Nucl Med Mol Imaging. 2015 Jun;49(2):115-21. doi: 10.1007/s13139-014-0308-y. Epub 2014 Dec 11.
Comparison of Therapeutic Efficacy and Clinical Parameters Between Recombinant Human Thyroid Stimulating Hormone and Thyroid Hormone Withdrawal in High-Dose Radioiodine Treatment with Differentiated Thyroid Cancer.
Nuclear medicine and molecular imaging
Sehun Choi, Chang Ju Na, Jeonghun Kim, Yeon-Hee Han, Hee-Kwon Kim, Hwan-Jeong Jeong, Myung-Hee Sohn, Seok Tae Lim
Affiliations
Affiliations
- Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
- Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea ; Department of Nuclear Medicine, Research Institute of Clinical Medicine, Cyclotron Research Center, Molecular Imaging & Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Gungiro, Deokjin-gu, Jeonju, Jeonbuk 561-180 Republic of Korea.
PMID: 26085856
PMCID: PMC4463877 DOI: 10.1007/s13139-014-0308-y
Abstract
PURPOSE: High-dose radioiodine treatment (HD-RIT) after injection of recombinant human thyroid stimulating hormone (rh-TSH) has become widely used. This study compared the therapeutic efficacy of HD-RIT and clinical parameters between rh-TSH supplement and thyroid hormone withdrawal (THW) after total thyroidectomy in patients with differentiated thyroid cancer.
METHODS: We retrospectively reviewed 266 patients (47 male and 219 female; age, 49.0 ± 10.9 years) with differentiated thyroid cancer detected from September 2011 to September 2012. Patients comprised THW (217, 81.6 %) and rh-TSH (49, 18.4 %). Inclusion criteria were: first HD-RIT; any TN stage; absence of distant metastasis. To evaluate the complete ablation of the remnant thyroid tissue or metastasis, we reviewed stimulated serum thyroglobulin (sTg), I-123 whole-body scan (RxWBS) on T4 off-state, and thyroid ultrasonography (US) or [F-18]-fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) 6-8 months after HD-RIT. We defined a complete ablation state when all three of the follow-up conditions were satisfied; <2.0 ng/ml of the sTg, I-123 RxWBS (-), and thyroid US or F-18 FDG PET/CT (-). If one of the three was positive, ablation was considered incomplete. We also compared various clinical biomarkers (body weight, body mass index, liver and kidney function) between THW and rh-TSH groups.
RESULTS: The rates of complete ablation were 73.7 % (160/217) for the THW group and 73.5 % (36/49) for the rh-TSH group. There was no significant difference between the two groups (p = 0.970). The follow-up aspartate transaminase (p = 0.001) and alanine transaminase (p = 0.001) were significantly higher in the THW group. The renal function parameters of blood urea nitrogen (p = 0.001) and creatinine (p = 0.005) tended to increase in the THW group. The change of body weight was + Δ0.96 (±1.9) kg for the THW group and was decreased by -Δ1.39 (±1.5) kg for the rh-TSH group. The change of body mass index was 0.4 (±0.7) kg/m(2) in the THW group and was decreased by -0.6 (±0.6) kg/m(2) in the rh-TSH group.
CONCLUSIONS: Consistent with previous studies, the rates of complete ablation between the THW and rh-TSH groups were not significantly different. The clinical parameters, as we mentioned above, were elevated for THW group but were irrelevant for the rh-TSH group. The findings favor HD-RIT after rh-TSH, especially for patients with chronic liver and kidney disease.
Keywords: Complete ablation rate; High-dose radioiodine therapy; Kidney function; Liver function; Recombinant human TSH; Thyroid cancer; Thyroid hormone withdrawal
References
- J Am Soc Nephrol. 2012 Jan;23(1):22-6 - PubMed
- J Nucl Med. 2006 Apr;47(4):648-54 - PubMed
- Endocrinol Metab Clin North Am. 1990 Sep;19(3):685-718 - PubMed
- Arch Intern Med. 1999 Jan 11;159(1):79-82 - PubMed
- Nucl Med Mol Imaging. 2012 Jun;46(2):89-94 - PubMed
- Thyroid. 2009 Nov;19(11):1167-214 - PubMed
- Cancer Res Treat. 2013 Mar;45(1):15-21 - PubMed
- J Nucl Med. 2008 Nov;49(11):1776-82 - PubMed
- Br J Cancer. 2003 Nov 3;89(9):1638-44 - PubMed
- J Gastroenterol Hepatol. 1995 May-Jun;10(3):344-50 - PubMed
- J Nucl Med. 2008 Sep;49(9):1445-50 - PubMed
- J Nucl Med. 2008 May;49(5):764-70 - PubMed
- Clin Endocrinol (Oxf). 2010 Dec;73(6):752-9 - PubMed
- Semin Perinatol. 1993 Aug;17(4):267-74 - PubMed
- J Clin Endocrinol Metab. 2006 Mar;91(3):926-32 - PubMed
- Hepatogastroenterology. 2000 Jul-Aug;47(34):919-21 - PubMed
- J Nucl Med. 2002 Nov;43(11):1482-8 - PubMed
- Endocrinol Metab Clin North Am. 2003 Jun;32(2):503-18 - PubMed
- Nephrol Dial Transplant. 2001 Sep;16(9):1799-806 - PubMed
Publication Types