This Article Full Text Full Text (PDF) Submit a related Letter to the Editor 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 Barbaro, D. Articles by Mariani, G. Search for Related Content PubMed PubMed Citation Articles by Barbaro, D. Articles by Mariani, G.

Radioiodine Treatment with 30 mCi after Recombinant Human Thyrotropin Stimulation in Thyroid Cancer: Effectiveness for Postsurgical Remnants Ablation and Possible Role of Iodine Content in L-Thyroxine in the Outcome of Ablation

Sezione Endocrinologia, Diabetologia e Malattie Metaboliche (D.B., P.L., P.O., C.P., F.P.), 1° Unitá Operativa (U.O.) Chirurgia (G.Me., M.C.), and U.O. Anatomia Patologica (U.S.), Spedali Riuniti, Azienda Sanitaria Locale 6, 57100 Livorno; and Dipartimento di Oncologia Istituto di Medicina Nucleare (G.B., G.Ma.), 56100 Pisa, Italy

Address all correspondence and requests for reprints to: Daniele Barbaro, M.D., Sezione Endocrinologia, Diabetologia e Malattie Metaboliche, Spedali Riuniti, Azienda Sanitaria Locale 6, Viale Alfieri 37, 57100 Livorno, Italy. E-mail: danielebarbaro{at}katamail.com.

The main steps in the management of differentiated thyroid cancer are thyroidectomy, treatment with iodine-131 (¹³¹I), and follow-up with whole-body scanning (WBS) and serum thyroglobulin (Tg) determination. Both ¹³¹I treatment and follow-up require maximum stimulation of normal or pathological thyroid remnants by TSH. The use of recombinant human TSH (rhTSH) has been shown to be useful for follow-up, whereas previous reports are not univocal regarding the use of ¹³¹I postsurgical ablation of thyroid remnants, at least when low doses (30 mCi) of ¹³¹I are administered. A possible explanation for the diminished effectiveness of ¹³¹I treatment after rhTSH may be the interference of iodine content of L-thyroxine (L-T4) therapy during the protocol of administration of rhTSH. We have evaluated the effectiveness of stimulation by rhTSH for radioiodine ablation of postsurgical remnants, stopping L-T4 the day before the first injection of rhTSH and restarting L-T4 the day after ¹³¹I. The study included two groups of patients: group 1 included 16 patients with differentiated thyroid cancer (15 papillary cancers and 1 follicular cancer, stages I and II), who were treated with 30 mCi ¹³¹I with the aid of rhTSH, using the standard protocol but stopping L-T4 as stated previously; and group 2 included 24 patients with the same features (histology and stage) of disease treated with 30 mCi in the hypothyroid state after L-T4 withdrawal. In both groups, serum TSH reached a very good stimulation level [76–210 U/liter (mean, 112 ± 11 SE) and 38–82 U/liter (mean, 51 ± 3 SE), respectively]. At the first WBS (after ¹³¹I treatment), all patients showed thyroid remnants. Furthermore, two patients of the first group and three patients of the second group showed lymph node metastases. After 1 yr, all patients were studied again and underwent WBS with a tracer dose of ¹³¹I and serum Tg measurement using rhTSH with the same protocol in both groups. The percentage of ablation (undetectable Tg and a negative WBS) was higher, although not reaching statistical significance, in patients treated with rhTSH: 81.2% in patients treated by rhTSH withdrawal and 75.0% in patients treated by L-T4 withdrawal, respectively. No patient experienced symptoms of hypothyroidism during the 4 d of L-T4 interruption, and serum T4 remained in the normal range. Urinary iodine was analyzed in both groups and compared with a control group of patients who received, for diagnostic purposes, rhTSH without stopping L-T4. In the first group, urinary iodine was 47.2 ± 4.0 µg/liter (mean ± SE; P = 0.21 vs. the second group, P = 0.019 vs. control group). In the second group, urinary iodine was 38.6 ± 4.0 µg/liter (mean ± SE; P < 0.001 vs. control group); urinary iodine in the control group was 76.4 ± 9.3 µg/liter (mean ± SE).

Our data show that rhTSH, as administered in the protocol stated previously, allows at least the same rate of ablation of thyroid remnants when low doses (30 mCi) of ¹³¹I are used. The possible role of interference of iodine content in L-T4 is not surprising if we consider that the amount of iodine in 30 mCi is negligible (5 µg) compared with the amount of iodine content in a daily dose of T₄ (50 µg). The cost of rhTSH seems modest compared with the high cost of complex therapeutic regimens in other areas of oncology and in consideration of the well-being of patients and of the high level of effectiveness of the treatment.

Abbreviations: DTC, Differentiated thyroid cancer; FT3, free T₃; FT4, free T₄; ¹³¹I, iodine-131; L-T4, L-thyroxine; rhTSH, recombinant human TSH; Tg, thyroglobulin; WBS, whole-body scanning.

