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Optimizing ¹³¹I Uptake After rhTSH Stimulation in Patients with Nontoxic Multinodular Goiter: Evidence from a Prospective, Randomized, Double-Blind Study

¹ Departments of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark; and ² Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

Correspondence: For correspondence or reprints contact: Søren Fast, Departments of Endocrinology and Metabolism, Odense University Hospital, DK-5000, Odense, Denmark. E-mail: Soeren.Fast{at}ouh.regionsyddanmark.dk

Prestimulation with recombinant human thyroid-stimulating hormone (rhTSH) augments radioiodine ¹³¹I therapy for benign nontoxic multinodular goiter. The purpose of this study was to determine the optimal time interval between rhTSH and ¹³¹I administration to enhance thyroid radioactive iodine uptake (RAIU). Methods: Patients were randomized, in a 2-factorial design, to receive either a 0.1-mg dose of rhTSH (n = 60) or placebo (n = 30) and to a time interval of 24, 48, or 72 h before ¹³¹I administration. The rhTSH- or placebo-stimulated RAIU study was performed at 4 wk after a baseline RAIU assessment in a tertiary referral center at a university hospital. A total of 90 patients (78 women; median age, 52 y; range, 22–83 y) referred to ¹³¹I therapy for symptomatic nontoxic goiter (median goiter volume, 63 mL; range, 25–464 mL) were included in the study. Change in thyroid RAIU was determined at 24 and 96 h after ¹³¹I tracer administration. Results: In the placebo subgroups, RAIU did not change significantly from baseline. The mean (±SE) 24-h RAIU increased from 33.8% ± 2.3% to 66.0% ± 1.8% (111.2% increase) with a 24-h interval, from 36.8% ± 2.1% to 64.6% ± 2.7% (83.3% increase) with a 48-h interval, and from 33.0% ± 2.7% to 49.6% ± 2.5% (62.4% increase) with a 72-h interval. All within-group changes were highly significant (P < 0.001). The effect was negatively correlated with initial RAIU (r = –0.703, P < 0.001). The increase in 24- and 96-h RAIU was significantly higher in the rhTSH/24-h group than it was in the rhTSH/72-h group (P = 0.023 and 0.012, respectively) and insignificantly higher than in the rhTSH/48-h group (P = 0.37 and 0.26, respectively). Conclusion: The effect of rhTSH on thyroid RAIU is most pronounced when administered 24 h before ¹³¹I administration and declines with longer time intervals. Whether there is a similar time dependency for goiter reduction after rhTSH-stimulated ¹³¹I-therapy remains to be clarified.

Key Words: endocrinology • radionuclide therapy • radiotracer tissue kinetics • goiter • radioiodine therapy • recombinant thyrotropin • rhTSH

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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JNM 2009 50: 11A-12A. [Full Text]