Recombinant human thyrotropin reducing insulin resistance in patients with differentiated thyroid cancer.

Abstract

ContextPostsurgical radioactive iodine (RAI) therapy is indicated for adults with differentiated thyroid cancer (DTC) who are at an intermediate-to-high risk of recurrence. Thyrotropin (TSH) stimulation to facilitate RAI uptake can be achieved by injection of recombinant human TSH (rhTSH) or thyroid hormone withdrawal (THW).ObjectiveThis study aimed to compare the effects of rhTSH administration and THW programs on insulin resistance.MethodsThis prospective observational study included 47 patients who received rhTSH injections and 29 patients who underwent THW. All participants underwent a baseline assessment 4 weeks before RAI administration and a follow-up assessment on the day of RAI administration. Blood samples were collected for laboratory analysis, and insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR).ResultsHomeostasis model assessment of insulin resistance significantly decreased after rhTSH administration (from 1.5 [0.8, 1.7] to 1.1 [0.7, 1.4], P = .004) and after THW (from 1.4 [0.9, 1.7] to 0.7 [0.5, 1.0], P P = .120). Logistic regression analysis identified a greater reduction in triglyceride levels (a decrease of ≥0.028 mmol/L) as an independent factor for HOMA-IR reduction (the decrease ≥0.4) in the rhTSH group (odds ratio = 6.064, 95% confidence interval: 1.428-25.757, P = .015).ConclusionThe rhTSH administration program attenuates insulin resistance in patients with DTC. The magnitude of HOMA-IR reduction in the rhTSH administration program is not significantly different from that in the THW program.