Utilidad de la tiroglobulina plasmática tras TSH humana recombinante en el cáncer diferenciado de tiroides libre de enfermedad

Información del artículo

Objetivos

Valorar la determinación de tiroglobulina (Tg) plasmática tras la administración de tirotropina (TSH) humana recombinante (TSHhr) en el seguimiento para valorar la persistencia de enfermedad o remisión del cáncer diferenciado de tiroides libre de enfermedad.

Material y métodos

Estudio prospectivo en 38 pacientes con cáncer diferenciado de tiroides libres de enfermedad con concentraciones indetectables de Tg en tratamiento hormonal supresor. Se determinó la Tg, la TSH, tiroxina libre, la triyodotironina libre inicial y las 48 y las 72 h tras la administración de 0,9 mg por vía intramuscular de TSHhr, gammagrafías de extensión tumoral (GET) en situación de retirada del tratamiento hormonal supresor y ecografías cervicales.

Resultados

La Tg tras TSHhr permaneció indetectable en 34 pacientes, y la ecografía y la GET resultaron negativas. En 3 pacientes se observó aumento de concentración de Tg tras TSHhr sin evidencia de enfermedad (ecografía y GET negativas) y en 1 paciente se observó un aumento de concentración de Tg tras la TSHhr, con presencia de enfermedad objetivada en la ecografía cervical y GET negativa.

Conclusiones

La determinación de Tg tras TSHhr, unida a la realización de la ecografía cervical, es una prueba endocrinológica funcional útil en los pacientes con cáncer diferenciado de tiroides libre de enfermedad. Su realización evita la retirada del tratamiento hormonal supresor y la realización de GET que suponen un mayor coste económico e incapacidad para el paciente sin aportar más información relevante.

Palabras clave:

TSH humana recombinante

Cáncer diferenciado de tiroides

Tiroglobulina plasmática

Objectives

To evaluate serum thyroglobulin (Tg) determination after recombinant human thyrotropin (rhTSH) administration as screening in the follow-up of patients with differentiated thyroid cancer (DTC).

Material and methods

A prospective study was performed in 38 patients with DTC without residual disease and undetectable Tg concentrations under thyroid hormone suppression therapy. Tg, thyroid-stimulating hormone, free T4, and free T3 were measured at baseline and 48 and 72 hours after administration of rhTSH (0.9 mg IM). In all patients, whole body scan (WBS) was performed after thyroid hormone withdrawal. Neck ultrasound was also performed.

Results

After rhTSH administration Tg remained undetectable in 34 patients with negative neck ultrasound and WBS. Tg increased after rhTSH administration in 3 patients without evidence of active disease (negative WBS and neck ultrasound) and in 1 patient with evidence of active disease in neck ultrasound and negative WBS.

Conclusions

Tg determination after rhTSH administration together with neck ultrasound is useful in the follow-up of patients with DTC and disease-free status. Tg determination avoids the need to withdraw thyroid hormone suppression and the use of other tests such as WBS, which lead to higher economic and social costs but do not provide further information in the follow-up of these patients.

Key words:

Recombinant human thyrotropin

Differentiated thyroid cancer

Serum thyroglobulin

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