title: Thyroid remnant ablation success and disease outcome in stage III or IV differentiated thyroid carcinoma: recombinant human thyrotropin versus thyroid hormone withdrawal.
abstract: BACKGROUND
  Most publications to date compare outcomes after post-surgical thyroid remnant ablation stimulated by recombinant human thyrotropin (rhTSH) versus thyroid hormone withholding/withdrawal (THW) in low-recurrence risk differentiated thyroid carcinoma (DTC) patients. We sought to perform this comparison in high-risk patients.
  
  
  METHODS
  We retrospectively analyzed ~9-year single-center experience in 70 consecutive adults with initial UICC (Union for International Cancer Control) stage III/IV, M0 DTC undergoing rhTSH-aided (N.=54) or THW-aided (N.=16) high-activity ablation. Endpoints included ablation success and DTC outcome. Assessed ≥1 year post-ablation, ablation success comprised a) no visible scintigraphic thyroid bed uptake or pathological extra-thyroidal uptake; b) undetectable stimulated serum thyroglobulin (Tg) without interfering autoantibodies; c) both criteria. DTC outcome, determined at the latest visit, comprised either 1) "no evidence of disease" (NED): undetectable Tg, negative Tg autoantibodies, negative most recent whole-body scan, no suspicious findings clinically, on neck ultrasonography, or on other imaging; 2) persistent disease: failure to attain NED; or 3) recurrence: loss of NED.
  
  
  RESULTS
  After the first ablative activity, ablation success by scintigraphic plus biochemical criteria was 64.8% in rhTSH patients, 56.3% in THW patients (P=NS). After 3.5-year versus 6.2-year median follow-up (P<0.05), DTC outcomes were NED, 85.2%, persistent disease, 13.0%, recurrence, 1.9%, in the rhTSH group and NED, 87.5%, persistent or recurrent disease, 6.3% each, in the THW group (P=NS).
  
  
  CONCLUSIONS
  In patients with initial stage III/IV, M0 DTC, rhTSH-aided and THW-assisted ablation were associated with comparable remnant eradication or DTC cure rates.
authors.affiliation: Department of Nuclear Medicine, "Reina Sofía" University Hospital, University of Córdoba, Córdoba, Spain - jantonio.vallejo.sspa@juntadeandalucia.es.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Vallejo Casas
authors.forename: Luisa M
authors.initials: LM
authors.lastname: Mena Bares
authors.forename: Maria A
authors.initials: MA
authors.lastname: Gálvez Moreno
authors.forename: Estefanía
authors.initials: E
authors.lastname: Moreno Ortega
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Marlowe
authors.forename: Francisco R
authors.initials: FR
authors.lastname: Maza Muret
authors.forename: María D
authors.initials: MD
authors.lastname: Albalá González
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011994:Recombinant Proteins / Q000494:pharmacology* / Q000627:therapeutic use; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000187:drug effects*; D013963:Thyroid Hormones / Q000378:metabolism*; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology*; D013972:Thyrotropin / Q000494:pharmacology* / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D011994:Recombinant Proteins; D013963:Thyroid Hormones; D013972:Thyrotropin