A pre-ablative thyroid-stimulating hormone with 30\u201370 mIU/L achieves better response to initial radioiodine remnant ablation in differentiated thyroid carcinoma patients

Juan Xiao,Hongying Jia,Jingjia Cao,Canhua Yun,Lina Wang,Chunchun Shao,Shouluan Ding,Fengyan Huang

doi:10.1038/s41598-020-80015-8

Juan Xiao, Hongying Jia + Show 6 more

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https://doi.org/10.1038/s41598-020-80015-8

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Abstract

Our aim was to clarify the optimum pre-ablative thyroid-stimulating hormone (TSH) level for initial radioiodine remnant ablation (RRA) in patients with differentiated thyroid carcinoma (DTC). From December 2015 to May 2019, 689 patients undergone RRA at Nuclear Medicine Department, Second Hospital of Shandong University were included in the study. Patients were categorized by their pre-ablative TSH level grouping of < 30, 30–70 and ≥ 70 mIU/L. Response to RRA were evaluated as complete response (including excellent and indeterminate response) and incomplete response (including biochemical and structural incomplete response) after a follow-up of 6–8 months. Multivariable binary logistic regression model was used to explore the optimum pre-ablative TSH level range and independent factors associated with response to RRA. Rates of complete response to RRA were 63.04%, 74.59% and 66.41% in TSH level groups of < 30, 30–70 and ≥ 70 mIU/L, separately. With multivariate analysis, the study found that pre-ablative TSH levels, gender and lymph node dissection were independent predictors of response to RRA. TSH between 30 and 70 mIU/L had a higher rate of complete response compared with TSH < 30 mIU/L, OR 0.451 (95% CI 0.215–0.958, P = 0.036). A pre-ablative TSH level of 30–70 mIU/L was appropriate for patients with DTC to achieve a better response to RRA.

Highlights

The incidence of differentiated thyroid cancer (DTC) has risen rapidly worldwide in the last few d ecades[1]
Nonspecific findings on imaging studies; faint uptake in thyroid bed on radioiodine remnant ablation (RRA) scanning; Nonstimulated Tg detectable, but < 1 ng/mL; Stimulated Tg detectable, but < 10 ng/mL or Anti-Tg antibodies stable or declining in the absence of structural or functional disease level for initial RRA, we retrospectively evaluated the relationship between pre-ablative thyroid-stimulating hormone (TSH) level and response to 131I therapy of differentiated thyroid carcinoma (DTC) patients
Excellent response (ER) was observed in 364 (52.83%) patients, Indeterminate response (IDR) was observed in 102 (14.80%) patients and both of them were classified into the group of complete response (n = 466, 67.63%); 55 (7.98%) patients had Biochemical incomplete response (BIR), 168 (24.38%) patients had Structural incomplete response (SIR), and both of them were classified into the group of incomplete response (n = 223, 32.37%)

Summary

Introduction

The incidence of differentiated thyroid cancer (DTC) has risen rapidly worldwide in the last few d ecades[1]. A goal TSH of > 30 mIU/L has been generally adopted in preparation for RRA therapy, which was recommended by American Thyroid Association (ATA) g uideline[5] This recommendation is based on only one old observational r esearch[3], and there is uncertainty on the optimal level of pre-ablative TSH in considering outcome effects. Nonspecific findings on imaging studies; faint uptake in thyroid bed on RRA scanning; Nonstimulated Tg detectable, but < 1 ng/mL; Stimulated Tg detectable, but < 10 ng/mL or Anti-Tg antibodies stable or declining in the absence of structural or functional disease level for initial RRA, we retrospectively evaluated the relationship between pre-ablative TSH level and response to 131I therapy of DTC patients

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