J Korean Med Sci.  2014 Jun;29(6):811-817. 10.3346/jkms.2014.29.6.811.

The Effectiveness of Recombinant Human Thyroid-Stimulating Hormone versus Thyroid Hormone Withdrawal Prior to Radioiodine Remnant Ablation in Thyroid Cancer: A Meta-Analysis of Randomized Controlled Trials

• Pak K
• Cheon GJ
• Kang KW
• Kim SJ
• Kim IJ
• Kim EE
• Lee DS
• Chung JK

• KMID: 1796944
• DOI: http://doi.org/10.3346/jkms.2014.29.6.811

Abstract

We evaluated the efficacy of recombinant human thyroid-stimulating hormone (rhTSH) versus thyroid hormone withdrawal (THW) prior to radioiodine remnant ablation (RRA) in thyroid cancer. A systematic search of MEDLINE, EMBASE, the Cochrane Library, and SCOPUS was performed. Randomized controlled trials that compared ablation success between rhTSH and THW at 6 to 12 months following RRA were included in this study. Six trials with a total of 1,660 patients were included. When ablation success was defined as a thyroglobulin (Tg) cutoff of 1 ng/mL (risk ratio, 0.99; 95% confidence interval, 0.96-1.03) or a Tg cutoff of 1 ng/mL plus imaging modality (RR 0.97; 0.90-1.05), the results of rhTSH and THW were similar. There were no significant differences when ablation success was defined as a Tg cutoff of 2 ng/mL (RR 1.03; 0.95-1.11) or a Tg cutoff of 2 ng/mL plus imaging modality (RR 1.02; 0.95-1.09). When a negative 131I-whole body scan was used solely as the definition of ablation success, the effects of rhTSH and THW were not significantly different (RR 0.97; 0.93-1.02). Therefore, ablation success rates are comparable when RRA is prepared by either rhTSH or THW.

Keyword

Thyroid Neoplasms; Thyrotropin Alfa

MeSH Terms

Catheter Ablation
Clinical Trials as Topic
Databases, Factual
Humans
Iodine Radioisotopes/*therapeutic use
Radiopharmaceuticals/*therapeutic use
Recombinant Proteins/biosynthesis/genetics/therapeutic use
Risk
Thyroglobulin/analysis/metabolism
Thyroid Neoplasms/*drug therapy/ultrasonography
Thyrotropin/genetics/metabolism/*therapeutic use
Treatment Outcome
Whole Body Imaging
Iodine Radioisotopes
Radiopharmaceuticals
Recombinant Proteins
Thyroglobulin
Thyrotropin

Figure

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  Fig. 1 Flow chart of the selection process.

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  Fig. 2 Comparison of ablation success, as defined by a Tg cutoff value of 1 ng/mL (A), and by a Tg cutoff value of 1 ng/mL plus imaging modality (B), between recombinant human thyroid stimulating hormone (rhTSH) and thyroid hormone withdrawal (THW).

• 

  Fig. 3 Comparison of ablation success, as defined by a Tg cutoff value of 2 ng/mL (A), and by a Tg cutoff value of 2 ng/mL plus imaging modality (B), between recombinant human thyroid stimulating hormone (rhTSH) and thyroid hormone withdrawal (THW).

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  Fig. 4 Comparison of ablation success, as defined by the 131I-whole body scan (WBS), between recombinant human thyroid stimulating hormone (rhTSH) and thyroid hormone withdrawal (THW).

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