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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


  1. Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
  2. 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


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


  1. J Am Soc Nephrol. 2012 Jan;23(1):22-6 - PubMed
  2. J Nucl Med. 2006 Apr;47(4):648-54 - PubMed
  3. Endocrinol Metab Clin North Am. 1990 Sep;19(3):685-718 - PubMed
  4. Arch Intern Med. 1999 Jan 11;159(1):79-82 - PubMed
  5. Nucl Med Mol Imaging. 2012 Jun;46(2):89-94 - PubMed
  6. Thyroid. 2009 Nov;19(11):1167-214 - PubMed
  7. Cancer Res Treat. 2013 Mar;45(1):15-21 - PubMed
  8. J Nucl Med. 2008 Nov;49(11):1776-82 - PubMed
  9. Br J Cancer. 2003 Nov 3;89(9):1638-44 - PubMed
  10. J Gastroenterol Hepatol. 1995 May-Jun;10(3):344-50 - PubMed
  11. J Nucl Med. 2008 Sep;49(9):1445-50 - PubMed
  12. J Nucl Med. 2008 May;49(5):764-70 - PubMed
  13. Clin Endocrinol (Oxf). 2010 Dec;73(6):752-9 - PubMed
  14. Semin Perinatol. 1993 Aug;17(4):267-74 - PubMed
  15. J Clin Endocrinol Metab. 2006 Mar;91(3):926-32 - PubMed
  16. Hepatogastroenterology. 2000 Jul-Aug;47(34):919-21 - PubMed
  17. J Nucl Med. 2002 Nov;43(11):1482-8 - PubMed
  18. Endocrinol Metab Clin North Am. 2003 Jun;32(2):503-18 - PubMed
  19. Nephrol Dial Transplant. 2001 Sep;16(9):1799-806 - PubMed

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