방사성 옥소 치료 및 전신스캔 전 처치 시의 갑상선 자극호르몬 농도에 따른 갑상선글로불린의 변화
Serum Thyroglobulin Varies according to Thyrotropin Levels during Preparation for Treatment by Radioactive Iodine Ablation and Scan
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Periods of L-T4 withdrawal and low iodine diet, which are required prior to the treatment and tracking tests that take place after a thyroidectomy, can be of a long duration and cause suffering for patients. The purpose of this study, conducted in South Korea, was to confirm if periods of L-T4 withdrawal and low iodine diet can be shortened by using TSH level prediction. By inquiring into the correlation between TSH level and serum Tg level, and measurement of the amount of iodine present in urine during the low iodine diet period, a thyroglobulin (Tg) cutoff level can be predicted. Methods: A total of 168 patients were included as research subjects. In each case, L-T4 was suspended 3-4 weeks prior to conducting radioactive iodine ablation and 131I scan, and then a low iodine diet was carried out for 2-4 weeks. Serum TSH, Tg and anti-Tg antibodies were measured on the second week of L-T4 withdrawal, and the spot urine Iodine/Creatinine ratio was measured on the second and fourth week after treatment.Results: Three weeks after L-T4 withdrawal, TSH levels increased to over 30μIU/㎖ in 97.2% of the patients, and serum thyroglobulin levels also increased with TSH level to over 30μIU/㎖. There was no measured difference in the amount of iodine in the subject’s urine during the low iodine diet period. Conclusion: It was found that L-T4 withdrawal can be reduced to 3 weeks or less, and that the Tg cutoff level differs according to TSH level. Based on these results, we suggested that the low iodine diet period can be reduced to 1-2 weeks.
Abstract
Purpose: Periods of L-T4 withdrawal and low iodine diet, which are required prior to the treatment and tracking tests that take place after a thyroidectomy, can be of a long duration and cause suffering for patients. The purpose of this study, conducted in South Korea, was to confirm if periods of L-T4 withdrawal and low iodine diet can be shortened by using TSH level prediction. By inquiring into the correlation between TSH level and serum Tg level, and measurement of the amount of iodine present in urine during the low iodine diet period, a thyroglobulin (Tg) cutoff level can be predicted. Methods: A total of 168 patients were included as research subjects. In each case, L-T4 was suspended 3-4 weeks prior to conducting radioactive iodine ablation and 131I scan, and then a low iodine diet was carried out for 2-4 weeks. Serum TSH, Tg and anti-Tg antibodies were measured on the second week of L-T4 withdrawal, and the spot urine Iodine/Creatinine ratio was measured on the second and fourth week after treatment.Results: Three weeks after L-T4 withdrawal, TSH levels increased to over 30μIU/㎖ in 97.2% of the patients, and serum thyroglobulin levels also increased with TSH level to over 30μIU/㎖. There was no measured difference in the amount of iodine in the subject’s urine during the low iodine diet period. Conclusion: It was found that L-T4 withdrawal can be reduced to 3 weeks or less, and that the Tg cutoff level differs according to TSH level. Based on these results, we suggested that the low iodine diet period can be reduced to 1-2 weeks.
