Follow-up of thyroid cancer patients using rhTSH -preliminary results

Summary

Aim: In the follow-up of patients with advanced stage thyroid cancer radioiodine scintigraphy, F-l 8-FDG PET and tumormarker hTg using stimulation with recombinant human TSH (rhTSH) were compared to the results of same diagnostic procedures during TSH-suppression or endogenous TSH-stimulation. Methods: 30 patients were investigated in hypothyroidism and after application of rhTSH regarding the serum hormone concentrations, hTg, radioiodine scans and FGD-PET scans. Results: Radioiodine avidity and FDG uptake were significantly higher in 7/30 and 3/5 patients, respectively, compared to endogenous stimulation or TSH-suppression. In about one third of patients hTg increased more than 30%. Conclusion: Our preliminary results indicate a sufficient feasibility and sensitivity of rhTSH not only in the follow-up by hTg and radioiodine scan but also in FDG-PET.

Zusammenfassung

Ziel: Untersucht wurden die Auswirkungen der Applikation von rekombinantem Thyreotropin (rhTSH) auf den Serum-hTg-Spiegel und die Ergebnisse von Radioiod-szintigraphie und F-18-FDG-PET im Rahmen der Nachsorge fortgeschrittener differenzierter Schilddrüsenkarzinome gegenüber Suppressionsbedingungen bzw. gegenüber endogener TSH-Stimulation. Methoden: 30 Patienten wurden jeweils in Hypothyreose und nach Gabe von rhTSH hinsichtlich der Serum-Hormonparameter, des Tumormarkers Thyreoglobulin, bezüglich lodavi-dität und 5 Patienten auch bezüglich FDG-Aufnahme von Rezidiv bzw. Metastasen untersucht. Ergebnisse: Die lodavidität und FDG-Aufnahme der Tumoren war bei 7/30 bzw. 3/5 signifikant höher nach rhTSH-Stimula-tion im Vergleich zu den Kontrollen unter endogener Stimulation oder Suppressionsbedingungen. Der hTg-Serumspiegel stieg bei rund einem Drittel der Patienten um mehr als 30% an. Schlussfolgerung: Diese ersten Ergebnisse deuten darauf hin, dass die Applikation von rhTSH nicht nur die Sensitivität der hTg-ßestimmung sondern auch der Radioiodszintigraphie und FDG PET gegenüber dem Zustand unter TSH-Suppression steigert und bezüglich der Sensitivität der endogenen TSH-Stimulation zumindest ebenbürtig ist.

Keywords

Thyroid cancer - recombinant TSH - PET - FDG - radioiodine - thyroglobulin

Schlüsselwörter

Schilddrüsenkarzinom - rekombinantes TSH - PET - FDG - Radioiod - Thyreoglobulin

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