Nucl Med Mol Imaging.  2015 Jun;49(2):115-121. 10.1007/s13139-014-0308-y.

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

• Choi S
• Na CJ
• Kim J
• Han YH
• Kim HK
• Jeong HJ
• Sohn MH
• Lim ST

• KMID: 2313257
• DOI: http://doi.org/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 THWgroup. 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 + Delta0.96 (+/-1.9) kg for the THW group and was decreased by -Delta1.39 (+/-1.5) kg for the rh-TSH group. The change of body mass index was 0.4 (+/-0.7) kg/m2 in the THW group and was decreased by -0.6 (+/-0.6) kg/m2 in the rh-TSH group.
CONCLUSIONS
Consistent with previous studies, the rates of complete ablation between the THWand 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.

Keyword

Thyroid cancer; High-dose radioiodine therapy; Recombinant human TSH; Thyroid hormone withdrawal; Complete ablation rate; Liver function; Kidney function

MeSH Terms

Alanine Transaminase
Aspartate Aminotransferases
Biomarkers
Blood Urea Nitrogen
Body Mass Index
Body Weight
Creatinine
Electrons
Female
Follow-Up Studies
Humans
Kidney
Kidney Diseases
Liver
Male
Neoplasm Metastasis
Positron-Emission Tomography and Computed Tomography
Retrospective Studies
Thyroglobulin
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Thyrotropin Alfa
Thyrotropin*
Ultrasonography
Alanine Transaminase
Aspartate Aminotransferases
Creatinine
Thyroglobulin
Thyrotropin
Thyrotropin Alfa