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Exp Clin Endocrinol Diabetes 2010; 118(8): 513-519
DOI: 10.1055/s-0029-1234086
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

The Use of Thyrogen® in the Treatment of Differentiated Thyroid Carcinoma: An Intraindividual Comparison of Clinical Effects and Implications of Daily Life

C. Dueren1 , M. Dietlein2 , M. Luster3 , F. Plenzig4 , R. Steinke5 , J. Grimm6 , P. Groth7 , W. Eichhorn8 , C. Reiners1
  • 1Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
  • 2Department of Nuclear Medicine, University of Cologne, Köln, Germany
  • 3Department of Nuclear Medicine, University of Ulm, Ulm, Germany
  • 4Genzyme GmbH, Neu-Isenburg, Germany
  • 5Center of Nuclear Medicine, Magdeburg, Germany
  • 6Center of Nuclear Medicine, Halle, Germany
  • 7Clinic of Nuclear Medicine, University Rostock, Rostock, Germany
  • 8Department of Nuclear Medicine, University of Mainz, Mainz, Germany
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Publikationsverlauf

received 24.02.2009 first decision 12.05.2009

accepted 26.06.2009

Publikationsdatum:
23. Oktober 2009 (online)

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Abstract

Aim: Withdrawal of levothyroxine with resultant hypothyroidism is still used in preparation for I-131 diagnostic whole-body scan (DWBS) and thyroglobulin (TG)-measurement in patients afflicted with differentiated thyroid cancer (DTC). Recombinant human thyroid-stimulating hormone (rhTSH) enhances TSH stimulation obviating the clinical and economical consequences of hypothyroidism. Primary aim of this study was an intraindividual comparison of diagnostic follow-up measurements under these two sets of conditions by taking clinical and socio-economic parameters into account. Second aim was to determine a clear patient preference for the one method or the other.

Methods: This non-interventional observational study included patients (n=192 signed informed consent, n=128 protocol compliant patients without need for therapeutic intervention) with DTC first treated by thyroidectomy and radioiodine ablation. Control visits including I-131 DWBS were planned at 3–6 months post-thyroidectomy after a phase (KU 1) of thyroid hormone withdrawal (THW) and again after 6–12 months later in a euthyroid state under exogenous stimulation with rhTSH (KU 2). Study design was open, prospective and multicentric. Data collected consisted of patient information (SF-12® Health Survey), thyroid-specific results of clinical examinations and several aspects of daily life, e. g., employment, days of absence from work and other economic aspects.

Results: In contrast to KU 1, in KU 2 there is a highly significant improvement (p<0.0001) in all studied clinical symptoms and aspects of managing daily life. A significant increase of the SF-12® health survey score could also be identified. Mental score showed a higher increase than physical score. Included patients were less absent from work before KU 2, (absent 4.5%, median 4 days in euthyroid state [range 2–5 d]), vs. before KU 1 (absent 47.8%, median 10 days in hypothyroid state [range 1–30 d]). After KU 2 7.7% of the euthyroid patients was absent from work (median 5 days) while 37.5% was after KU 1 (median 6 days).

Conclusion: Included patients benefited subjectively and objectively from the use of rhTSH for diagnostic procedures in the treatment of DTC. A clear preference (127 of 128) of analyzed patients could be identified for exogenous stimulation with rhTSH.

Key words

rhTSH - thyroid cancer - hypothyroidism - diagnostic whole body

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Correspondence

Dr. C. Dueren

Department of Nuclear Medicine

University of Wuerzburg

Josef-Schneider-Straße 2

97080 Wuerzburg

Germany

Telefon: +49/9312/013 58 68

Fax: +49/9312/013 59 70

eMail: dueren_c@klinik.uni-wuerzburg.de