Abstract
We aimed to determine whether recombinant human thyrotropin (rhTSH) plus 3.7 GBq could replace thyroid hormone withdrawal (THW) plus 5.55 GBq for adjuvant radioactive iodine (RAI) therapy in differentiated thyroid cancer (DTC) patients with T4 or N1b disease. This study was a retrospective study comparing ablation success rate, response to initial therapy, and recurrence-free survival (RFS) of patients with rhTSH plus 3.7 GBq versus those with THW plus 5.55 GBq in 253 DTC patients with T4 or N1b disease. There were no differences in the TSH-stimulated thyroglobulin level, rate of incomplete response after initial treatment, or the RFS between the two treatment strategies. However, thyroid bed uptake on follow-up diagnostic RAI whole-body scanning (WBS) was more frequently observed in the group treated with rhTSH plus 3.7 GBq than in the group with THW plus 5.55 GBq. Adjuvant RAI therapy with rhTSH plus 3.7 GBq had comparable results in the absence of persistent tumor, compared with that with THW plus 5.55 GBq. Although thyroid bed uptake was more frequently observed, rhTSH plus 3.7 GBq may be used instead of THW plus 5.55 GBq for adjuvant RAI therapy in patients with T4 or N1b disease.
Highlights
IntroductionPostoperative radioactive iodine (RAI) therapy has been used for patients with differentiated thyroid cancer (DTC) to remove residual normal thyroid tissue after thyroidectomy (remnant ablation), or to treat potential metastatic disease (adjuvant therapy)
Postoperative radioactive iodine (RAI) therapy has been used for patients with differentiated thyroid cancer (DTC) to remove residual normal thyroid tissue after thyroidectomy, or to treat potential metastatic disease
National health insurance of the Republic of Korea has covered the use of rhTSH for remnant ablation and adjuvant therapy if the activity of RAI is less than 3.7 GBq
Summary
Postoperative radioactive iodine (RAI) therapy has been used for patients with differentiated thyroid cancer (DTC) to remove residual normal thyroid tissue after thyroidectomy (remnant ablation), or to treat potential metastatic disease (adjuvant therapy). In ATA low risk disease, the rate of ablation success with an administered activity of 1.11 GBq (30 mCi) was reported to be non-inferior compared to 3.7 GBq (100 mCi) after preparation with THW or rhTSH7,8. Hugo et al reported rhTSH preparation for RAI remnant ablation can be effectively used in intermediate and high-risk patients without known distant metastasis[9]. National health insurance of the Republic of Korea has covered the use of rhTSH for remnant ablation and adjuvant therapy if the activity of RAI is less than 3.7 GBq. as of October 2013, we changed the strategy of adjuvant RAI therapy in our institution to rhTSH plus 3.7 GBq instead of THW plus 5.55 GBq in patients with T4 or N1b thyroid cancer, to achieve better quality of life for patients and lower rates of adverse events. We aimed to determine whether rhTSH plus 3.7 GBq of RAI could be used instead of THW plus 5.55 GBq of RAI for adjuvant RAI therapy in patients with T4 or N1b disease
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