Simulation of post-thyroidectomy treatment alternatives for triiodothyronine or thyroxine replacement in pediatric thyroid cancer patients.

Thyroid : Official Journal of the American Thyroid Association
Rotem Ben-ShacharJoseph J Distefano

Abstract

As in adults, thyroidectomy in pediatric patients with differentiated thyroid cancer is often followed by (131)I remnant ablation. A standard protocol is to give normalizing oral thyroxine (T(4)) or triiodothyronine (T(3)) after surgery and then withdraw it for 2 to 6 weeks. Thyroid remnants or metastases are treated most effectively when serum thyrotropin (TSH) is high, but prolonged withdrawals should be avoided to minimize hypothyroid morbidity. A published feedback control system model of adult human thyroid hormone regulation was modified for children using pediatric T(4) kinetic data. The child model was developed from data for patients ranging from 3 to 9 years old. We simulated a range of T(4) and T(3) replacement protocols for children, exploring alternative regimens for minimizing the withdrawal period, while maintaining normal or suppressed TSH during replacement. The results are presented with the intent of providing a quantitative basis to guide further studies of pediatric treatment options. Replacement was simulated for up to 3 weeks post-thyroidectomy, followed by various withdrawal periods. T(4) vs. T(3) replacement, remnant size, dose size, and dose frequency were tested for effects on the time for TSH to reac...Continue Reading

References

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Citations

Feb 1, 2013·Journal of Thyroid Research·Johannes W DietrichElisavet H Fotiadou
Feb 21, 2016·Thyroid : Official Journal of the American Thyroid Association·Simon X HanJoseph J DiStefano Iii
Jul 5, 2016·Frontiers in Endocrinology·Johannes W DietrichRudolf Hoermann
Dec 6, 2019·Frontiers in Endocrinology·Joseph DiStefano, Jacqueline Jonklaas

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