ABSTRACT
Recombinant human thyroid-stimulating hormone (rhTSH) enhances 131I uptake, permitting a decrease in radiation for the treatment of multinodular goiter (MNG). Our objective was to evaluate the safety and efficacy of a single 0.1-mg dose of rhTSH, followed by 30 mCi 131I, in patients with MNG. Seventeen patients (15 females, 59.0 ± 13.1 years), who had never been submitted to 131I therapy, received a single 0.1-mg injection of rhTSH followed by 30 mCi 131I on the next day. Mean basal thyroid volume measured by computed tomography was 106.1 ± 64.4 mL. 131I 24-h uptake, TSH, free-T4, T3, thyroglobulin, anti-thyroid antibodies, and thyroid volume were evaluated at regular intervals of 12 months. Mean 131I 24-h uptake increased from 18.1 ± 9.7 to 49.6 ± 13.4 percent (P < 0.001), a median 2.6-fold increase (1.2 to 9.2). Peak hormonal levels were 10.86 ± 5.44 mU/L for TSH (a median 15.5-fold increase), 1.80 ± 0.48 ng/dL for free-T4, 204.61 ± 58.37 ng/dL for T3, and a median of 557.0 ng/mL for thyroglobulin. The adverse effects observed were hyperthyroidism (17.6 percent), painful thyroiditis (29.4 percent) and hypothyroidism (52.9 percent). Thyroid volume was reduced by 34.3 ± 14.3 percent after 6 months (P < 0.001) and by 46.0 ± 14.6 percent after 1 year (P < 0.001). Treatment of MNG with a single 0.1-mg dose of rhTSH, followed by a fixed amount of radioactivity of 131I, leads to an efficacious decrease in thyroid volume for the majority of the patients, with a moderate incidence of non-serious and readily treatable adverse effects.
Subject(s)
Female , Humans , Male , Middle Aged , Goiter, Nodular/radiotherapy , Iodine Radioisotopes/administration & dosage , Thyrotropin/administration & dosage , Combined Modality Therapy , Follow-Up Studies , Goiter, Nodular/drug therapy , Recombinant Proteins/administration & dosage , Treatment OutcomeABSTRACT
Os auto-anticorpos anti tireoglobulina (AAT) e antimicrossomal/peroxidase (AAM) estão altamente associados às doenças auto-imunes da tireóide e tem sido investigados por métodos diversos. O presente estudo foi realizado em um grupo de 108 pacientes oom doença da tireóide (Tireoidite de Hashimoto, n = 43; Doença de Graves - n = 13 e Bócio colóide - n = 52) e em 25 doadores sadios de banco de sangue do Hospital de Clínicas - UFPR. Os anticorpos AAM e AAT foram analisados simultaneamente pelo métodos de Aglutinação Passiva (AP), IRMA e Imunofluorescência Indireta (IFI) com o objetivo de padronizar este último em nosso serviço e compará-lo com os demais. A positividade para os AAM na Tireoidite de Hashimoto, na Doença de Graves e no Bócio colóide variou de 62,8% a 81,4%, 76,8% a 92,3% e 5,76% 19,2%, respectivamente. O coeficiente de relação dos níveis de anticorpos detectados pelos três métodos ressaltou alta significância(AAT,r=0,60 a 0,74 e AAM r=0,84 a 0,91; p< 0,01). A análise dos resultados evidenciou que embora para os AAM a IFI tenha apresentado sensibilidade ligeiramente inferior aos outros métodos, seu uso traria resultados mais confiáveis no laboratório clínico,com grande redução no custo da análise.