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Moon JB, Jeon S, Park KS, Yoo SW, Kang SR, Cho SG, Kim J, Lee C, Song HC, Min JJ, Bom HS, Kwon SY. Change of Therapeutic Response Classification According to Recombinant Human Thyrotropin-Stimulated Thyroglobulin Measured at Different Time Points in Papillary Thyroid Carcinoma. Nucl Med Mol Imaging 2021; 55:116-122. [PMID: 34093891 DOI: 10.1007/s13139-021-00699-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/05/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose We investigated whether response classification after total thyroidectomy and radioactive iodine (RAI) therapy could be affected by serum levels of recombinant human thyrotropin (rhTSH)-stimulated thyroglobulin (Tg) measured at different time points in a follow-up of patients with papillary thyroid carcinoma (PTC). Methods A total of 147 PTC patients underwent serum Tg measurement for response assessment 6 to 24 months after the first RAI therapy. Serum Tg levels were measured at 24 h (D1Tg) and 48-72 h (D2-3Tg) after the 2nd injection of rhTSH. Responses were classified into three categories based on serum Tg corresponding to the excellent response (ER-Tg), indeterminate response (IR-Tg), and biochemical incomplete response (BIR-Tg). The distribution pattern of response classification based on serum Tg at different time points (D1Tg vs. D2-3Tg) was compared. Results Serum D2-3Tg level was higher than D1Tg level (0.339 ng/mL vs. 0.239 ng/mL, P < 0.001). The distribution of response categories was not significantly different between D1Tg-based and D2-3Tg-based classification. However, 8 of 103 (7.8%) patients and 3 of 40 (7.5%) patients initially categorized as ER-Tg and IR-Tg based on D1Tg, respectively, were reclassified to IR-Tg and BIR-Tg based on D2-3Tg, respectively. The optimal cutoff values of D1Tg for the change of response categories were 0.557 ng/mL (from ER-Tg to IR-Tg) and 6.845 ng/mL (from IR-Tg to BIR-Tg). Conclusion D1Tg measurement was sufficient to assess the therapeutic response in most patients with low level of D1Tg. Nevertheless, D2-3Tg measurement was still necessary in the patients with D1Tg higher than a certain level as response classification based on D2-3Tg could change.
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Affiliation(s)
- Jang Bae Moon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
| | - Subin Jeon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
| | - Ki Seong Park
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Nuclear Medicine, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do Republic of Korea
| | - Changho Lee
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
- Department of Nuclear Medicine, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do Republic of Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Nuclear Medicine, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do Republic of Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
- Department of Nuclear Medicine, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do Republic of Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
- Department of Nuclear Medicine, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do Republic of Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
- Department of Nuclear Medicine, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do Republic of Korea
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Berstein LM, Vasilyev DA, Radzhabova ZA, Poroshina TE. Thyroglobulin test at 3 weeks after surgery in well-differentiated thyroid cancer and its predictive value: the role of endocrine–metabolic status. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2014. [DOI: 10.2217/ije.14.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim & methods: The present pilot study included 50 differentiated thyroid cancer (DTC) patients (mean age: 45.8 ± 1.8 years, range: 18–73 years) who were followed after surgery for in average 30.0 ± 2.6 months. All patients were subdivided into two groups as having either <2 ng/ml or ≥2 ng/ml blood thyroglobulin level 3 weeks after the operation (3-WTT). Results: Subsequent tumor progression was revealed more often in patients with higher thyroglobulinemia (≥2 ng/ml) in both low- and high-risk DTC groups. Patients with high-risk DTC and 3-week thyroglobulin levels ≥2 ng/ml were more likely to have a higher pre-surgical thyrotropin (TSH) levels. On the contrary, patients with low-risk DTC and 3-week thyroglobulin level ≥2 ng/ml demonstrated tendency to higher preoperative serum insulin levels and higher BMI. Conclusion: These differential findings could suggest that, whereas maximal suppression of TSH is reasonable in high-risk DTC patients, in low-risk DTC patients, for whom this is not justified, a moderate TSH suppression supplemented by multivalent drugs, such as antidiabetic biguanide metformin, could be advised.
