title: Preparation by recombinant human thyrotropin or thyroid hormone withdrawal are comparable for the detection of residual differentiated thyroid carcinoma.
abstract: Clinical recurrences of differentiated thyroid carcinoma occur in 20% of patients after thyroid surgery. We performed a retrospective analysis of a cohort of patients undergoing routine follow-up testing to detect recurrent thyroid carcinoma over a 2-yr period. One group was prepared for testing by thyroid hormone withdrawal (THW), and the other group remained on thyroid hormone and received injections of recombinant human TSH (rhTSH) before diagnostic whole-body radioiodine scanning (DxWBS). We hypothesized that no differences in the ability to detect residual disease would exist between these 2 groups. Two hundred and eighty-nine patients were examined by both DxWBS and by measurement of the serum thyroglobulin (Tg) response to elevated TSH levels. THW was used for 161 patients, and rhTSH preparation was used for 128 patients. Based on all available testing results, we categorized patients as having metastatic disease, thyroid bed uptake only, or no evidence of disease. We examined the sensitivity, specificity, positive and negative predictive values of the DxWBS, and the stimulated Tg after preparation by THW or rhTSH. Patients with thyroid bed were not considered in accuracy testing. The sensitivity and specificity of the 2 tests were comparable between groups. No significant differences were present in the positive or negative predictive values between groups. The highest negative predictive value (97%) was in patients who had both a negative DxWBS and low stimulated Tg levels after rhTSH. In summary, we were unable to demonstrate a difference in the diagnostic accuracy of DxWBS and/or Tg between patients prepared by either THW or rhTSH. We conclude that preparing patients by rhTSH is diagnostically equivalent to preparing them by THW.
authors.affiliation: Endocrinology Service, Department of Medicine, Memorial Hospital for Cancer and Allied Diseases, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Robbins
authors.forename: R M
authors.initials: RM
authors.lastname: Tuttle
authors.forename: R N
authors.initials: RN
authors.lastname: Sharaf
authors.forename: S M
authors.initials: SM
authors.lastname: Larson
authors.forename: H K
authors.initials: HK
authors.lastname: Robbins
authors.forename: R A
authors.initials: RA
authors.lastname: Ghossein
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.forename: W D
authors.initials: WD
authors.lastname: Drucker
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D019275:Radiopharmaceuticals; D011994:Recombinant Proteins; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013963:Thyroid Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D013965:Thyroidectomy; D013972:Thyrotropin; D014055:Tomography, Emission-Computed
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D011994:Recombinant Proteins; D013963:Thyroid Hormones; D019788:Fluorodeoxyglucose F18; D013972:Thyrotropin