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Recombinant Human Thyrotropin Stimulation of Fluoro-D-Glucose Positron Emission Tomography Uptake in Well-Differentiated Thyroid Carcinoma

Division of Nuclear Medicine, Department of Radiology (B.B.C., P.P., C.C., R.W., P.L.), and Division of Endocrinology and Metabolism, Department of Medicine (M.E., P.L.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287

Address all correspondence and requests for reprints to: Bennett B. Chin, M.D., Duke University School of Medicine, Department of Radiology, Division of Nuclear Medicine, Box 3949, DUMC Erwin Road–Duke North, Room 1410, Durham, North Carolina 27710. E-mail: chin0004{at}mc.duke.edu.

TSH stimulates thyrocyte metabolism, glucose transport, and glycolysis. 2-Deoxy-2-[18F]fluoro-D-glucose (FDG) is a glucose analog used in positron emission tomography (PET) to detect occult well-differentiated thyroid carcinoma. The objective of this study was to examine the effects of recombinant human TSH (rTSH) on FDG PET uptake in patients with residual or recurrent disease. Seven patients with well-differentiated thyroid carcinoma, negative 131-I scintigraphy, and biochemical evidence of residual disease were randomized and prospectively studied with FDG PET both on thyroid hormone suppression and rTSH stimulation within 1 wk. All lesions seen on the TSH suppression scans were seen on the rTSH stimulation studies. rTSH stimulation studies identified four additional lesions not seen on TSH suppression. One patient was positive on rTSH stimulation alone. The mean (2.54 ± 0.72 vs. 1.79 ± 0.88) and maximum (2.49 ± 0.95 vs. 1.74 ± 0.81) lesion to background ratios were significantly higher with rTSH stimulation, compared with TSH suppression (P = 0.02 for both). rTSH stimulation improves the detectability of occult thyroid metastases with FDG PET, compared with scans performed on TSH suppression.

This work was supported by Johns Hopkins University School of Medicine General Clinical Research Center, NIH/NCRR Grant M01 RR00052 (to B.B.C.).

Abbreviations: CT, Computed tomography; FDG, 2-deoxy-2-[18F]fluoro-D-glucose; 131-I, 131-iodine; L/B, lesion to background ratio; PET, positron emission tomography; rTSH, recombinant human TSH; SUV, standardized uptake value.

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