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Affiliation(s)
- Lev M Berstein
- NN Petrov Research Institute of Oncology, Pesochny, Leningradskaya 68, St Petersburg 197758, Russia
| | - Dmitry A Vasilyev
- NN Petrov Research Institute of Oncology, Pesochny, Leningradskaya 68, St Petersburg 197758, Russia
| | - Zamira A Radzhabova
- NN Petrov Research Institute of Oncology, Pesochny, Leningradskaya 68, St Petersburg 197758, Russia
| | - Tatyana E Poroshina
- NN Petrov Research Institute of Oncology, Pesochny, Leningradskaya 68, St Petersburg 197758, Russia
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Khan MU, Nawaz MK, Shah MA, Syed AA, Khan AI. Judicious use of recombinant TSH in the management of differentiated thyroid carcinoma. Ann Nucl Med 2010; 24:609-15. [PMID: 20700666 DOI: 10.1007/s12149-010-0404-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 07/14/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the feasibility of using recombinant human TSH (rhTSH) in conjunction with ¹³¹I to treat patients with differentiated thyroid carcinoma. METHODS Between July 2003 and April 2009, 14 patients [mean age, 39.1 years (range 14-71 years)], of whom seven were treated for remnant ablation and seven for irresectable or metastatic disease, received rhTSH-aided ¹³¹I therapy. None had an adequate rise in TSH. The mean ¹³¹I dosage administered was 5206.3 MBq. Baseline thyroglobulin/anti-thyroglobulin (Tg/anti-Tg) and TSH levels were documented. rhTSH (0.9 mg) was given intramuscularly on days 1 and 2, and TSH levels were recorded. ¹³¹I was given when the TSH level rose to >30 μIU/ml. Tg/anti-Tg levels were measured at 3-month intervals. A ¹³¹I whole-body scan (¹³¹I scan) was performed 6 or 12 months after treatment. RESULTS The baseline median valid Tg and TSH levels were 76.2 ng/ml (range 14.1 to >30000) and 3.63 μIU/ml (range 1.36-11.0), respectively. The rise in TSH level was 34.8-96.9 μIU/ml after the first rhTSH injection and 33.1 to >75 μIU/ml after the second injection. The post-therapy ¹³¹I scan showed uptake at disease sites in all patients, indicating the initial empirical adequacy of treatment. Follow-up ¹³¹I scan was positive for four patients, but negative for three of these patients after subsequent therapy. Complete resolution of disease was seen in eight patients and partial resolution in four after 3 months of therapy; one had stable disease; and in one patient with progressive disease, complete resolution was achieved after repeated ¹³¹I doses with thyroxine withdrawal. After a median follow-up of 39.2 months, all patients were alive and no disease recurrence was observed. The overall response rate at 3 months was 86% and had improved to 93% at the time of this review. The final ablation rate in seven patients was 100%. Apart from notable neck swelling in four patients, which was responsive to medication, and headache in two patients, no significant short-term side-effects of therapy were seen. CONCLUSION In our setting, the use of rhTSH-aided ¹³¹I ablation and treatment was safe and effective.
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Affiliation(s)
- Muhammad Umar Khan
- Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
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Abstract
Recombinant human thyroid-stimulating hormone (rhTSH), used to enhance diagnostic radioiodine whole body scanning and thyroglobulin testing, has dramatically altered the management of patients with thyroid cancer. Withdrawal from thyroid hormone suppression therapy and subsequent hypothyroidism is no longer the only safe and effective method for thyroid cancer surveillance. Currently, rhTSH is only approved for the monitoring of low-risk patients with well-differentiated thyroid cancer and radioactive iodine administration, in selected cases. Additional applications of rhTSH include enhancing the sensitivity of positron emission tomography in thyroid cancer, the management of multinodular goiter, and dynamic testing of thyroid reserve. The diagnostic and therapeutic role of rhTSH in these areas is discussed in this review.
