Thyroid remnant dose: 124I-PET/CT dosimetric comparison of rhTSH versus thyroid hormone withholding before radioiodine remnant ablation in differentiated thyroid cancer.
OBJECTIVE
Recombinant human thyroid-stimulating hormone (rhTSH) recently was approved as an alternative to thyroid hormone withholding (THW) to elevate TSH for thyroid remnant ablation in differentiated thyroid carcinoma patients. High ablation success rates are reported with diverse rhTSH-aided (131)I activities. Improved renal function causes approximately 50% faster radioiodine clearance under euthyroidism versus hypothyroidism. Knowledge of comparative remnant radioiodine kinetics, particularly the remnant radiation dose in Gy/GBq of administered (131)I activity (RDpA), could assist in choosing rhTSH-aided ablative activities.


METHODS
To compare the RDpA, determined through (124)I-positron emission tomography/computed tomography (PET/CT), under the two stimulation methods, we retrospectively divided into two groups 55 consecutive totally-thyroidectomized, radioiodine-naïve patients. The rhTSH group (n=16) received (124)I on thyroid hormone, 24 h after two consecutive daily intramuscular injections of rhTSH, 0.9 mg. The THW group (n=39) received (124)I after weeks-long THW, when serum TSH first measured > or = 25 mIU/L. We performed PET investigations 4 h, 24 h, 48 h, 72 h and 96 h and PET/CT 25 h after (124)I administration.


RESULTS
Median stimulated serum thyroglobulin was 15 times higher (p=0.023) and M1 disease almost twice as prevalent (p=0.05) in rhTSH versus THW patients. Mean+/-standard deviation RDpA was statistically equivalent between the groups: rhTSH, 461+/-600 Gy/GBq, THW, 302+/-329 Gy/GBq, two-sided p=0.258.


CONCLUSIONS
rhTSH or THW deliver statistically equivalent radiation doses to thyroid remnant and may be chosen based on safety, quality-of-life, convenience and pharmacoeconomic factors. Institutional fixed radioiodine activities formulated for use with THW need not be adjusted for rhTSH-aided ablation.
Department of Nuclear Medicine, University of Duisburg/Essen, Essen, Germany. lutz.freudenberg@uni-due.de
L S
LS
Freudenberg
C
C
Frömke
T
T
Petrich
R J
RJ
Marlowe
W W
WW
Koska
W
W
Brandau
E G
EG
Eising
E J
EJ
Knust
A
A
Bockisch
W
W
Jentzen
D055011:Ablation Techniques; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000532:radiotherapy*; D002648:Child; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013954:Thyroglobulin / Q000097:blood; D013963:Thyroid Hormones / Q000097:blood / Q000528:radiation effects; D013964:Thyroid Neoplasms / Q000532:radiotherapy*; D013972:Thyrotropin / Q000627:therapeutic use*; D016896:Treatment Outcome; D028761:Withholding Treatment; D055815:Young Adult
D007457:Iodine Radioisotopes; D013963:Thyroid Hormones; D013972:Thyrotropin; D013954:Thyroglobulin