title: Radioiodine thyroid remnant ablation after recombinant human thyrotropin or thyroid hormone withdrawal in patients with high-risk differentiated thyroid cancer.
abstract: To supplement limited relevant literature, we retrospectively compared ablation and disease outcomes in high-risk differentiated thyroid carcinoma (DTC) patients undergoing radioiodine thyroid remnant ablation aided by recombinant human thyrotropin (rhTSH) versus thyroid hormone withdrawal/withholding (THW). Our cohort was 45 consecutive antithyroglobulin antibody- (TgAb-) negative, T3-T4/N0-N1-Nx/M0 adults ablated with high activities at three referral centers. Ablation success comprised negative (<1 μg/L) stimulated serum thyroglobulin (Tg) and TgAb, with absent or <0.1% scintigraphic thyroid bed uptake. "No evidence of disease" (NED) comprised negative unstimulated/stimulated Tg and no suspicious neck ultrasonography or pathological imaging or biopsy. "Persistent disease" was failure to achieve NED, "recurrence," loss of NED status. rhTSH patients (n = 18) were oftener ≥45 years old and higher stage (P = 0.01), but otherwise not different than THW patients (n = 27) at baseline. rhTSH patients were significantly oftener successfully ablated compared to THW patients (83% versus 67%, P < 0.02). After respective 3.3 yr and 4.5 yr mean follow-ups (P = 0.02), NED was achieved oftener (72% versus 59%) and persistent disease was less frequent in rhTSH patients (22% versus 33%) (both comparisons P = 0.03). rhTSH stimulation is associated with at least as good outcomes as is THW in ablation of high-risk DTC patients.
authors.affiliation: Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Córdoba 2351, 5th Floor, Buenos Aires 1424, Argentina.
authors.forename: Fabián
authors.initials: F
authors.lastname: Pitoia
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Marlowe
authors.forename: Erika
authors.initials: E
authors.lastname: Abelleira
authors.forename: Eduardo N
authors.initials: EN
authors.lastname: Faure
authors.forename: Fernanda
authors.initials: F
authors.lastname: Bueno
authors.forename: Diego
authors.initials: D
authors.lastname: Schwarzstein
authors.forename: Rubén Julio
authors.initials: RJ
authors.lastname: Lutfi
authors.forename: Hugo
authors.initials: H
authors.lastname: Niepomniszcze