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Impact of renal function and demographic / anthropomorphic variables on peak TSH after recombinant human thyrotropin stimulation: A stepwise forward multiple regression analysis.
MedLine Citation:
PMID:  23136932     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: When applying the recommended standard doses of recombinant human TSH (rhTSH) in the diagnostic / therapeutic course of patients with differentiated thyroid cancer (DTC) the resulting peak TSH levels vary extensively. Previous studies applying multivariate statistics identified patient-inherent variables influencing the rhTSH / peak TSH relation. However, those results were inconclusive and partly conflicting. Notably, no independent role of renal functioning was substantiated despite the fact that the kidneys are known to play a prominent role in TSH blood clearance. Therefore, the study's aim was to specifically investigate the impact of the renal function on peak TSH concentration after standard rhTSH stimulation besides additional demographic and anthropometric parameters. The second objective was to calculate a ranking regarding the effect sizes of the identified variables on peak TSH. Methods: 286 patients with DTC were included. Univariate and multivariate analyses were performed testing the correlation of serum creatinine and glomerular filtration rate (GFR) as surrogate parameters of renal function, age, gender, weight, height and body surface area (BSA) with the peak TSH level. In six additional patients the subsequent TSH pharmacokinetics after the TSH peak were measured and qualitatively compared. Results: By univariate analyses, TSH correlated negatively with BSA, GFR, weight and height and positively with age, female gender and serum creatinine (p<0.001). At the multivariate stage, the stepwise forward multiple linear regression revealed BSA and renal function as the two most influential independent variables followed by age, gender and height. The pharmacokinetic datasets indicated that these identified parameters also influence the TSH decline over time. Conclusion: Identifying those patients with a favourable combination of parameters predicting a high peak TSH is the first step towards an individualization of rhTSH dosing. Additionally, the subsequent TSH decrease over time needs to be taken into account. The complete understanding of the interrelation of the identified key parameters and both TSH peak and subsequent TSH pharmacokinetics might allow for a more personalized rhTSH dosage strategy to achieve sufficient TSH levels instead of the fixed dosing procedure used at present.
Authors:
Hubertus Hautzel; Elisabeth K Pisar; David Lindner; Matthias Schott; Rüdiger Grandt; Hans-Wilhelm Mueller
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-9
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  -     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
University of Duesseldorf, Department of Nuclear Medicine, Moorenstr. 5, Düsseldorf, Germany, 40225, +49 (0)2461 615767, +49 (0)2461 611691; h.hautzel@fz-juelich.de.
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