This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Robbins, R. J. Articles by Drucker, W. D. Search for Related Content PubMed PubMed Citation Articles by Robbins, R. J. Articles by Drucker, W. D.

Preparation by Recombinant Human Thyrotropin or Thyroid Hormone Withdrawal Are Comparable for the Detection of Residual Differentiated Thyroid Carcinoma

Endocrinology and Nuclear Medicine Services, Departments of Medicine (R.J.R., R.M.T., R.N.S., H.K.R., W.D.D.), Pathology (R.A.G.), Radiology (S.M.L.), and Epidemiology and Biostatistics (A.S.), Memorial Hospital for Cancer and Allied Diseases, Memorial Sloan-Kettering Cancer Center, New York, New York 10021

Address all correspondence and requests for reprints to: Richard J. Robbins, M.D., Endocrinology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021.

Clinical recurrences of differentiated thyroid carcinoma occur in 20% of patients after thyroid surgery. We performed a retrospective analysis of a cohort of patients undergoing routine follow-up testing to detect recurrent thyroid carcinoma over a 2-yr period. One group was prepared for testing by thyroid hormone withdrawal (THW), and the other group remained on thyroid hormone and received injections of recombinant human TSH (rhTSH) before diagnostic whole-body radioiodine scanning (DxWBS). We hypothesized that no differences in the ability to detect residual disease would exist between these 2 groups. Two hundred and eighty-nine patients were examined by both DxWBS and by measurement of the serum thyroglobulin (Tg) response to elevated TSH levels. THW was used for 161 patients, and rhTSH preparation was used for 128 patients. Based on all available testing results, we categorized patients as having metastatic disease, thyroid bed uptake only, or no evidence of disease. We examined the sensitivity, specificity, positive and negative predictive values of the DxWBS, and the stimulated Tg after preparation by THW or rhTSH. Patients with thyroid bed were not considered in accuracy testing. The sensitivity and specificity of the 2 tests were comparable between groups. No significant differences were present in the positive or negative predictive values between groups. The highest negative predictive value (97%) was in patients who had both a negative DxWBS and low stimulated Tg levels after rhTSH. In summary, we were unable to demonstrate a difference in the diagnostic accuracy of DxWBS and/or Tg between patients prepared by either THW or rhTSH. We conclude that preparing patients by rhTSH is diagnostically equivalent to preparing them by THW.

This article has been cited by other articles:

				R. M. Tuttle, M. Brokhin, G. Omry, A. J. Martorella, S. M. Larson, R. K. Grewal, M. Fleisher, and R. J. Robbins Recombinant Human TSH-Assisted Radioactive Iodine Remnant Ablation Achieves Short-Term Clinical Recurrence Rates Similar to Those of Traditional Thyroid Hormone Withdrawal J. Nucl. Med., May 1, 2008; 49(5): 764 - 770. [Abstract] [Full Text] [PDF]

				R. C. Smallridge, S. E. Meek, M. A. Morgan, G. S. Gates, T. P. Fox, S. Grebe, and V. Fatourechi Monitoring Thyroglobulin in a Sensitive Immunoassay Has Comparable Sensitivity to Recombinant Human TSH-Stimulated Thyroglobulin in Follow-Up of Thyroid Cancer Patients J. Clin. Endocrinol. Metab., January 1, 2007; 92(1): 82 - 87. [Abstract] [Full Text] [PDF]

				R. T. Kloos and E. L. Mazzaferri A Single Recombinant Human Thyrotropin-Stimulated Serum Thyroglobulin Measurement Predicts Differentiated Thyroid Carcinoma Metastases Three to Five Years Later J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5047 - 5057. [Abstract] [Full Text] [PDF]

				R. J. Robbins, S. Srivastava, A. Shaha, R. Ghossein, S. M. Larson, M. Fleisher, and R. M. Tuttle Factors Influencing the Basal and Recombinant Human Thyrotropin-Stimulated Serum Thyroglobulin in Patients with Metastatic Thyroid Carcinoma J. Clin. Endocrinol. Metab., December 1, 2004; 89(12): 6010 - 6016. [Abstract] [Full Text] [PDF]

				K. Pacak, G. Eisenhofer, and D. S. Goldstein Functional Imaging of Endocrine Tumors: Role of Positron Emission Tomography Endocr. Rev., August 1, 2004; 25(4): 568 - 580. [Abstract] [Full Text] [PDF]

				A. A. Driedger and N. Kotowycz Two Cases of Thyroid Carcinoma That Were Not Stimulated by Recombinant Human Thyrotropin J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 585 - 590. [Abstract] [Full Text] [PDF]

				F. Sorvillo, G. Mazziotti, A. Carbone, M. Piscopo, M. Rotondi, M. Cioffi, P. Musto, B. Biondi, S. Iorio, G. Amato, et al. Recombinant Human Thyrotropin Reduces Serum Vascular Endothelial Growth Factor Levels in Patients Monitored for Thyroid Carcinoma Even in the Absence of Thyroid Tissue J. Clin. Endocrinol. Metab., October 1, 2003; 88(10): 4818 - 4822. [Abstract] [Full Text] [PDF]

