Age influences TSH serum levels after withdrawal of l-thyroxine or rhTSH stimulation in patients affected by differentiated thyroid cancer

Abstract

Recombinant human TSH (rhTSH) has been recently suggested for radioiodine ablation in patients with differentiated thyroid cancer (DTC). To date, studies are still not available about the effectiveness of rhTSH stimulation depending on the age, since serum TSH clearance may be different in younger and in older patients. The aim of this study was to investigate the influence of age to serum TSH levels after rhTSH stimulation and thyroid hormone withdrawal (THW). We retrospectively evaluated two groups of consecutive DTC patients: group 1 (311 patients, age 49.0 ± 13.6 years, ranging 15–86) underwent rhTSH stimulation 6–12 months after thyroid ablation (rhTSH-group); group 2 (84 patients, age 46.9 ± 13.5 years, ranging 20–77) was followed by THW (THW-group). The influence of age, gender, body mass index and body surface area to serum TSH levels were evaluated in both groups. RhTSH-group: on day 5 (d5), TSH levels were 32.7 ± 21.4 μU/ml (range 0.8–136.6). By univariate analysis, d5-TSH was positively related to age ( r = 0.27, p = 0.0001) and no correlations were found with the other parameters. At multivariate analysis, both age and gender (female) were independently associated with d5-TSH levels. THW-group: after thyroid hormone withdrawal, TSH levels were 71.1 ± 36.4 μU/ml (range 8.5–200). At univariate analysis, only age was significantly and negatively related to serum TSH levels ( r = − 0.31, p = 0.004). Our data indicate that age and gender seem to positively influence serum TSH levels after rhTSH stimulation. An opposite effect of age on serum TSH levels has been observed after THW. Therapeutic implications ( 131I-treatment) of these findings have to be better investigated in prospective studies.