Skarulis MC, Sarlis NJ. Recombinant human thyrotropin for the diagnosis and treatment of a highly functional metastatic struma ovarii. J Clin Endocrinol Metab 2000; 85:237–244.

    CAS  PubMed  Google Scholar 

  12. Luster M, Reinhardt W, Korber C, Lassmann M, Haenscheid H, Michalowski U, Rendl J, Eising E, Mann K, Reiners C. The use of recombinant human TSH in a patient with metastatic follicular carcinoma and insufficient endogenous TSH production. J Endocrinol Invest 2000; 23:473–475.

    CAS  PubMed  Google Scholar 

  13. Schlesinger T, Flower MA, McCready VR. Radiation dose assessments in radioiodine (131I) therapy. 1. The necessity for in vivo quantitation and dosimetry in the treatment of carcinoma of the thyroid. Radiother Oncol 1989; 14:35–41.

    CAS  PubMed  Google Scholar 

  14. Furhang EE, Larson SM, Buranapong P, Humm JL. Thyroid cancer dosimetry using clearance fitting. J Nucl Med 1999; 40:131–136.

    CAS  PubMed  Google Scholar 

  15. Haugen BR, Pacini F, Reiners C, Schlumberger M, Ladenson PW, Sherman SI, Cooper DS, Graham KE, Braverman LE, Skarulis MC, Davies TF, DeGroot LJ, Mazzaferri EL, Daniels GH, Ross DS, Luster M, Samuels MH, Becker DV, Maxon HR, III, Cavalieri RR, Spencer CA, McEllin K, Weintraub BD, Ridgway EC. A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab 1999; 84:3877–3885.

    CAS  PubMed  Google Scholar 

  16. Schlumberger M, Challeton C, De Vathaire F, Travagli JP, Gardet P, Lumbroso JD, Francese C, Fontaine F, Ricard M, Parmentier C. Radioactive iodine treatment and external radiotherapy for lung and bone metastases from thyroid carcinoma. J Nucl Med 1996; 37:598–605.

    CAS  PubMed  Google Scholar 

  17. Maxon HR, Thomas SR, Hertzberg VS, Kereiakes JG, Chen IW, Sperling MI, Saenger EL. Relation between effective radiation dose and outcome of radioiodine therapy for thyroid cancer. N Engl J Med 1983; 309:937–941.

    CAS  PubMed  Google Scholar 

  18. Park SG, Reynolds JC, Brucker-Davis F, Whatley M, McEllin K, Maxted D, Robbins J, Weintraub BD. Iodine kinetics during I-131 scanning in patients with thyroid cancer: comparison of studies with recombinant TSH (rhTSH) vs. hypothyroidism [abstract]. J Nucl Med 1996; 37:15P.

    Google Scholar 

  19. Goslings BM. Proceedings: effect of a low iodine diet on 131-I therapy in follicular thyroid carcinomata. J Endocrinol 1975; 64:30P.

    CAS  Google Scholar 

  20. Sonenberg M. Low-iodine diet in the treatment of differentiated thyroid cancer with radioactive iodine. Endocrine 2002; 17:141–143.

    CAS  PubMed  Google Scholar 

  21. Durski JM, Weigel RJ, McDougall IR. Recombinant human thyrotropin (rhTSH) in the management of differentiated thyroid cancer. Nucl Med Commun 2000; 21:521–528.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported in part by Genzyme B.V. Netherlands, Naarden, The Netherlands. We are grateful to Eilis Haughian for her valuable suggestions. We thank Hans van Asselt for his excellent technical assistance.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Room E02.222, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Bart de Keizer, Anne Hoekstra, Peter P. van Rijk & John M. H. de Klerk

  2. Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

    Boudewijn Brans & Rudi A. Dierckx

  3. Department of Endocrinology, University Medical Center Utrecht, The Netherlands

    Pierre M. J. Zelissen, Hans P. F. Koppeschaar & Cees J. M. Lips

Authors
  1. Bart de Keizer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Boudewijn Brans
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anne Hoekstra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pierre M. J. Zelissen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans P. F. Koppeschaar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cees J. M. Lips
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter P. van Rijk
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rudi A. Dierckx
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. John M. H. de Klerk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bart de Keizer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Keizer, B., Brans, B., Hoekstra, A. et al. Tumour dosimetry and response in patients with metastatic differentiated thyroid cancer using recombinant human thyrotropin before radioiodine therapy. Eur J Nucl Med 30, 367–373 (2003). https://doi.org/10.1007/s00259-002-1076-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-002-1076-y

Keywords

Search

Navigation