title: Radioiodine therapy of benign non-toxic goitre. Potential role of recombinant human TSH.
abstract: This review provides an update on recombinant human TSH (rh-TSH) augmented radioiodine (¹³¹I) therapy and outlines its potential role in the treatment of symptomatic benign multinodular non-toxic goitre. In some countries, ¹³¹I has been used for three decades to reduce the size of nodular goitres. The feasibility of ¹³¹I therapy depends on an adequate thyroid ¹³¹I uptake. Based on a two-fold increase in thyroid ¹³¹I uptake, superiority studies have convincingly demonstrated that the absorbed thyroid ¹³¹I dose can be increased without increasing the administered ¹³¹I activity, resulting in a 35-56% amplification of goitre reduction at one-year post radioiodine compared to conventional (without rh-TSH) ¹³¹I therapy. Although patient satisfaction is not improved at one-year, this approach facilitates tracheal decompression and is particularly promising in large goitres. The majority of multinodular non-toxic goitre patients may not require amplified goitre reduction. But as an alternative strategy, rh-TSH allows up to 80% reduction of the therapeutic ¹³¹I activity while still achieving goitre reduction comparable to that of conventional ¹³¹I therapy and maintaining high patient satisfaction. The dose-reduction (equality) strategy is attractive in terms of minimizing post-therapeutic restrictions and in reducing the potential risk of radiation-induced malignancy. Adverse effects like temporary thyroid swelling and thyroid hormone excess are to a large extent dose-dependent and generally 0.1mg rh-TSH or less is well tolerated. Based on these results we conclude that rh-TSH augmented ¹³¹I therapy is a promising new therapeutic principle allowing the tailoring of an optimal ¹³¹I therapy on the individual level.
authors.affiliation: Department of Endocrinology and Metabolism, Odense University Hospital, Denmark. Soeren.Fast@ouh.regionsyddanmark.dk
authors.forename: S
authors.initials: S
authors.lastname: Fast
authors.forename: S J
authors.initials: SJ
authors.lastname: Bonnema
authors.forename: L
authors.initials: L
authors.lastname: Hegedüs
mesh_terms: D006044:Goiter, Nodular / Q000532:radiotherapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013963:Thyroid Hormones / Q000378:metabolism; D013972:Thyrotropin / Q000627:therapeutic use*
chemical_list: D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013963:Thyroid Hormones; D013972:Thyrotropin