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Affiliation(s)
- Loukas Gourgiotis
- National Institutes of Health, Clinical Endocrinology Branch, National Institute of Diabetes, Digestive and Kidney Diseases, 10 Center Drive MSC 1771, Building 10, Room 8S235B, Bethesda, Maryland 20892-1771, USA
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Woodrum DT, Gauger PG. Role of131I in the treatment of well differentiated thyroid cancer. J Surg Oncol 2005; 89:114-21. [PMID: 15719384 DOI: 10.1002/jso.20185] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
(131)I is an integral component in postsurgical management of well-differentiated thyroid cancer (WDTC), which includes papillary and follicular types. (131)I is used postsurgically to either destroy remaining thyroid tissue (thyroid ablation) or to treat recurrence and metastases (radioiodine therapy). (131)I is no longer a routine diagnostic modality, but it is widely used for remnant ablation after thyroidectomy for WDTC > 1 cm, under conditions of thyroxine withdrawal. It is generally-though not unanimously-accepted that postsurgical radioiodine is the most powerful method by which to lengthen disease-free survival. (131)I cannot be used if the residual thyroid remnant is large; many surgeons therefore perform near-total or total thyroidectomy for all WDTC > 1 cm. Since 1997, radioiodine treatment has been performed in outpatient settings, where side effects are common, but mild and transient. Secondary screening is by physical exam, thyroglobulin measurements, and (131)I diagnostic whole-body scans. This is performed under conditions of thyrotropin stimulation, which is accomplished either by thyroxine withdrawal or administration of recombinant human thyrotropin. While most cancers are well treated with radioiodine, some advanced cancers may no longer take up radioiodine, rendering them resistant to treatment. For these cancers, redifferentiation therapy and molecular target-specific medicines hold future promise for improved treatment.
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Affiliation(s)
- Derek T Woodrum
- Division of Endocrine Surgery, University of Michigan Department of Surgery, Ann Arbor, Michigan, USA
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de Mendonça F, de Oliveira JE, Bartolini P, Ribela MTCP. Two-step chromatographic purification of recombinant human thyrotrophin and its immunological, biological, physico-chemical and mass spectral characterization. J Chromatogr A 2005; 1062:103-12. [PMID: 15679148 DOI: 10.1016/j.chroma.2004.10.084] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A purification strategy for rapidly obtaining recombinant human thyrotropin (rhTSH) was designed based on size exclusion and reversed-phase high-performance liquid chromatographic (HPLC) analysis, carried out on hTSH-secreting CHO cell conditioned medium. These analyses permitted the identification of the main contaminants to be eliminated. Considering that hTSH is highly hydrophobic and elutes only with the addition of organic solvents, hydrophobic interaction chromatography was adopted as the first purification step; this resulted in the elimination of, among others, the major contaminant. A second purification step, based on size exclusion chromatography, was then utilized, being effective in the elimination of other previously identified contaminating proteins. Useful purity, as high as 99% at the chemical reagent level, and recoveries (37%) were obtained by adopting this two step strategy, which also provided adequate material for physico-chemical, immunological and biological characterization. This included matrix-assisted laser desorption ionization time-of-flight mass spectral analysis (MALDI-TOF-MS), Western blotting analysis, in vivo biological assay, size-exclusion HPLC (HPSEC) and reversed-phase HPLC (RP-HPLC) analysis, which confirmed the integrity and bioactivity of our rhTSH in comparison with the only two reference preparations available at the milligram level of native (hTSH-NIDDK) and recombinant (Thyrogen) hTSH. Thyrogen and rhTSH-IPEN, when compared to pit-hTSH-NIDDK, presented more than twice as much biological activity and about 7% increased molecular mass by MALDI-TOF-MS analysis, an accurate heterodimer mass determination providing the Mr values of 29,611, 29,839 and 27,829, respectively. The increased molecular mass of the two recombinant preparations was also confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and HPSEC analysis. Comparing the two recombinant preparations, minor though interesting physico-chemical and biological differences were also observed.
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Affiliation(s)
- Fernanda de Mendonça
- Biotechnology Department, IPEN-CNEN, Cidade Universitária, 05508-900 São Paulo, Brazil
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