Compliance with follow-up and the informative value of diagnostic whole-body scan in patients with differentiated thyroid carcinoma given recombinant human TSH.
OBJECTIVE
Protocols for monitoring patients with differentiated thyroid cancer (DTC) include measurement of serum Tg and, for most patients, whole-body scan (WBS) with low radioiodine activities ('diagnostic' WBS). Recently, recombinant human thyroid-stimulating hormone (rhTSH) has become available to provide the TSH stimulation necessary for these procedures, whilst avoiding thyroid hormone withdrawal and hypothyroid complications. In addition, the inclusion of diagnostic WBS in DTC follow-up has recently become controversial. We have assessed the compliance with withdrawal-aided monitoring and the informative value of diagnostic WBS in consecutive tertiary referral center patients.


METHODS
Forty-eight patients received rhTSH (0.9 mg) in two consecutive daily injections, with radioiodine administration 24 h, diagnostic WBS 48 h, and serum Tg testing prior to and 72 h later.


METHODS
Compliance with withdrawal-aided monitoring was assessed with a questionnaire provided by the referring physician, patient record analysis, and patient interview. The informative value of diagnostic WBS was assessed by comparing findings against serum Tg measurements in light of physical and other radiological examinations.


RESULTS
Forty of the forty-eight patients were female, the mean age was 43.9 years and the median follow-up from diagnosis was 4.5 years (range 1-19 years). Twenty-seven (56%) patients were compliant and 12 (25%) were non-compliant; compliance was not known in nine. Of 17 patients with clinically suspicious or significant findings on any available modality, four had uptake outside the thyroid bed on WBS but stimulated Tg <2.5 ng/ml on immunometric assay, while five had a negative WBS with serum Tg >2.5 ng/ml.


CONCLUSIONS
Thyroid hormone withdrawal substantially impairs, and rhTSH administration substantially promotes, compliance with DTC monitoring. rhTSH-aided WBS is informative and should be included in the follow-up of unselected patients with DTC.
Cohen
Ohad
O
Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
Dabhi
Sari
S
Karasik
Avraham
A
Zila Zwas
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000097:blood / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D011994:Recombinant Proteins; D013375:Substance Withdrawal Syndrome / Q000097:blood / Q000209:etiology; D011795:Surveys and Questionnaires; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging*; D013972:Thyrotropin; D014915:Whole-Body Counting
D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin; D013954:Thyroglobulin