Radioiodine Therapy for Well-Differentiated Thyroid Cancer

Radioiodine therapy with 131I remains the mainstay of standard treatment for well-differentiated thyroid cancer (DTC). Prognosis is good but concern exists that 131I-emitted ionizing radiation may induce double-strand breaks in extra-thyroidal tissues, increasing the risk of secondary malignancies. We, therefore, sought to evaluate the induction and 2-year persistence of micronuclei (MN) in lymphocytes from 26 131I-treated DTC patients and the potential impact of nine homologous recombination (HR), non-homologous end-joining (NHEJ), and mismatch repair (MMR) polymorphisms on MN levels. MN frequency was determined by the cytokinesis-blocked micronucleus assay while genotyping was performed through pre-designed TaqMan® Assays or conventional PCR-restriction fragment length polymorphism (RFLP). MN levels increased significantly one month after therapy and remained persistently higher than baseline for 2 years. A marked reduction in lymphocyte proliferation capacity was also apparent 2 years after therapy. MLH1 rs1799977 was associated with MN frequency (absolute or net variation) one month after therapy, in two independent groups. Significant associations were also observed for MSH3 rs26279, MSH4 rs5745325, NBN rs1805794, and tumor histotype. Overall, our results suggest that 131I therapy may pose a long-term challenge to cells other than thyrocytes and that the individual genetic profile may influence 131I sensitivity, hence its risk-benefit ratio. Further studies are warranted to confirm the potential utility of these single nucleotide polymorphisms (SNPs) as radiogenomic biomarkers in the personalization of radioiodine therapy.

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Clinical outcomes of patients with T4 or N1b well-differentiated thyroid cancer after different strategies of adjuvant radioiodine therapy

Scientific Reports ◽

10.1038/s41598-019-42083-3 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Shin Young Jeong ◽

Sang-Woo Lee ◽

Wan Wook Kim ◽

Jin Hyang Jung ◽

Won Kee Lee ◽

...

Keyword(s):

Thyroid Cancer ◽

Clinical Outcomes ◽

Differentiated Thyroid Cancer ◽

Radioiodine Therapy ◽

Well Differentiated

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Effects of Thyroid Hormone Withdrawal and Recombinant Human Thyrotropin on Glomerular Filtration Rate During Radioiodine Therapy for Well-Differentiated Thyroid Cancer

Thyroid ◽

10.1089/thy.2015.0173 ◽

2015 ◽

Vol 25 (12) ◽

pp. 1291-1296 ◽

Cited By ~ 8

Author(s):

George Barberio Coura-Filho ◽

Jose Willegaignon ◽

Carlos Alberto Buchpiguel ◽

Marcelo Tatit Sapienza

Keyword(s):

Thyroid Cancer ◽

Glomerular Filtration Rate ◽

Thyroid Hormone ◽

Glomerular Filtration ◽

Filtration Rate ◽

Differentiated Thyroid Cancer ◽

Radioiodine Therapy ◽

Thyroid Hormone Withdrawal ◽

Well Differentiated ◽

Recombinant Human Thyrotropin

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Recombinant human thyrotropin in radioiodine diagnostics and radioiodine ablation of patients with well-differentiated thyroid cancer: the first experience in Russia

Endocrine Surgery ◽

10.14341/serg9806 ◽

2018 ◽

Vol 12 (3) ◽

pp. 128-139

Author(s):

Ivan I. Dedov ◽

Pavel O. Rumyantsev ◽

Ksenia S. Nizhegorodova ◽

Konstantin Y. Slashchuk ◽

Valentina S. Yasyuchenya ◽

...

Keyword(s):

Thyroid Cancer ◽

Side Effects ◽

Thyroid Hormones ◽

Differentiated Thyroid Cancer ◽

Radioiodine Therapy ◽

Thyroid Stimulating Hormone ◽

Efficacy And Safety ◽

Post Surgery ◽

Radioiodine Ablation ◽

Well Differentiated

Background. Traditional endogenous stimulation of thyroid-stimulating hormone (TSH) by means of long-term withdrawal of thyroid hormones for radioiodine diagnostics and radioiodine therapy causes severe hypothyroidism, which worsens patients’ general well-being and may lead to side effects and cause tumor growth and dissemination. Exogenous stimulation with recombinant human TSH (rh-TSH, thyrotropin-alfa) causes short-term increases in TSH levels and does not have the above-mentioned side effects. Purpose. To estimate the efficacy and safety of rh-TSH in preparation of patients with well-differentiated thyroid cancer for radioiodine diagnostics and radioiodine therapy. Methods. We conducted an interventional single-center prospective unblinded uncontrolled study of the efficacy and safety of thyrotropin-alfa to prepare patients with well-differentiated thyroid cancer to radioiodine diagnostics and post-surgery radioiodine ablation. The study included 88 patients with well-differentiated thyroid cancer: 54 patients were prepared for post-surgery radioiodine ablation; 34 patients – for radioiodine diagnostics to evaluate combined treatment efficacy and exclusion of tumor recurrence. The level of TSH, thyroglobulin, antibodies to thyroglobulin, whole body scintigraphy, and side effects were measured during exogenous stimulation with thyrotropin-alfa. Results. The level of TSH reached or exceed the target level (30 mIU/ml) 24 hours after the first injection of recombinant thyrotropin-alfa in 86% of patients; after 48 hours in 100%, the level exceeding 100 IU/ml was observed in 66 (75.1%) patients. The maximum levels of thyroglobulin and antibodies to thyroglobulin were reached 72 and 48 hours after the first injection, respectively. The injections of thyrotropin-alfa were well-tolerated by the patients. In the group for radioiodine diagnostics 2 (5.8%) patients complained of fatigue, 1 (2.9%) patient had signs of dyspeptic disorder, while in the group for radioiodine ablation 4 (7.4%) patients complained of fatigue, 1 (1.8%) patient had marked memory problems that disappeared later (they must have been caused by the patient’s advanced age (82 years)). Conclusions. Exogenous recombinant human thyroid-stimulating hormone (thyrotropin-alpha) is highly effective in preparation of patients with well-differentiated thyroid cancer for radioiodine diagnostics and radioiodine ablation. It does not have side effects, which are typical of withdrawal of thyroid hormones. The levels of thyroglobulin and antibodies to thyroglobulin measured 72 hours after the first injection of thyrotropin-alfa have the biggest diagnostic informative value.

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