Aplicación de la TSH humana recombinante en el protocolo diagnóstico del cáncer diferenciado de tiroides / Application of recombinant human TSH in the diagnostic protocol of differentiated thyroidcarcinoma

Objetivos: Describir los resultados preliminares de la aplicación de esta nueva técnica en la práctica diagnóstica habitual en el manejo del cáncer diferenciado de tiroides (CDT). Material y métodos: Se realizó rastreo corporal total (RCT) con 131I tras estimulación con TSH recombinante humana (rhTSH) en un grupo de 102 pacientes con CDT en seguimiento, todos tratados mediante tiroidectomía total. La pauta de administración fue de 0,9 mg rhTSH los días primeros y segundo del procedimiento, seguidos de 185 MBq de 131I administrados vía oral el día siguiente y posterior rastreo gammagráfico a las 48 horas. Se determinaron TSH, tiroglobulina (Tg) y anticuerpos antitiroglobulina en suero, mediante técnicas inmunométricas, a las 24 y 72 horas de la última administración de la rhTSH. Resultados. Los valores de TSH a las 24 horas tras estimulación con rhTSH fueron de 147,54 ± 46,46 mUI/l. En 62 pacientes se obtuvieron valores de Tg negativa (< 1 ng/ml), de los que 50 presentaron rastreo negativo y doce positivo. Entre los que tuvieron Tg positiva (37), 17 presentaron rastreo negativo (confirmándose presencia de enfermedad en 7 pacientes mediante otras técnicas de imagen) y 20 positivo. Conclusiones: La administración de rhTSH produjo en todos los casos un significativo aumento de la TSH, permitiendo la realización de los controles habituales de seguimiento de los pacientes de forma similar a la supresión hormonal. No han existido evidencias de efectos secundarios significativos, y su utilización permite obviar los inconvenientes derivados de la supresión, manteniendo una buena calidad de vida en los pacientes

Objectives: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC).Material and methods: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. Results: TSH values at 24 hours after exogenous stimulation were 147.54 ± 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. Conclusions: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients

[Application of recombinant human TSH in the diagnostic protocol of differentiated thyroid carcinoma]. / Aplicación de la TSH humana recombinante en el protocolo diagnóstico del cáncer diferenciado de tiroides.

OBJECTIVES: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC). MATERIAL AND METHODS: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. RESULTS: TSH values at 24 hours after exogenous stimulation were 147.54 +/- 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. CONCLUSIONS: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients.