Metabolic Effects of Synthetic Thyroid Hormone for Thyroid Cancer Treatment
Information source: National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov processed this data on August 23, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Malignant Struma Ovarii; Papillary Thyroid Cancer; Hurthle Cell Thyroid Cancer; Follicular Thyroid Cancer; Tall Cell Variant Thyroid Cancer
Phase: Phase 1
Status: Completed
Sponsored by: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Official(s) and/or principal investigator(s): Kong Y Chen, Ph.D., Principal Investigator, Affiliation: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Summary
Background:
- Thyroid hormone is produced by the thyroid gland, an organ at the base of the neck.
Thyroid hormone controls the body's metabolism and the function of many organs. The thyroid
gland produces two forms of thyroid hormone: T4 and T3. People who have thyroid cancer are
treated with thyroid hormone therapy (synthetic T4, levothyroxine), which at times needs to
be stopped to allow for cancer treatments. At these times, a different form of thyroid
hormone (synthetic T3, liothyronine) is used to reduce the symptoms caused by low levels of
thyroid hormone. Researchers want to know more about how changes in T3 hormone affect the
body and organ function.
Objectives:
- To study how changes in T3 hormone levels affect the body and organ function.
Eligibility:
- Individuals at least 18 years of age who have had most or all of their thyroid removed to
treat thyroid cancer who need to stop taking their regular thyroid hormone dose in
preparation for the treatment of thyroid cancer.
Design:
- The study involves a screening visit and a baseline evaluation. It also includes an
11-day inpatient hospital stay.
- Participants will be screened with a physical exam and medical history. They will also
have blood tests and a neck ultrasound.
- Participants will be evaluated with a physical exam, blood tests, and the following
procedures:
- Glucose tolerance test to measure blood sugar
- Tests of body fat, muscle strength, and calorie burning levels
- Imaging studies of the heart, liver, and thigh muscles
- Quality of life questionnaires
- Food preference and diet questionnaires
- After 4 weeks of treatment with T3 hormone, participants will have an 11-day inpatient
hospital stay to study the effect of thyroid hormone on their metabolism. The stay will
involve the same tests done in the baseline evaluation.
Clinical Details
Official title: Pharmacokinetic and Pharmacodynamic Studies of Liothyronine. A Study on the Metabolic Effects of Thyroid Hormone
Study design: Time Perspective: Prospective
Detailed description:
In human adults thyroid hormone action plays a critical role in the modulation of metabolism
and the function of virtually all organ/systems. The specificity of the hormonal action is
ultimately the result of the interaction of the active hormone, triiodothyronine (T3), with
the receptors isoforms and the co-activators and co-repressors specific for the various
cells target of the hormonal action. Circulating and tissue levels of T3 are the result of
the secretion of T3 and its precursor, thyroxine (T4), from the thyroid gland, the
peripheral conversion of T4 into T3, and the degradation of these hormones. This complex
system has only been partially studied in humans and very little is known regarding the
kinetics of T3, and in particular on the correlation between circulating levels of T3 and
end-organ target tissue thyroid hormone action.
The aim of this protocol is to characterize the pharmacokinetics of T3 and its biological
effects at various concentrations in a cohort of thyroidectomized patients undergoing
thyroid hormone replacement therapy withdrawal for the management of thyroid cancer.
Sixteen patients with a clinical indication for thyroid hormone withdrawal in preparation
for 131I therapy or 123I diagnostic scan for follow-up and management of differentiated
thyroid cancer will be recruited for this study. After enrollment in the study, the patients
baseline characteristics will be determined during an outpatient visit while receiving
levothyroxine (L-T4) therapy. The L-T4 therapy then will be suspended and substituted with
an equivalent thrice daily liothyronine (L-T3) therapy for one month. Patients will be
admitted to the NIH Clinical Center on the day prior to withdrawal of the T3 therapy until
the diagnostic scan or the administration of radioactive iodine. During the hospitalization
for this research protocol, which is expected to last eleven days, the following studies
will be performed: serial blood sampling for circulating thyroid hormones to obtain
pharmacokinetic parameters of L-T3, lipids, glucose and insulin, resting energy expenditure,
echocardiogram, skeletal muscle strength measurement, cardiac, hepatic and skeletal muscles
MRI, and quality of life and well-being questionnaires. The pharmacokinetic parameters of
L-T3 will also be assessed with the first dose after the diagnostic scan or the
administration of radioactive iodine.
