Ablation of Thyroid Residues with 30 mCi 131I: A Comparison in Thyroid Cancer Patients Prepared with Recombinant Human TSH or Thyroid Hormone Withdrawal
Furio Pacini,
Eleonora Molinaro,
Maria Grazia Castagna,
Francesco Lippi,
Claudia Ceccarelli,
Laura Agate,
Rossella Elisei and
Aldo Pinchera
Department of Endocrinology and Metabolism, University of Pisa, 56124 Pisa, Italy
Address all correspondence and requests for reprints to: F. Pacini, M.D., Department of Endocrinology, Via Paradisa, 2, 56124 Pisa, Italy.
Abstract
The aim of the study was to assess whether stimulation by recombinanthuman TSH (rhTSH) may be used in patients with differentiatedthyroid carcinoma for postsurgical ablation of thyroid remnantsusing a 30-mCi standard dose of 131I during thyroid hormonetherapy. The rate of ablation was prospectively compared inthree groups of patients consecutively assigned to one of threetreatment arms: in the first arm, patients (n = 50) were treatedwhile hypothyroid (HYPO); in the second arm, patients (n = 42)were treated while HYPO and stimulated in addition with rhTSH(HYPO + rhTSH); in the third arm, patients (n = 70) were treatedwhile euthyroid (EU) on thyroid hormone therapy and stimulatedwith rhTSH (EU + rhTSH). The outcome of thyroid ablation wasassessed by conventional HYPO 131I scan performed in HYPO state6–10 months after ablation.
Basal serum TSH was elevated in the HYPO and HYPO + rhTSH groups.In the EU + rhTSH group, basal serum TSH was 1.3 ± 2.5µU/ml (range, <0.005–11.9 µU/ml). AfterrhTSH, serum TSH significantly increased in the HYPO + rhTSHgroup and the EU + rhTSH group.
Basal 24-h radioiodine thyroid bed uptake was 5.8 ± 5.7%(range, 0.2–21%) and 5.4 ± 5.7% (range, 0.2–26%)in the HYPO and HYPO + rhTSH groups, respectively. In the HYPO+ rhTSH group, mean 24-h thyroid bed uptake rose to 9.4 ±9.5% (range, 0.2–46%) after rhTSH (P < 0.0001). The24-h uptake after rhTSH in the EU + rhTSH group was 2.5 ±4.3% (range, 0.1–32%), significantly lower (P < 0.0001)than that found in the HYPO and HYPO + rhTSH groups.
The rate of successful ablation was similar in the HYPO andHYPO + rhTSH groups (84% and 78.5%, respectively). A significantlylower rate of ablation (54%) was achieved in the EU + rhTSHgroup.
Mean initial dose rate (the radiation dose delivered duringthe first hour after treatment) was significantly lower in theEU + rhTSH group (10.7 ± 12.6 Gy/h) compared with theHYPO + rhTSH group (48.5 ± 43 Gy/h) and the HYPO group(27.1 ± 42.5 Gy/h).
In conclusion, our study indicates that by using stimulationwith rhTSH, a 30-mCi standard dose of radioiodine is not sufficientfor a satisfactory thyroid ablation rate. Possible reasons forthis failure may be the low 24-h radioiodine uptake, the lowinitial dose rate delivered to the residues, and the acceleratediodine clearance observed in EU patients. Possible alternativesfor obtaining a satisfactory rate of thyroid ablation with rhTSHmay consist of increasing the dose of radioiodine or using differentprotocols of rhTSH administration producing more prolonged thyroidcells stimulation.
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