				C. Menzel, W. T. Kranert, N. Dobert, M. Diehl, T. Fietz, N. Hamscho, U. Berner, and F. Grunwald rhTSH Stimulation Before Radioiodine Therapy in Thyroid Cancer Reduces the Effective Half-Life of 131I J. Nucl. Med., July 1, 2003; 44(7): 1065 - 1068. [Abstract] [Full Text] [PDF]

				R. J. Robbins and K. S. Pentlow Coming of Age: Recombinant Human Thyroid-Stimulating Hormone as a Preparation for 131I Therapy in Thyroid Cancer J. Nucl. Med., July 1, 2003; 44(7): 1069 - 1071. [Full Text] [PDF]

				R. J. Robbins and A. K. Robbins Recombinant Human Thyrotropin and Thyroid Cancer Management J. Clin. Endocrinol. Metab., May 1, 2003; 88(5): 1933 - 1938. [Full Text] [PDF]

				E. L. Mazzaferri, R. J. Robbins, C. A. Spencer, L. E. Braverman, F. Pacini, L. Wartofsky, B. R. Haugen, S. I. Sherman, D. S. Cooper, G. D. Braunstein, et al. A Consensus Report of the Role of Serum Thyroglobulin as a Monitoring Method for Low-Risk Patients with Papillary Thyroid Carcinoma J. Clin. Endocrinol. Metab., April 1, 2003; 88(4): 1433 - 1441. [Abstract] [Full Text] [PDF]

				E. Baudin, C. D. Cao, A. F. Cailleux, S. Leboulleux, J. P. Travagli, and M. Schlumberger Positive Predictive Value of Serum Thyroglobulin Levels, Measured during the First Year of Follow-Up after Thyroid Hormone Withdrawal, in Thyroid Cancer Patients J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 1107 - 1111. [Abstract] [Full Text] [PDF]

				R. J. Robbins, S. M. Larson, N. Sinha, A. Shaha, C. Divgi, K. S. Pentlow, R. Ghossein, and R. M. Tuttle A Retrospective Review of the Effectiveness of Recombinant Human TSH as a Preparation for Radioiodine Thyroid Remnant Ablation J. Nucl. Med., November 1, 2002; 43(11): 1482 - 1488. [Abstract] [Full Text] [PDF]

				F. Pacini, E. Molinaro, M. G. Castagna, F. Lippi, C. Ceccarelli, L. Agate, R. Elisei, and A. Pinchera Ablation of Thyroid Residues with 30 mCi 131I: A Comparison in Thyroid Cancer Patients Prepared with Recombinant Human TSH or Thyroid Hormone Withdrawal J. Clin. Endocrinol. Metab., September 1, 2002; 87(9): 4063 - 4068. [Abstract] [Full Text] [PDF]

				L. Fugazzola, A. Mihalich, L. Persani, N. Cerutti, M. Reina, M. Bonomi, E. Ponti, D. Mannavola, E. Giammona, G. Vannucchi, et al. Highly Sensitive Serum Thyroglobulin and Circulating Thyroglobulin mRNA Evaluations in the Management of Patients with Differentiated Thyroid Cancer in Apparent Remission J. Clin. Endocrinol. Metab., July 1, 2002; 87(7): 3201 - 3208. [Abstract] [Full Text] [PDF]

				R. J. Robbins, J. T. Chon, M. Fleisher, S. M. Larson, and R. M. Tuttle Is the Serum Thyroglobulin Response to Recombinant Human Thyrotropin Sufficient, by Itself, to Monitor for Residual Thyroid Carcinoma? J. Clin. Endocrinol. Metab., July 1, 2002; 87(7): 3242 - 3247. [Abstract] [Full Text] [PDF]

				L. Wartofsky Using Baseline and Recombinant Human TSH-Stimulated Tg Measurements to Manage Thyroid Cancer without Diagnostic 131I Scanning J. Clin. Endocrinol. Metab., April 1, 2002; 87(4): 1486 - 1489. [Full Text] [PDF]

				E. L. Mazzaferri and R. T. Kloos Is Diagnostic Iodine-131 Scanning with Recombinant Human TSH Useful in the Follow-Up of Differentiated Thyroid Cancer after Thyroid Ablation? J. Clin. Endocrinol. Metab., April 1, 2002; 87(4): 1490 - 1498. [Abstract] [Full Text] [PDF]

				R. M. Tuttle, M. Fleisher, G. L. Francis, and R. J. Robbins Serum Vascular Endothelial Growth Factor Levels Are Elevated in Metastatic Differentiated Thyroid Cancer but Not Increased by Short-Term TSH Stimulation J. Clin. Endocrinol. Metab., April 1, 2002; 87(4): 1737 - 1742. [Abstract] [Full Text] [PDF]