Abstract
Simple SummaryIn recent years, there has been a clear trend toward personalized therapy procedures in patients with thyroid cancer with the aim to avoid unnecessary overtreatment of patients and to ensure an improved quality of life. We confirmed that early diagnostic control at 6 months after initial radioiodine therapy shows no significant disadvantages compared to a delayed control after 9 months. Further, it was observed that patients stimulated by hormone withdrawal before radioiodine therapy had significantly better outcomes compared to patients stimulated exogenously with recombinant human thyroid-stimulating hormone (rhTSH). However, early diagnostic control after TSH stimulation represents the most balanced solution for the patient, specifically regarding hypothyroidism symptoms after hormone withdrawal.Background: The aim was to assess ablation success after initial radioiodine (RAI) therapy in early-stage PTC patients and compare outcomes of first diagnostic control after 6 and 9 months (6m/9m-DC) to examine whether time could possibly avoid unnecessary overtreatment. Methods: There were 353 patients who were matched regarding age, sex, and tumor stage and divided in two groups depending on time of first DC (6m- and 9m-DC). Therapy response was defined as thyroglobulin level <0.5 ng/mL, no pathological uptake in the diagnostic I-131 whole-body scintigraphy (WBS), and no further RAI therapy courses. The 6m-DC group was further divided into endogenously and exogenously stimulated TSH before RAI therapy and compared regarding outcome. Results: No significant differences were found between 6m-DC vs. 9m-DC regarding I-131 uptake in WBS (p = n.s.), Tg levels (p = n.s.), re-therapy rates (p = n.s.), and responder rates (p = n.s.). Significantly less relevant pathological I-131 uptake was found in WBS (p = 0.006) in endogenously compared to exogenously stimulated 6m-DC patients, resulting in lower re-therapy (p = 0.028) and higher responder rates (p = 0.001). Conclusion: DC at 6 months after RAI therapy and stimulation with recombinant human thyroid-stimulating hormone (rhTSH) represent the most balanced solution. Particularly regarding quality of life and mental relief of patients, early DC with rhTSH represents sufficient and convenient assessment of ablation success.
Highlights
Differentiated thyroid carcinoma (DTC) is the most common malignant endocrine neoplasm with increasing incidence worldwide [1]
TNM stage was classified according to the seventh edition of the American
Therapy, patients were stimulated with recombinant human thyroid-stimulating hormone i.m. on 2 consecutive days or underwent hormone withdrawal prior to RAI therapy to achieve TSH levels ≥30 μU/mL
Summary
Differentiated thyroid carcinoma (DTC) is the most common malignant endocrine neoplasm with increasing incidence worldwide [1]. A diagnostic control, including a I-131 whole-body scintigraphy (WBS) under TSH stimulation, neck ultrasound, and laboratory examination, is recommended, which should be performed 6 to 12 months after RAI therapy (first diagnostic control (DC)), depending on the respective guidelines. The optimal time to perform DC to evaluate ablation success after initial radioiodine therapy in DTC patients is widely discussed among experts and results in different recommendations in the corresponding. The aim was to assess ablation success after initial radioiodine (RAI) therapy in early-stage PTC patients and compare outcomes of first diagnostic control after 6 and 9 months (6m/9m-DC) to examine whether time could possibly avoid unnecessary overtreatment. Less relevant pathological I-131 uptake was found in WBS (p = 0.006) in endogenously compared to exogenously stimulated 6m-DC patients, resulting in lower re-therapy (p = 0.028) and higher responder rates (p = 0.001). Conclusion: DC at 6 months after RAI therapy and stimulation with recombinant human thyroid-stimulating hormone (rhTSH) represent the most balanced solution
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