Combined treatment of the highly differentiated cancer of thyroid gland: recombinant human thyrotropin-alpha is in the focus
DOI:
https://doi.org/10.15587/2313-8416.2016.64975Keywords:
highly differentiated cancer of thyroid gland, recombinant human thyrotropin-alpha, life quality, thyroglobulin, ablation, radioiodine therapyAbstract
Aim. An assessment of the effectiveness of treatment and also the detection of advantages of prescription of the recombinant human thyrotropin-alpha (rhTTH) in postoperative period in patients with the highly differentiated cancer of thyroid gland (HDCTG) comparing with traditional method of preparation (cancellation of the thyroid hormones) to the treatment using radioactive iodine.
Methods. There was carried out an analysis of the treatment of 100 patients with HDCTG: the control group – 56 patients (standard tactics), the main group – 44 patients (the use of rhTTH). There was carried out the scanning of all the body in 48 hours after administration of 150 MBc 131I, was detected the concentration of thyroglobulin and antibodies to it, the level of thyrotropic hormone, was carried out the ultrasound of neck and also questioning about the life quality.
Results. The comparative analysis of the data of studied groups demonstrated the reliably less number of isotope accumulation nidi in persons whose preparation was carried out with the help of rhTTH, that is the absence of visible catch in 25 % of cases in patients from the category of low risk (in 5,7 times higher than in analogous cohort of the control group– 4,4 %) and in 7,1 % – in patients from the high risk group. The number of cases of the minimal visible catch <0,1 % in patients of the high risk category is reliably higher comparing with the control one (78,1 % and 56,1 % respectively, Р<0,01). The level of stimulated serum thyroglobulin >2,0 ng/ml was detected in 3,1 % of cases in the main group whereas in the control one – 13,1 %; within 1,0–2,0 ng/ml was detected reliably less often in the main group: 8,3 % in the low risk patients and 12,5 % – in the high risk ones comparing with the control group (28,6 % and 31,7 % respectively). The effective decrease of thyroglobulin level in 6–8 months after radioiodine therapy was detected in 22 (91,7 %) patients of the main low risk group and in 27 (84,4 %) – ones of the high risk that is reliably higher than in the control group (60,0 % and 53,7 % respectively, Р<0,01). In the main group was not observed any clinical relapse of disease or persistence of pathological tumor process, in the control group on the contrary – 2 clinical relapses (4,9 %) and 4 cases (9,7 %) of persistence of disease. In the main group nobody needed the repeated operation during 6 months after radioiodine therapy because of absence of the regional metastases of papillary carcinoma. The negative assessment of health was observed in 10,7 % of cases in the control group and was not fixed in the main one. The positive assessment of health was observed in 63,6 % of patient who took recombinant TTH comparing with the control group – 21,4 %.
Conclusions. The research demonstrated that combined treatment of the group of patients with HDCTG with the use of rhTTH is reliably more effective comparing with the group of patients who were prepared to treatment with the radioactive iodine using traditional method. The received results ground by the new proofs the advantages of the use of recombinant human thyrotropin-alpha
References
Jepshtejn, E. V., Olejnik, V. A., Komissarenko, I. V. et. al (1999). Diagnostika i lechenie raka shhitovidnoj zhelezy. Zhurn. Akad. med. nauk Ukrainy, 3, 516–524.
Dedov, I. I., Mel'nichenko, G. A., Troshina, E. A. et. al (2008). Spornye voprosy taktiki lechenija differencirovannogo raka shhitovidnoj zhelezy. Probl. Jendokrinol, 54 (2), 14–22.
Oliynyk, V., Epshtein, O., Sovenko, T., Tronko, M., Elisei, R., Pacini, F., Pinchera, A. (2001). Post-surgical ablation of thyroid residues with radioiodine in Ukrainian children and adolescents affected by post-Chernobyl differentiated thyroid cancer. Journal of Endocrinological Investigation, 24 (6), 445–447. doi: 10.1007/bf03351045
Gul'chij, N. V., Dinec, A. V. (2012). Osobennosti gormonal'noj terapii posle operacij po povodu raka shhitovidnoj zhelezy. Mezhdunar. jendokr. zhurn., 1 (41).
Cailleux, A. F., Baudin, E., Travagli, J. P., Ricard, M., Schlumberger, M. (2000). Is Diagnostic Iodine-131 Scanning Useful after Total Thyroid Ablation for Differentiated Thyroid Cancer? The Journal of Clinical Endocrinology & Metabolism, 85 (1), 175–178. doi: 10.1210/jcem.85.1.6310
Fernandes, K. P., Cernea, C. R., Paraventi, C. et. al (2005). Quality of Life After Thyroidectomy: A Proposal For A New Questionnaire. Ann. Meet. Progr. Amer. Head Neck Surg. Boca Ration, Florida, 56.
