Recombinant human thyrotropin before 131I therapy in patients with nodular goitre: a meta‐analysis of randomized controlled trials
Abstract
Summary: Background: Recombinant human thyrotropin (rhTSH) can be used to enhance radioiodine therapy for shrinking multinodular goitre. The aim of this meta‐analysis was to compare the effectiveness of rhTSH pretreatment and radioiodine therapy with that of radioiodine alone for treating benign nodular goitre. Methods: The PubMed, EMBASE, Cochrane Library, Scopus and ClinicalTrials.gov databases were searched to identify studies published before September 2014. A meta‐analysis was performed to calculate the pooled effect size using random‐effects models. The primary outcome was the reduction in thyroid volume. Secondary outcomes included thyroid function, extent of tracheal compression, radioactive iodine uptake, incidence of hypothyroidism and other complications. Results: Nine RCTs including 416 patients were selected. The reductions in thyroid volume were significantly greater in the rhTSH pretreatment groups than those in the radioiodine alone groups at 12 months (weighted mean difference: 14·42%; 95% CI: 4·51–24·34% in high‐dose rhTSH vs radioiodine alone; weighted mean difference: 19·66%; 95% CI: 3·67–35·65% in low‐dose rhTSH vs radioiodine alone). The incidence of hypothyroidism in the high‐dose rhTSH groups was significantly higher than that in the radioiodine alone groups. No significant difference in the incidence of hypothyroidism occurred between the low‐dose rhTSH groups and the radioiodine alone groups. Conclusions: The overall results indicated that using rhTSH before radioiodine therapy resulted in a greater thyroid volume reduction than radioiodine therapy alone. An increased incidence of hypothyroidism was observed in patients receiving high‐dose rhTSH. Low‐dose rhTSH before radioiodine therapy is more efficacious than radioiodine therapy alone for treating nontoxic benign thyroid nodules.
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Both pretreatment with MMI allowing TSH to rise slightly and off-label use of rhTSH may reduce the total activity of RAI needed, but they increase the risk of hypothyroidism.
“Both pretreatment with MMI allowing the TSH to rise slightly (270) and the off-label use of rhTSH (271) may reduce the total activity of RAI needed, but they increase the risk of hypothyroidism (see prior discussion Section [K1]).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [271]
Application of rhTSH before RAI therapy in nontoxic MNG or TMNG results in greater thyroid volume reduction but higher hypothyroidism rates than RAI therapy alone.
“Similarly, a recent meta-analysis indicated that the application of recombinant human TSH (rhTSH) before RAI therapy in nontoxic MNG or TMNG results in greater thyroid volume reduction but higher hypothyroidism rates than RAI therapy alone (271).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [271]
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- Authors
- Lee, Y., Tam, K., Lin, Y., Leu, W., Chang, J., Hsiao, C., Hsu, M., & Hsieh, A.
- Affiliations
- Taipei Medical University-Shuang Ho Hospital (TW)
- Corresponding author
- Hsieh, An‐Tsz
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2014-12-29
- Volume
- 83
- Issue
- 5
- Pages
- 702-710
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W2142688526
- Cited by
- 16
- References
- 31
- Citations by year
- 2024: 1 · 2022: 4 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 1 · 2016: 3
- FWCI
- 0.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Taipei Medical University (103HCP009)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- recombinant human thyrotropin, radioiodine therapy, nodular goiter, multinodular goiter, thyroid volume reduction, hypothyroidism, tracheal compression, radioiodine uptake, benign thyroid nodules
- MeSH terms
- Goiter, Nodular, Humans, Hypothyroidism, Iodine Radioisotopes, Recombinant Proteins, Thyroid Gland, Thyrotropin, Randomized Controlled Trials as Topic, Chemotherapy, Adjuvant
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