Insufficient elevation of TSH before therapy with I131 in a patient with metastatic differentiated thyroid carcinoma
DOI:
https://doi.org/10.31053/1853.0605.v80.n2.38112Keywords:
thyroid neoplasms, thyrotropine, iodineAbstract
Guidelines suggest a thyrotropin (TSH) stimulation level ≥30 mIU/l for the administration of 131-iodine (I131) in patients with differentiated thyroid carcinoma (DTC). We present a patient with follicular thyroid carcinoma (FTC), with spinal metastasis as the initial manifestation, who after 6 weeks without levothyroxine did not present an elevation of ≥30 mIU/l of TSH. This situation was interpreted as secondary to the presence of functioning metastases and it was decided, regardless of the TSH level, to administer a therapeutic dose of I131, with iodine-uptake lesions in the liver and spine being confirmed.
References
1.Pitoia, F, Califano, I, Vázquez, A, Faure, E, Gauna, A, Orlandi, A, Vanelli, A, Novelli, JL, Mollerach, A, Fadel, A, San Martín, A, Figari, M, Cabezón, C. Consenso intersocietario* sobre tratamiento y Consenso intersocietario* sobre tratamiento y seguimiento de pacientes con cáncer diferenciado de tiroides. Revista argentina de endocrinología y metabolismo, 51(2), 85-118.
2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020.
3. Edmonds CJ, Hayes S, Kermode JC, Thompson BD. Measurement of serum TSH and thyroid hormones in the management of treatment of thyroid carcinoma with radioiodine. Br J Radiol. 1977 Nov;50(599):799-807. doi: 10.1259/0007-1285-50-599-799.
4. Kogai T, Endo T, Saito T, Miyazaki A, Kawaguchi A, Onaya T. Regulation by thyroid-stimulating hormone of sodium/iodide symporter gene expression and protein levels in FRTL-5 cells. Endocrinology. 1997 Jun;138(6):2227-32. doi: 10.1210/endo.138.6.5189.
5. Vrachimis A, Riemann B, Mäder U, Reiners C, Verburg FA. Endogenous TSH levels at the time of 131I ablation do not influence ablation success, recurrence-free survival or differentiated thyroid cancer-related mortality. Eur J Nucl Med Mol Imaging. 2016 Feb;43(2):224-231. doi: 10.1007/s00259-015-3223-2.
6. Zhao T, Liang J, Guo Z, Li T, Lin Y. In Patients With Low- to Intermediate-Risk Thyroid Cancer, a Preablative Thyrotropin Level of 30 μIU/mL Is Not Adequate to Achieve Better Response to 131I Therapy. Clin Nucl Med. 2016 Jun;41(6):454-8. doi: 10.1097/RLU.0000000000001167.
7. Nutting C, Hyer S, Vini L, Harmer C. Failure of TSH rise prior to radio-iodine therapy for thyroid cancer: implications for treatment. Clin Oncol (R Coll Radiol). 1999;11(4):269-71. doi: 10.1053/clon.1999.9061.
8. Zheng W, Rui Z, Wang X, Li N, Tan J, Liu W. The Influences of TSH Stimulation Level, Stimulated Tg Level and Tg/TSH Ratio on the Therapeutic Effect of 131I Treatment in DTC Patients. Front Endocrinol (Lausanne). 2021 Jun 11;12:601960. doi: 10.3389/fendo.2021.601960.
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