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KMID : 1148920150490020115
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Nuclear Medicine and Molecular Imaging
2015 Volume.49 No. 2 p.115 ~ p.121
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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
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Choi Se-Hun
Na Chang-Ju
Kim Jeong-Hun
Han Yeon-Hee
Kim Hee-Kwon
Jeong Hwan-Jeong
Sohn Myung-Hee
Lim Seok-Tae
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Abstract
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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/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 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.
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KEYWORD
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Thyroid cancer, High-dose radioiodine therapy, Recombinant human TSH, Thyroid hormone withdrawal, Complete ablation rate, Liver function, Kidney function
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