Assessment of recombinant human thyrotropin application in following-up patients with well-differentiated thyroid carcinoma

Abstract

Background/Aim. The most sensitive indicators for detecting recurrence of well-differentiated thyroid cancer (DTC) are 131I whole body scintigraphy (WBS) and measurement of serum thyroglobulin (Tg). In order to perform it, it is necessary to raise the level of endogenous tiroidstimulating hormon (TSH), which can be achieved by Lthyroxine withdrawal for 3-5 weeks or administration of recombinant human thyrotropin (rhTSH) without requiring the discontinuation of thyroid hormone therapy. The aim of this study was to assess the effect of rhTSH using in comparison to the traditional thyroid hormone withdrawal in the follow-up of patients with DTC. Methods. This retrospective study included 44 patients, mean age 48.8 years, with DTC divided into 2 groups. The group I consisted of patients (n = 31) in which the analysis in the follow-up (WBS with 131I, TSH, Tg and antiTgAt) made in the hypothyroid state, and group II patients (n = 13) in which they made after the administration of rhTSH. The presence of 13 symptoms and signs of hypothyroidism was investigated on the day of giving 131I. Quality of life was evaluated using a modified form: the quality of life scale (SF-36) completed on the day of giving 131I. Results. In both groups, serum TSH reached a very good stimulation level, but significantly higher in the group II (group I 30.3-101.5 ?lU/mL, group II 68.6-192.0 ?lU/mL, p < 0.05). In both groups, TSHstimulated Tg was higher (group I 0.1-546.0 ng/mL, group II 0.1-7517 ng/mL) comapred to value during the Lthyroxine therapy (group I 0.1-495.0 ng/mL, group II 0.1- 2785 ng/mL). There was no difference in technical quality of WBS obtained from both groups. The patients in the group I had attended 8-13 symptoms of hypothyroidism, while patients in group II did not have symptoms of hypothyroidism. The patients after application of rhTSH, showed statistically significantly better quality of life as compared with those who showed to have L-thyroxine withdrawal, (74-91 points vs 43-62 points; p < 0.05). The rhTSH was well tolerated, with nausea occurring in only one patient. Conclusion. Administration of rhTSH in the follow- up of patients with DTC prevents the debilitating effects of hypothyroidism contributing to the maintenance of metabolic homeostasis of the organism and preserves the quality of life. RhTSH is safe, effective and easy to use, but is still an expensive product in our country.Uvod/Cilj. Najosjetljiviji indikatori otkrivanja recidiva dobro diferentovanog karcinoma stitaste zlijezde su scintigrafija cijelog tijela 131I i mjerenje nivoa serumskog tireoglobulina (Tg). Za njihovo izvodjenje potrebno je da se povisi nivo endogenog tireoidstimulisuceg hormona (TSH) sto se moze postici prekidom uzimanja terapije L-tiroksina tokom 3-5 nedelja ili davanjem rekombinantnog humanog tireotropina (rhTSH) bez prekidanja uzimanja terapije tireoidnim hormonima. Cilj ovog rada bio je ocjena upotrebe rhTSH u odnosu na tradicionalni prekid uzimanja supstitucionosupresorne terapije u pracenju bolesnika sa dobro diferentovanim karcinomom stitaste zlijezde. Metode. Ispitivanje je obavljeno kao retrospektivna studija kojom je bilo obuhvaceno 44 bolesnika sa dobro diferentovnim karcinomom stitaste zlijezde podijeljenih u dve grupe. Grupu I cinili su bolesnici (n = 31) kod kojih su analize za pracenje bolesti (scintigrafija cijelog tijela sa 131I, mjerenje nivoa TSH, Tg i antiTgAt) uradjene u hipotireoidnom stanju, a grupu II bolesnici (n = 13) kod kojih su iste analize obavljene nakon davanja rhTSH. Za procjenu pojave simptoma i znakova hipotireoidizma ispitivano je prisustvo 13 simptoma na dan davanja 131I. Kvalitet zivota je ocenjen pomocu modifikovanog upitnika [Skala kvalitete zivota (SF-36)] ispunjenog na dan davanja 131I. Rezultati. U obe grupe postignut je veoma dobar stimulativni nivo TSH, ali znacajno visi u grupi II (grupa I 30,3-101,5 ?lU/mL, grupa II 68,60-192,00 ?lU/mL, p < 0,05). U obe grupe vrijednosti Tg bile su vise tokom stimulacije TSH-om (grupa I 0,1-546,0 ng/mL, grupa II 0,1-7517 ng/mL) u odnosu na period uzimanja Ltiroksina (grupa I, 0,1-495,0 ng/mL, grupa II 0,1-2785 ng/mL). Nije bilo razlike u tehnickim kvalitetima dobijenih scintigrama cijelog tijela u obe grupe. Bolesnici iz grupe I imali su prisutno 8-13 simptoma hipotireoidizma, dok bolesnici iz grupe II nisu imali prisutne simptome hipotireoidizma. Znatno bolji kvalitet zivota imali su bolesnici poslije aplikacije rhTSH, 74 do 91 boda, u poredjenju sa onima koji su prekinuli uzimanje L-tiroksina, 43 do 62 boda (p < 0,05). Bolesnici su dobro podnosili rhTSH; samo kod jednog bolesnika zabiljezena je nauzeja. Zakljucak. Upotreba rhTSH u pracenju bolesnika sa dobro diferentovanim karcinomom stitaste zlijezde sprecava pojavu simptoma hipotireoidizma doprinoseci odrzavanju metabolicke homeostaze organizma i ocuvanju kvaliteta zivota. Rekombinantni humani tireotropin je bezbjedan, efikasan i jednostavan za upotrebu, ali za nase uslove jos uvijek skup preparat.