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

• Published in: Nuclear medicine and molecular imaging Vol. 49; no. 2; pp. 115 - 121
• Main Authors: Choi, Sehun, Na, Chang Ju, Kim, Jeonghun, Han, Yeon-Hee, Kim, Hee-Kwon, Jeong, Hwan-Jeong, Sohn, Myung-Hee, Lim, Seok Tae
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2015; 대한핵의학회
• Subjects: Cardiology; Imaging; Medicine; Medicine & Public Health; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Radiology; 방사선과학; Liver function; Thyroid cancer; Complete ablation rate; Thyroid hormone withdrawal; Recombinant human TSH; Kidney function; High-dose radioiodine therapy
• ISSN: 1869-3474; 1869-3482
• 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.