This article has been cited by other articles:

				M Chianelli, V Todino, F M Graziano, C Panunzi, D Pace, R Guglielmi, A Signore, and E Papini Low-activity (2.0 GBq; 54 mCi) radioiodine post-surgical remnant ablation in thyroid cancer: comparison between hormone withdrawal and use of rhTSH in low-risk patients Eur. J. Endocrinol., March 1, 2009; 160(3): 431 - 436. [Abstract] [Full Text] [PDF]

				M. R. Haymart Understanding the Relationship Between Age and Thyroid Cancer Oncologist, March 1, 2009; 14(3): 216 - 221. [Abstract] [Full Text] [PDF]

				H. Remy, I. Borget, S. Leboulleux, N. Guilabert, F. Lavielle, J. Garsi, C. Bournaud, S. Gupta, M. Schlumberger, and M. Ricard 131I Effective Half-Life and Dosimetry in Thyroid Cancer Patients J. Nucl. Med., September 1, 2008; 49(9): 1445 - 1450. [Abstract] [Full Text] [PDF]

				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]

				T. Pilli, E. Brianzoni, F. Capoccetti, M. G. Castagna, S. Fattori, A. Poggiu, G. Rossi, F. Ferretti, E. Guarino, L. Burroni, et al. A Comparison of 1850 (50 mCi) and 3700 MBq (100 mCi) 131-Iodine Administered Doses for Recombinant Thyrotropin-Stimulated Postoperative Thyroid Remnant Ablation in Differentiated Thyroid Cancer J. Clin. Endocrinol. Metab., September 1, 2007; 92(9): 3542 - 3546. [Abstract] [Full Text] [PDF]

				H. Hanscheid, M. Lassmann, M. Luster, S. R. Thomas, F. Pacini, C. Ceccarelli, P. W. Ladenson, R. L. Wahl, M. Schlumberger, M. Ricard, et al. Iodine Biokinetics and Dosimetry in Radioiodine Therapy of Thyroid Cancer: Procedures and Results of a Prospective International Controlled Study of Ablation After rhTSH or Hormone Withdrawal J. Nucl. Med., April 1, 2006; 47(4): 648 - 654. [Abstract] [Full Text] [PDF]

				F. Pacini, P. W. Ladenson, M. Schlumberger, A. Driedger, M. Luster, R. T. Kloos, S. Sherman, B. Haugen, C. Corone, E. Molinaro, et al. Radioiodine Ablation of Thyroid Remnants after Preparation with Recombinant Human Thyrotropin in Differentiated Thyroid Carcinoma: Results of an International, Randomized, Controlled Study J. Clin. Endocrinol. Metab., March 1, 2006; 91(3): 926 - 932. [Abstract] [Full Text] [PDF]

				S. Pena, S. Arum, M. Cross, B. Magnani, E. N. Pearce, M. E. Oates, and L. E. Braverman 123I Thyroid Uptake and Thyroid Size at 24, 48, and 72 Hours after the Administration of Recombinant Human Thyroid-Stimulating Hormone to Normal Volunteers J. Clin. Endocrinol. Metab., February 1, 2006; 91(2): 506 - 510. [Abstract] [Full Text] [PDF]

				B Jarzab, D Handkiewicz-Junak, and J Wloch Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review Endocr. Relat. Cancer, December 1, 2005; 12(4): 773 - 803. [Abstract] [Full Text] [PDF]

				F. Pacini, M. Schlumberger, C. Harmer, G. G Berg, O. Cohen, L. Duntas, F. Jamar, B. Jarzab, E. Limbert, P. Lind, et al. Post-surgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report Eur. J. Endocrinol., November 1, 2005; 153(5): 651 - 659. [Abstract] [Full Text] [PDF]

				E. L. Mazzaferri Empirically Treating High Serum Thyroglobulin Levels J. Nucl. Med., July 1, 2005; 46(7): 1079 - 1088. [Full Text] [PDF]

				M. G. Castagna, A. Pinchera, A. Marsili, M. Giannetti, E. Molinaro, P. Fierabracci, L. Grasso, F. Pacini, F. Santini, and R. Elisei Influence of Human Body Composition on Serum Peak Thyrotropin (TSH) after Recombinant Human TSH Administration in Patients with Differentiated Thyroid Carcinoma J. Clin. Endocrinol. Metab., July 1, 2005; 90(7): 4047 - 4050. [Abstract] [Full Text] [PDF]

				M. Luster, F. Lippi, B. Jarzab, P. Perros, M. Lassmann, C. Reiners, and F. Pacini rhTSH-aided radioiodine ablation and treatment of differentiated thyroid carcinoma: a comprehensive review Endocr. Relat. Cancer, March 1, 2005; 12(1): 49 - 64. [Abstract] [Full Text] [PDF]

				C. S. Bal, A. Kumar, and G. S. Pant Radioiodine Dose for Remnant Ablation in Differentiated Thyroid Carcinoma: A Randomized Clinical Trial in 509 Patients J. Clin. Endocrinol. Metab., April 1, 2004; 89(4): 1666 - 1673. [Abstract] [Full Text] [PDF]