J Korean Soc Endocrinol.  2006 Jun;21(3):204-212. 10.3803/jkes.2006.21.3.204.

Analysis of the Pharmacokinetics of Recombinant Human TSH in Patients with Thyroid Papillary Carcinoma

• Jung TS
• Jung HS
• Jung JH
• Chung YJ
• Oh EY
• Min YK
• Lee MS
• Lee MK
• Kim KW
• Chung JH

• KMID: 2200732
• DOI: http://doi.org/10.3803/jkes.2006.21.3.204

Abstract

BACKGROUND: Individual variations of the pharmacokinetics of recombinant human TSH (rhTSH) might influence the efficacy of the radioactive iodine (RAI) uptake. We studied to investigate the individual pharmacokinetics of rhTSH and the effect of the anthropometric parameters on the serum TSH levels in patients with thyroid papillary carcinoma.
METHODS
We selected 16 patients with conventional rhTSH administration for the preparation of RAI administration between June 2004 and May 2005. We measured serum TSH levels at 24-hour (prior to second rhTSH injection), 48-hour (peak level, prior to RAI administration) and 96-hour (prior to scanning) after the first rhTSH injection. We analyzed the correlation of each TSH levels with age, height, weight, creatinine clearance, body mass index (BMI), and body surface area (BSA).
RESULTS
Peak TSH levels were negatively correlated with weight, BMI, and BSA. Among them, weight was an independent parameter by multivariate analysis. Decrement of serum TSH levels from the peak to the level at 96-hour was negatively correlated with weight, BMI, and BSA. It was positively correlated with increment of serum TSH levels from the level at 24-hour to the peak level. Serum TSH level at 96-hour was lower than 25 mU/L in nine of 16 patients.
CONCLUSION
Body weight was inversely correlated with peak TSH level after rhTSH administration. rhTSH-stimulated TSH levels might be exaggerated to unwanted levels, and very rapidly degraded in lower-weighted patients. We should make up for the rhTSH regimen considering the individual variations of its pharmacokinetics.

MeSH Terms

Body Mass Index
Body Surface Area
Body Weight
Carcinoma, Papillary*
Creatinine
Humans
Iodine
Multivariate Analysis
Pharmacokinetics*
Thyroid Gland*
Thyroid Neoplasms
Thyrotropin
Thyrotropin Alfa*
Creatinine
Iodine
Thyrotropin
Thyrotropin Alfa

Figure

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  Fig. 1 Protocol for this study. Serum TSH was measured for three times, at 24 hours, 48 hours and 96 hours after the first rhTSH injection.

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  Fig. 2 Changes in serum TSH levels at 24-hour, 48-hour and 96-hour after the first rhTSH administration. A, The changes of serum TSH levels of lower-weighted patients (body weight < 62.9 kg) were rapidly increased to the peak and rapidly cleared out of the body. B, The changes of serum TSH levels in higher-weighted patients (body weight > 62.9 kg) were slowly increased to the peak level and slowly decreased to the basal level. C, The changes of serum TSH levels in all 16 patients. Among them, serum TSH levels of nine patients were lower than 25 mU/L at 96-hour. This graph was lineated by linking of the four points of serum TSH levels at 0-hour, 24-hour, 48-hour and 96-hour. Therefore, serum TSH levels of this graph at other time might be different from actual serum TSH levels.

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  Fig. 3 Linear regression analysis between serum peak TSH after rhTSH injection and body weight A, body mass index B and body surface area C. The peak serum TSH level was negatively related to body weight (r = -0.74; P = 0.001), BMI (r = -0.59; P = 0.017) and BSA (r = -0.64; P = 0.007).

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  Fig. 4 Linear regression analysis between decrement of serum TSH levels from the peak to the level at 96-hour and body weight (A), body mass index (B), body surface area (C) and increment of serum TSH levels at 24-hour to the peak (D). Decrement of serum TSH levels from the peak to the level at 96-hour was negatively related with body weight (r = -0.70; P = 0.003), BMI (r = -0.58; P = 0.018) and BSA (r = -0.61; P = 0.012) and positively related with increment of serum TSH levels from the level at 24-hour to the peak level (r = 0.63; P = 0.009).

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