Abstract：
BACKGROUND: rhTSH-assisted radioiodine therapy of multinodular goiter is not fully known and only a few studies, with a limited number of patients have evaluated the effect of rhTSH assisted radioiodine therapy beyond 1 year. Though there is an effective and safe management of benign non-toxic MNG available, it is not applicable to all patient categories in Kuwait covering the impact of the past environmental events (Gulf War) and the genetic relation. The proposed project aims to address those points raised, that is exclusive to the Kuwait population.
METHODS: In this cohort study, 2 groups of patients, group one (G1) and group two (G2) patients (N=50, ≥18 years old) went undergo evaluated according to a proposed criteria followed by FNA to exclude cancer, toxicity and those who have refused surgery. All patients had a CT scan, TSH, T3, T4 and CBC and complete biomedical tests at a 6-months interval during the treatment period and the follow up. The Volumetric application of GE 670 SPECT/CT (i.e. Xeleris) and in-house developed MATLAB used for quantitative measurement. All patients had a 131-I uptake at baseline and 24 intervals post intramuscular a single dose of 0.3mg or 0.1mg (group 1, group 2) of rhTSH.
RESULTS: There was no significant difference in TSH levels at 24-month follow-up between the two groups (p=0.327), whereas there was a statistically significant difference at the baseline and at the 6-months interval between the 2 groups for T4. Post treatment follow up at the 24-hour time point, Group 1 displayed significantly higher uptake than Group 2 (G1:41.74 ± 6.27 vs. G2:34.80 ± 3.84, p < 0.001). The change in I131 uptake from baseline to 24 hours was significantly greater in Group 1compared to Group 2 (p < 0.001). The ROC analysis (AUC) post treatment indicated an excellent discriminatory power for AUC (0.960) and (p < 0.001). There was a much better correlation posttreatment between BMI and thyroid volume for group 1 (R2=0.661) than for group 2 (R2=0.008). Our results suggest 42.1% thyroid volume reduction for group 1 and 20% for group 2.
CONCLUSIONS: The study underscores the potential benefits of the higher rhTSH dose (0.3mg) in managing multinodular non-toxic goiter for the Kuwaiti population and the region considering the impact of dietary, and experience to the drastic environmental exposure.
METHODS: In this cohort study, 2 groups of patients, group one (G1) and group two (G2) patients (N=50, ≥18 years old) went undergo evaluated according to a proposed criteria followed by FNA to exclude cancer, toxicity and those who have refused surgery. All patients had a CT scan, TSH, T3, T4 and CBC and complete biomedical tests at a 6-months interval during the treatment period and the follow up. The Volumetric application of GE 670 SPECT/CT (i.e. Xeleris) and in-house developed MATLAB used for quantitative measurement. All patients had a 131-I uptake at baseline and 24 intervals post intramuscular a single dose of 0.3mg or 0.1mg (group 1, group 2) of rhTSH.
RESULTS: There was no significant difference in TSH levels at 24-month follow-up between the two groups (p=0.327), whereas there was a statistically significant difference at the baseline and at the 6-months interval between the 2 groups for T4. Post treatment follow up at the 24-hour time point, Group 1 displayed significantly higher uptake than Group 2 (G1:41.74 ± 6.27 vs. G2:34.80 ± 3.84, p < 0.001). The change in I131 uptake from baseline to 24 hours was significantly greater in Group 1compared to Group 2 (p < 0.001). The ROC analysis (AUC) post treatment indicated an excellent discriminatory power for AUC (0.960) and (p < 0.001). There was a much better correlation posttreatment between BMI and thyroid volume for group 1 (R2=0.661) than for group 2 (R2=0.008). Our results suggest 42.1% thyroid volume reduction for group 1 and 20% for group 2.
CONCLUSIONS: The study underscores the potential benefits of the higher rhTSH dose (0.3mg) in managing multinodular non-toxic goiter for the Kuwaiti population and the region considering the impact of dietary, and experience to the drastic environmental exposure.
摘要：
背景：rhTSH辅助放射性碘治疗多结节性甲状腺肿还没有完全了解，只有少数研究，在有限数量的患者中，评估了rhTSH辅助放射性碘治疗超过1年的效果。虽然对良性无毒MNG有有效和安全的管理，它不适用于科威特的所有患者类别，包括过去环境事件（海湾战争）和遗传关系的影响。拟议的项目旨在解决提出的这些问题，这是科威特人民独有的。
方法：在这项队列研究中，2组患者，第一组（G1）和第二组（G2）患者（N=50，≥18岁）根据建议的标准进行评估，然后FNA排除癌症，毒性和那些拒绝手术的人。所有病人都做了CT扫描,TSH,T3，T4和CBC并在治疗期间和随访期间间隔6个月完成生物医学测试。GE670SPECT/CT（即Xeleris）的体积应用和内部开发的MATLAB用于定量测量。所有患者在基线时摄取131-I，肌肉后24次，单次剂量为0.3mg或0.1mg（第1组，第2组）的rhTSH。
结果：两组在24个月随访时的TSH水平没有显着差异（p=0.327），而在基线和6个月间隔的T4两组间有统计学差异.治疗后24小时时间点随访，第1组的摄取明显高于第2组（G1：41.74±6.27vs.G2:34.80±3.84,p<0.001)。与第2组相比，第1组的I131摄取从基线到24小时的变化明显更大（p<0.001）。治疗后的ROC分析(AUC)表明对AUC(0.960)和(p<0.001)具有优异的辨别能力。治疗后第1组（R2=0.661）的BMI与甲状腺体积之间的相关性明显优于第2组（R2=0.008）。我们的结果表明，第1组甲状腺体积减少了42.1％，第2组甲状腺体积减少了20％。
结论：该研究强调了更高的rhTSH剂量（0.3mg）对科威特人口和考虑饮食影响的地区管理多结节性无毒甲状腺肿的潜在益处，以及对剧烈环境暴露的体验。
方法：在这项队列研究中，2组患者，第一组（G1）和第二组（G2）患者（N=50，≥18岁）根据建议的标准进行评估，然后FNA排除癌症，毒性和那些拒绝手术的人。所有病人都做了CT扫描,TSH,T3，T4和CBC并在治疗期间和随访期间间隔6个月完成生物医学测试。GE670SPECT/CT（即Xeleris）的体积应用和内部开发的MATLAB用于定量测量。所有患者在基线时摄取131-I，肌肉后24次，单次剂量为0.3mg或0.1mg（第1组，第2组）的rhTSH。
结果：两组在24个月随访时的TSH水平没有显着差异（p=0.327），而在基线和6个月间隔的T4两组间有统计学差异.治疗后24小时时间点随访，第1组的摄取明显高于第2组（G1：41.74±6.27vs.G2:34.80±3.84,p<0.001)。与第2组相比，第1组的I131摄取从基线到24小时的变化明显更大（p<0.001）。治疗后的ROC分析(AUC)表明对AUC(0.960)和(p<0.001)具有优异的辨别能力。治疗后第1组（R2=0.661）的BMI与甲状腺体积之间的相关性明显优于第2组（R2=0.008）。我们的结果表明，第1组甲状腺体积减少了42.1％，第2组甲状腺体积减少了20％。
结论：该研究强调了更高的rhTSH剂量（0.3mg）对科威特人口和考虑饮食影响的地区管理多结节性无毒甲状腺肿的潜在益处，以及对剧烈环境暴露的体验。