The results obtained from this study will help in understanding the effects of thyroid
hormone on metabolism, and may lead to important information on how to optimize the duration
of the thyroid hormone therapy withdrawal for the treatment of thyroid cancer.
Eligibility
Minimum age: 18 Years.
Maximum age: N/A.
Gender(s): Both.
Criteria:
- INCLUSION CRITERIA:
Subjects will be adult volunteers older than age 18 who underwent total thyroidectomy for
the treatment of differentiated thyroid cancer, previously undergone radioactive iodine
ablation of the thyroid gland remnant, with clinical indication for withdrawal from
thyroid hormone replacement therapy in preparation for nuclear medicine imaging or
therapeutic procedures with radioactive iodine. The patient population will be recruited
from the participants in the 77-DK-0096 natural history protocol: Studies on Thyroid
Nodules and Thyroid Cancer , PI Monica C. Skarulis and from the 10-C-0102 natural
history protocol: Clinical and Genetic Studies in Familial Non-Medullary Thyroid Cancer
, PI Electron Kebebew.
EXCLUSION CRITERIA:
1. Significant thyroid residual greater than 5 gm as measure by ultrasound or greater
than 5 percent uptake at 24 H on (123) I pre-treatment thyroid scan.
2. Renal insufficiency or estimated creatinine clearance less than or equal to 60
mL/min/1. 73M(2) BSA by MDRD equation before thyroid hormone withdrawal.
3. Liver disease or ALT > 2. 5 times the upper laboratory reference limit.
4. Pharmacologic therapy for the treatment of psychiatric conditions.
5. History of, and/or current coronary artery disease.
6. Current history or symptoms compatible with psychosis or major depression (including
history of hospitalization for depression, history of attempted suicide, history of
suicidal ideation). Use of antipsychotic medications.
7. History of drug or alcohol abuse within the last year; current use of illicit drugs
or alcohol abuse (CAGE> 3).
8. Pregnancy (women of child-bearing potential must have a negative pregnancy test prior
to inclusion) or use of hormonal contraceptives.
9. Known allergy to L-T3.
10. Current use of prescription medication or certain non-prescription medications and
dietary supplements known to affect thyroid function and/or metabolism, or alter the
pharmacokinetics of L-T3.
11. Inability or unwillingness to follow the low-iodine, metabolic diet or non-compliance
to the L-T3 administration regimen.
12. The presence of persistent diarrhea or malabsorption syndromes that would interfere
with the patient s ability to adequately absorb drugs.
13. Inability to obtain venous access for sample collection, or basal hemoglobin of less
than or equal to 10 g/dL.
14. Low functional status (ECOG Performance Status > 2)
Locations and Contacts
National Institutes of Health Clinical Center, 9000 Rockville Pike, Bethesda, Maryland 20892, United States
Additional Information
NIH Clinical Center Detailed Web Page
Related publications: Yen PM. Physiological and molecular basis of thyroid hormone action. Physiol Rev. 2001 Jul;81(3):1097-142. Review. Bianco AC, Salvatore D, Gereben B, Berry MJ, Larsen PR. Biochemistry, cellular and molecular biology, and physiological roles of the iodothyronine selenodeiodinases. Endocr Rev. 2002 Feb;23(1):38-89. Review. Nguyen TT, DiStefano JJ 3rd, Yamada H, Yen YM. Steady state organ distribution and metabolism of thyroxine and 3,5,3'-triiodothyronine in intestines, liver, kidneys, blood, and residual carcass of the rat in vivo. Endocrinology. 1993 Dec;133(6):2973-83.
Starting date: September 2011
Last updated: December 18, 2014
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