46002
document
Recombinant human thyrotropin-stimulated radioiodine therapy of nodular goiter allows major reduction of the radiation burden with retained efficacy . CONTEXT AND OBJECTIVE Stimulation with recombinant human TSH ( rhTSH ) before radioiodine ( 131I ) therapy augments goiter volume reduction ( GVR ) . Observations indicate that rhTSH has a preconditioning effect beyond increasing thyroid ( 131 ) I uptake . We test the hypothesis that an equivalent GVR might be obtained by an absorbed thyroid dose well below what has been used previously . PATIENTS AND DESIGN In a double-blinded setup , 90 patients ( 78 women ; median age , 52 yr ; range , 22-83 ) with a nontoxic nodular goiter ( median size , 63 ml ; range , 25-379 ml ) were randomized to either 0.1 mg rhTSH ( n=60 ) followed by a thyroid dose of 50 Gy or placebo followed by 100 Gy ( n=30 ) . RESULTS At 12 months , the mean relative GVR in the placebo and the rhTSH group was identical ( 35+/-3 % ; P=0.81 ) . The median administered 131I-activity was 170 MBq ( 45-1269 ) in the rhTSH group and 559 MBq ( 245-3530 ) in the placebo group ( 70 % reduction , P < 0.0001 ) . According to the official radiation regulation , hospitalization was required in 14 patients in the placebo group vs. one patient in the rhTSH group ( P < 0.0001 ) . In both groups , goiter-related symptoms were effectively relieved in the majority of patients . The prevalence of myxedema ( 10 % ) did not differ among groups . CONCLUSIONS This is the first study to demonstrate that rhTSH not only increases the thyroid 131I uptake , but per se potentiates the effect of 131I-therapy , allowing a major reduction of the 131I-activity without compromising efficacy . This approach is attractive in terms of minimizing posttherapeutic restrictions and in reducing the potential risk of radiation-induced malignancy .
46003
Intervention_Pharmacological
Recombinant human thyrotropin-stimulated radioiodine therapy
46004
Intervention_Pharmacological
recombinant human TSH ( rhTSH )
46005
Intervention_Physical
radioiodine ( 131I ) therapy
46006
Intervention_Pharmacological
rhTSH
46007
Intervention_Pharmacological
rhTSH
46008
Intervention_Physical
thyroid dose of 50 Gy
46009
Intervention_Control
placebo
46010
Intervention_Control
placebo
46011
Intervention_Pharmacological
rhTSH
46012
Intervention_Pharmacological
rhTSH
46013
Intervention_Control
placebo
46014
Intervention_Control
placebo
46015
Intervention_Pharmacological
rhTSH
46016
Intervention_Pharmacological
rhTSH
46017
Intervention_Physical
131I-therapy
46018
Outcome_Other
radiation burden
46019
Outcome_Other
efficacy .
46020
Outcome_Physical
goiter volume reduction ( GVR )
46021
Outcome_Physical
relative GVR
46022
Outcome_Physical
131I-activity
46023
Outcome_Other
hospitalization
46024
Outcome_Physical
goiter-related symptoms
46025
Outcome_Physical
myxedema
46026
Outcome_Physical
thyroid 131I uptake
46027
Outcome_Other
131I-activity
46028
Outcome_Other
efficacy .
46029
Outcome_Other
posttherapeutic restrictions