갑상선 유두암 환자에서 재조합 인간 갑상선자극호르몬(rhTSH)의 약동학 분석 = Analysis of the Pharmacokinetics of Recombinant Human TSH in Patients with Thyroid Papillary Carcinoma

다국어 초록 (Multilingual 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. (J Kor Soc Endocrinol 21:204~212, 2006)

국문 초록 (Abstract)

연구배경: rhTSH 주사의 약동학은 환자 개인의 신체적 특성에 따라 차이가 있을 수 있으며, 그 차이가 방사성요오드 섭취의 효율성에 영향을 줄 수 있을 것이다. 본 연구에서는 환자 개인별 rhTSH 주사의 약동학에 대해 평가하였고, 혈청 TSH 농도에 영향을 미칠 수 있는 환자의 신체적 특성을 분석하였다. 방법: 갑상선 유두암으로 갑상선전절제술을 시행받고 방사성요오드 투여 전처치로 rhTSH 주사를 사용하는 환자 16예를 대상으로 하였다. 첫번째 rhTSH를 주사하고 24시간, 48 시간 그리고 96 시간째의 혈청 TSH 농도를 측정하였다. 측정된 혈청 TSH 농도와 환자의 연령, 신장, 체중, 크레아티닌 제거율, 체질량지수 그리고 체표면적과의 연관성에 대해 분석하였다. 결과: 혈청 TSH 농도 최고치와 환자의 체중, 체질량지수 그리고 체표면적과는 역상관 관계에 있었으나, 다중회귀분석에 의하여 체중만이 유일한 독립적인 인자이었다. 혈청 TSH 농도가 최고치에서 감소되는 정도(▽TSH) 역시 환자의 체중, 체질량지수 그리고 체표면적과 역상관 관계에 있었고, 혈청 TSH 농도가 최고치로 상승되는 정도(△TSH)와 비례관계에 있었다. 16예 중 9예(56.3%)에서 방사성요오드 스캔을 촬영하기 직전(첫 번째 rhTSH 주사 후 96시간째)의 혈청 TSH 농도가 25 mU/L 미만으로 낮게 측정되었다.

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