Endogenous TSH levels at the time of131I ablation do not influence ablation success, recurrence-free survival or differentiated thyroid cancer-related mortality.
OBJECTIVE
Based on a single older study it is established dogma that TSH levels should be ≥30 mU/l at the time of postoperative131I ablation in differentiated thyroid cancer (DTC) patients. We sought to determine whether endogenous TSH levels, i.e. after levothyroxine withdrawal, at the time of ablation influence ablation success rates, recurrence-free survival and DTC-related mortality.


METHODS
A total of 1,873 patients without distant metastases referred for postoperative adjuvant131I therapy were retrospectively included from 1991 onwards. Successful ablation was defined as stimulated Tg <1 μg/l.


RESULTS
Age, gender and the presence of lymph node metastases were independent determinants of TSH levels at the time of ablation. TSH levels were not significantly related to ablation success rates (p = 0.34), recurrence-free survival (p = 0.29) or DTC -elated mortality (p = 0.82), but established risk factors such as T-stage, lymph node metastases and age were. Ablation was successful in 230 of 275 patients (83.6 %) with TSH <30 mU/l and in 1,359 of 1,598 patients (85.0 %) with TSH ≥30 mU/l. The difference was not significant (p = 0.55). Of the whole group of 1,873 patients, 21 had recurrent disease. There were no significant differences in recurrence rates between patients with TSH <30 mU/l and TSH ≥30 mU/l (p = 0.16). Ten of the 1,873 patients died of DTC. There were no significant differences in DTC-specific survival between patients with TSH <30 mU/l and TSH ≥30 mU/l (p = 0.53).


CONCLUSIONS
The precise endogenous TSH levels at the time of131I ablation are not related to the ablation success rates, recurrence free survival and DTC related mortality. The established dogma that TSH levels need to be ≥30 mU/l at the time of131I ablation can be discarded.
Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.
Alexis
A
Vrachimis
Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.
Burkhard
B
Riemann
Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.
Uwe
U
Mäder
Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.
Christoph
C
Reiners
Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany. fverburg@ukaachen.de.|Department of Nuclear Medicine, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. fverburg@ukaachen.de.
Frederik A
FA
Verburg
131I Ablation; Differentiated thyroid cancer; Prognosis; TSH levels