title: Comparison of Therapeutic Efficacy and Clinical Parameters Between Recombinant Human Thyroid Stimulating Hormone and Thyroid Hormone Withdrawal in High-Dose Radioiodine Treatment with Differentiated Thyroid Cancer.
abstract: OBJECTIVE
  High-dose radioiodine treatment (HD-RIT) after injection of recombinant human thyroid stimulating hormone (rh-TSH) has become widely used. This study compared the therapeutic efficacy of HD-RIT and clinical parameters between rh-TSH supplement and thyroid hormone withdrawal (THW) after total thyroidectomy in patients with differentiated thyroid cancer.
  
  
  METHODS
  We retrospectively reviewed 266 patients (47 male and 219 female; age, 49.0 ± 10.9 years) with differentiated thyroid cancer detected from September 2011 to September 2012. Patients comprised THW (217, 81.6 %) and rh-TSH (49, 18.4 %). Inclusion criteria were: first HD-RIT; any TN stage; absence of distant metastasis. To evaluate the complete ablation of the remnant thyroid tissue or metastasis, we reviewed stimulated serum thyroglobulin (sTg), I-123 whole-body scan (RxWBS) on T4 off-state, and thyroid ultrasonography (US) or [F-18]-fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) 6-8 months after HD-RIT. We defined a complete ablation state when all three of the follow-up conditions were satisfied; <2.0 ng/ml of the sTg, I-123 RxWBS (-), and thyroid US or F-18 FDG PET/CT (-). If one of the three was positive, ablation was considered incomplete. We also compared various clinical biomarkers (body weight, body mass index, liver and kidney function) between THW and rh-TSH groups.
  
  
  RESULTS
  The rates of complete ablation were 73.7 % (160/217) for the THW group and 73.5 % (36/49) for the rh-TSH group. There was no significant difference between the two groups (p = 0.970). The follow-up aspartate transaminase (p = 0.001) and alanine transaminase (p = 0.001) were significantly higher in the THW group. The renal function parameters of blood urea nitrogen (p = 0.001) and creatinine (p = 0.005) tended to increase in the THW group. The change of body weight was + Δ0.96 (±1.9) kg for the THW group and was decreased by -Δ1.39 (±1.5) kg for the rh-TSH group. The change of body mass index was 0.4 (±0.7) kg/m(2) in the THW group and was decreased by -0.6 (±0.6) kg/m(2) in the rh-TSH group.
  
  
  CONCLUSIONS
  Consistent with previous studies, the rates of complete ablation between the THW and rh-TSH groups were not significantly different. The clinical parameters, as we mentioned above, were elevated for THW group but were irrelevant for the rh-TSH group. The findings favor HD-RIT after rh-TSH, especially for patients with chronic liver and kidney disease.
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Sehun
authors.initials: S
authors.lastname: Choi
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Chang Ju
authors.initials: CJ
authors.lastname: Na
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Jeonghun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Yeon-Hee
authors.initials: YH
authors.lastname: Han
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea ; Department of Nuclear Medicine, Research Institute of Clinical Medicine, Cyclotron Research Center, Molecular Imaging & Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Gungiro, Deokjin-gu, Jeonju, Jeonbuk 561-180 Republic of Korea.
authors.forename: Hee-Kwon
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea ; Department of Nuclear Medicine, Research Institute of Clinical Medicine, Cyclotron Research Center, Molecular Imaging & Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Gungiro, Deokjin-gu, Jeonju, Jeonbuk 561-180 Republic of Korea.
authors.forename: Hwan-Jeong
authors.initials: HJ
authors.lastname: Jeong
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea ; Department of Nuclear Medicine, Research Institute of Clinical Medicine, Cyclotron Research Center, Molecular Imaging & Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Gungiro, Deokjin-gu, Jeonju, Jeonbuk 561-180 Republic of Korea.
authors.forename: Myung-Hee
authors.initials: MH
authors.lastname: Sohn
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea ; Department of Nuclear Medicine, Research Institute of Clinical Medicine, Cyclotron Research Center, Molecular Imaging & Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Gungiro, Deokjin-gu, Jeonju, Jeonbuk 561-180 Republic of Korea.
authors.forename: Seok Tae
authors.initials: ST
authors.lastname: Lim
keywords: Complete ablation rate; High-dose radioiodine therapy; Kidney function; Liver function; Recombinant human TSH; Thyroid cancer; Thyroid hormone withdrawal