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Willy-Anne Nieuwlaat, Dyde A. Huysmans, Ad R. Hermus, Authors’ Response: Pretreatment with a Single, Low Dose of Recombinant Human Thyrotropin Allows Dose Reduction of Radioiodine Therapy in Patients with Nodular Goiter, The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 12, 1 December 2003, Pages 6114–6115, https://doi.org/10.1210/jc.2003-031590
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To the editor:
We thank Dr. Bonnema and colleagues for their comments. Indeed, our study (1) is an observational study, not a randomized trial, comparing the safety and efficacy of 131I therapy after treatment with various doses of recombinant human TSH (rhTSH) with that of standard 131I therapy, i.e. without pretreatment with rhTSH. As Bonnema et al. emphasize, rhTSH administration in patients with nodular goiters might induce acute increases in serum thyroid hormone levels and thyroid size. At the start of our study, no data on this issue were available. Therefore, the principal aim of our study was to explore the short-term safety of the administration of a therapeutic dose of 131I after pretreatment with a single dose of rhTSH. For safety reasons, we used low doses of rhTSH (0.01 or 0.03 mg), and we adjusted the therapeutic dose of 131I to the rhTSH-induced increase in 24-h radioactive iodine uptake, as determined in a diagnostic study, using a tracer dose of 131I. We did not aim at doses higher than 100 μCi (3.7 MBq) 131I per gram of thyroid tissue retained at 24 h. We agree that thyroid volume measurements in the first few days after rhTSH administration would have been informative. However, because in our study a therapeutic dose of 131I was given 24 h after rhTSH administration, radiation safety regulations in our hospital precluded such early measurements. Anyhow, we did not observe symptoms and signs of (worsening of) tracheal compression in the first days after rhTSH administration.