Elisei, R., Corone, C., Driedger, A. et. al (2007). Follow-up of differentiated thyroid cancer patients who underwent radioiodine ablation of postsurgical thyroid remnants after recombinant human thyrotropin or thyroid hormone withdrawal. Ann. Congr. Europ. Assoc. Nucl. Med. Copenhagen, Denmark, 405.
Tuttle, R. M., Lopez, N., Leboeuf, R., Minkowitz, S. M., Grewal, R., Brokhin, M. et. al (2010). Radioactive Iodine Administered for Thyroid Remnant Ablation Following Recombinant Human Thyroid Stimulating Hormone Preparation Also Has an Important Adjuvant Therapy Function. Thyroid, 20 (3), 257–263. doi: 10.1089/thy.2009.0401
Hanscheid, H., Lassmann, M., Luster, M. et. al (2006). Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J. Nucl. Med., 47 (4), 648–654.
Mernagh, P., Campbell, S., Dietlein, M., Luster, M., Mazzaferri, E., Weston, A. R. (2006). Cost-effectiveness of using recombinant human TSH prior to radioiodine ablation for thyroid cancer, compared with treating patients in a hypothyroid state: the German perspective. European Journal of Endocrinology, 155 (3), 405–414. doi: 10.1530/eje.1.02223
Merdad, M., Eskander, A., De Almeida, J., Freeman, J., Rotstein, L., Ezzat, S. et. al (2014). Current management of papillary thyroid microcarcinoma in Canada. Journal of Otolaryngology – Head & Neck Surgery, 43 (1). doi: 10.1186/s40463-014-0032-8
Sugitani, I., Fujimoto, Y. (2010). Does Postoperative Thyrotropin Suppression Therapy Truly Decrease Recurrence in Papillary Thyroid Carcinoma? A Randomized Controlled Trial. The Journal of Clinical Endocrinology & Metabolism, 95 (10), 4576–4583. doi: 10.1210/jc.2010-0161
Hay, I. D., Hutchinson, M. E., Gonzalez-Losada, T., McIver, B., Reinalda, M. E., Grant, C. S. et. al (2008). Papillary thyroid microcarcinoma: A study of 900 cases observed in a 60-year period. Surgery, 144 (6), 980–988. doi: 10.1016/j.surg.2008.08.035
Pacini, F., Ladenson, P. W., Schlumberger, M., Driedger, A., Luster, M., Kloos, R. T. et. al (2006). Radioiodine Ablation of Thyroid Remnants after Preparation with Recombinant Human Thyrotropin in Differentiated Thyroid Carcinoma: Results of an International, Randomized, Controlled Study. The Journal of Clinical Endocrinology & Metabolism, 91 (3), 926–932. doi: 10.1210/jc.2005-1651
Chianelli, M., Todino, V., Graziano, F. M., Panunzi, C., Pace, D., Guglielmi, R. et. al (2008). Low-activity (2.0 GBq; 54 mCi) radioiodine post-surgical remnant ablation in thyroid cancer: comparison between hormone withdrawal and use of rhTSH in low-risk patients. European Journal of Endocrinology, 160 (3), 431–436. doi: 10.1530/eje-08-0669
Vartanian, J. G., Carvalho, A. L., Furia, A. L. et. al (2007). Questionnaries Validated in Brazilian Population for Evaluation of the Quality of Life in Patients with Head and Neck Cancer. Rev. Brasil. Cirur. Cabeç. Pescoç., 36, 108–115.
Ain, K. B. (2015). Radioiodine-remnant ablation in low-risk differentiated thyroid cancer: pros. Endocrine, 50 (1), 61–66. doi: 10.1007/s12020-015-0668-9
Borget, I., Remy, H., Chevalier, J., Ricard, M., Allyn, M., Schlumberger, M., De Pouvourville, G. (2008). Length and cost of hospital stay of radioiodine ablation in thyroid cancer patients: comparison between preparation with thyroid hormone withdrawal and thyrogen. European Journal of Nuclear Medicine and Molecular Imaging, 35 (8), 1457–1463. doi: 10.1007/s00259-008-0754-9
Downloads
Published
Issue
Section
License
Copyright (c) 2016 Петро Петрович Зінич
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our journal abides by the Creative Commons CC BY copyright rights and permissions for open access journals.
Authors, who are published in this journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the journal under the terms of a Creative Commons CC BY, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form in which it has been published by the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.