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DOI: 10.3413/Nukmed-0808-16-03
Recombinant human thyrotropin stimulated 131I treatment for multinodular goiter
Rekombinantes rhTSH zur Stimulation der 131I-Behandlung bei Struma multinodosaPublication History
received:
09 March 2016
accepted in revised form:
22 July 2016
Publication Date:
09 January 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/201606/lookinside/thumbnails/10-3413-nukmed-0808-16-03_de-1.jpg)
Summary
The aim of the study was to investigate the effects of rhTSH stimulation before 131I treatment in patients with MNG. Methods: Sources included the Cochrane Library, MEDLINE, EMBASE, and SCOPUS database (all until January 2016). Randomized controlled trials (RCTs) that assessed the efficacy of rhTSH-stimulated 131I treatment compared to placebo or 131I treatment alone were collected. Two authors performed the data extraction independently. Results: Six RCTs involving 294 patients with MNG were included in this review. Altogether 168 patients were randomized to rhTSH-stimulated 131I therapy, and 126 to either placebo and 131I or 131I alone. rhTSH-stimulated 131I vs placebo and 131I or 131I alone for MNG showed no statistically significant difference in quality of life and all-cause mortality. rhTSH- (at a dose of 0.03 mg and above) stimulated 131I treatment for MNG showed significant benefits in thyroid volume reduction. 131I treatment with rhTSH stimulation at high doses (0.03 mg, 0.1 mg, 0.3 mg and 0.45 mg) for MNG caused significantly higher adverse effects and hypothyroidism. Conclusions: The overall results indicated that using rhTSH at high doses of 0.03–0.45 mg before 131I therapy resulted in a greater TVR than 131I therapy alone for patients with non-toxic MNG. However, an increased incidence of adverse effects and hypothyroidism was observed in patients receiving highdose of rhTSH pretreatment than in patients who received low-dose rhTSH pretreatment. Therefore, a dose of 0.03 mg rhTSH pretreatment before 131I therapy may be more potent than 131I alone in treating patients with non-toxic MNG who either had a contraindication for or declined surgery.
Zusammenfassung
Ziel der Studie war, bei Patienten mit Struma multinodosa (MNG) die Effekte einer rhTSH Stimulation vor der Behandlung mit 131I zu untersuchen. Methoden: Recherche in Cochrane Library, MEDLINE, EMBASE und der SCOPUS Datenbank (alle bis Januar 2016). Ausgewählt wurden randomisierte, kontrollierte Studien (RCT), in denen die Wirksamkeit einer rhTSH-stimulierten 131I-Therapie vs. Placebo oder 131I-Therapie alleine untersucht wurde. Zwei Autoren extrahierten unabhängig voneinander die Daten. Ergebnisse: Sechs RCT an 294 Patienten mit MNG wurden in das Review aufgenommen. Insgesamt 168 Patienten wurden randomisiert einer rhTSH-stimulierten 131I-Therapie und 126 entweder Placebo und 131I oder 131I alleine zugeteilt. Die rhTSH-stimulierte 131I-Therapie bei MNG ergab vs. Placebo und 131I oder 131I alleine keine statistisch signifikanten Unterschiede bei Lebensqualität und Gesamtmortalität. Bei der Volumenreduktion der Schilddrüse (TVR) zeigte die mit rhTSH (Dosierungen von 0,03 mg und höher) stimulierte 131I-Therapie bei MNG signifikante Vorteile. Die 131I-Therapie mit hochdosierter (0,03 mg, 0,1 mg, 0,3 mg und 0,45 mg) rhTSH-Stimulation bei MNG verursachte signifikant mehr Nebenwirkungen und Hypothyreosen. Schlussfolgerungen: Allgemein deuten die Ergebnisse darauf hin, dass die Stimulation mit hohen rhTSH-Dosen von 0,03–0,45 mg vor der 131I-Therapie bei Patienten mit einer nich ttoxischen MNG zu einer größeren TVR führte als die 131I-Therapie alleine. Jedoch wurde unter einer Vorbehandlung mit hochdosiertem rhTSH eine höhere Inzidenz von Nebenwirkungen und Hypothyreosen beobachtet als bei Patienten, die rhTSH in niedriger Dosierung erhielten. Somit könnte bei Patienten mit nicht toxischer MNG, bei denen eine Operation kontraindiziert ist oder abgelehnt wird, eine Vorbehandlung mit 0,03 mg rhTSH vor der 131I-Therapie potenter sein als die 131I-Therapie alleine.
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