참고문헌 (25)
- Black EG, "Serial serum thyroglobulin measurements in the management of differentiated thyroid carcinoma", Clin Endocrinol (Oxf), 27, pp.115~120 (1987)
- Pacini F, "Serum thyroglobulin concentrations and 131I whole body scans in the diagnosis of metastases from differentiated thyroid carcinoma (after thyroidectomy)", Clin Endocrinol (Oxf), 13, pp.107~110 (1980)
- Refetoff S, "The value of serum thyroglobulin measurement in clinical practice", JAMA, 250, pp.2352~2357 (1983)
- Black EG, "Serum thyroglobulin in thyroid cancer", Lancet, 2, pp.443~445 (1981)
- Pacini F, "Diagnostic value of a single serum thyroglobulin determination on and off thyroid suppressive therapy in the follow-up of patients with differentiated thyroid cancer", Clin Endocrinol (Oxf), 23, pp.405~411 (1985)
- Rubello D, "Clinical meaning of circulating antithyroglobulin antibodies in differentiated thyroid cancer: a prospective study", J Nucl Med, 33, pp.1478~1480 (1992)
- Black EG, "Should one measure serum thyroglobulin in the presence of anti-thyroglobulin antibodies?", Clin Endocrinol (Oxf), 19, pp.597~601 (1983)
- Spencer CA, "Serum thyroglobulin autoantibodies: prevalence, influence on serum thyroglobulin measurement, and prognostic significance in patients with differentiated thyroid carcinoma", J Clin Endocrinol Metab, 83, pp.1121~1127 (1998)
- Cooper DS, "American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 16, pp.109~142 (2006)
- Edmonds CJ, "Measurement of serum TSH and thyroid hormones in the management of treatment of thyroid carcinoma with radioiodine", Br J Radiol, 50, pp.799~807 (1977)
- Duntas LH, "Short-term hypothyroidism after Levothyroxine-withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences", Eur J Endocrinol, 156, pp.13~19 (2007)
- Luster M, "Thyroid hormone withdrawal in patients with differentiated thyroid carcinoma: a one hundred thirty-patient pilot survey on consequences of hypothyroidism and a pharmacoeconomic comparison to recombinant thyrotropin administration", Thyroid, 15, pp.1147~1155 (2005)
- Dow KH, "Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy", Thyroid, 7, pp.613~619 (1997)
- Schroeder PR, "A comparison of short-term changes in health-related quality of life in thyroid carcinoma patients undergoing diagnostic evaluation with recombinant human thyrotropin compared with thyroid hormone withdrawal", J Clin Endocrinol Metab, 91, pp.878~884 (2006)
- Grigsby PW, "Preparation of patients with thyroid cancer for 131I scintigraphy or therapy by 1-3 weeks of thyroxine discontinuation", J Nucl Med, 45, pp.567~570 (2004)
- Kuijt WJ, "Children with differentiated thyroid cancer achieve adequate hyperthyrotropinemia within 14 days of levothyroxine withdrawal", J Clin Endocrinol Metab, 90, pp.6123~6125 (2005)
- Müller-Gärtner HW, "Clinical evaluation of tumor characteristics predisposing serum thyroglobulin to be undetectable in patients with differentiated thyroid cancer", Cancer, 61, pp.976~981 (1988)
- Feldt-Rasmussen U, "European interlaboratory comparison of serum thyroglobulin measurement", J Endocrinol Invest, 11, pp.175~181 (1988)
- Ng Tang Fui SC, "Serum thyroglobulin concentrations and whole-body radioiodine scan in follow-up of differentiated thyroid cancer after thyroid ablation", Br Med J, 2, pp.298~300 (1979)
- Ozata M, "Serum thyroglobulin in the follow-up of patients with treated differentiated thyroid cancer", J Clin Endocrinol Metab, 79, pp.98~105 (1994)
- Välimäki M, "How to deal with undetectable and low measurable serum thyroglobulin levels in the follow-up of patients with differentiated thyroid carcinoma?", Acta Endocrinol (Copenh), 110, pp.487~492 (1985)
- Pacini F, "Serum thyryroglubulin determination in thyroid cancer. A ten years experience", The thyroid 1988: Proceedings of International thyroid symposium, pp.685~689 (1988), Elsevier Science
- Kim HK, "Usefulness of iodine", creatinine ratio from spot-urine samples to evaluate the effectiveness of low-iodine diet preparation for radioiodine therapy, 2010, pp.73, 114~118
- Pluijmen MJ, "Effects of low-iodide diet on postsurgical radioiodide ablation therapy in patients with differentiated thyroid carcinoma", Clin Endocrinol (Oxf), 58, pp.428~435 (2003)
- Maxon HR, "Relation between effective radiation dose and outcome of radioiodine therapy for thyroid cancer", N Engl J Med, 309, pp.937~941 (1983)