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Radioiodine ablation with 1,850 MBq in association with rhTSH in patients with differentiated thyroid cancer

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A Correction to this article was published on 02 April 2018

Abstract

Purpose

The aim of this study was to evaluate the efficacy of post-operative radioiodine ablation with 1,850 MBq after recombinant human thyrotropin (rhTSH) administration in patients with differentiated thyroid carcinoma (DTC). We also aimed to assess the prognostic role of several patient features on the outcome of ablation.

Methods

We retrospectively analyzed data from a total of 125 patients with DTC who underwent post-operative radioiodine ablation with 1,850 MBq of 131I after preparation with rhTSH. One injection of 0.9 mg rhTSH was administered on each of two consecutive days; 131I therapy was delivered 24 h after the last injection, followed by a post-therapy whole-body scan. Successful ablation was assessed 6–12 months later and defined as an rhTSH-stimulated serum thyroglobulin (Tg) level ≤1.0 ng/ml and a normal neck ultrasound.

Results

Patients were stratified according to the American Thyroid Association (ATA) Management Guidelines for Differentiated Thyroid Cancer. Successful ablation was achieved in 82.4 % of patients, with an ablation rate of 95.1 % in low-risk patients and 76.2 % in intermediate-risk patients. Analyzing the correlation between ablation outcome and patient characteristics, we found a statistically significant association between failure to ablate and class of risk based on ATA guidelines (p = 0.025) and a stimulated Tg value at ablation of above 5 ng/ml (p < 0.001).

Conclusion

The use of 1,850 MBq post-operative radioiodine thyroid remnant ablation in association with rhTSH is effective for low- and intermediate-risk patients. Moreover, in our study, we found a statistical correlation between failure to ablate and class of risk based on ATA guidelines for DTC and a stimulated Tg value at ablation.

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References

  1. Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167

    Article  CAS  PubMed  Google Scholar 

  2. Cooper DS, Doherty GM, Haugen BR et al (2009) Revised management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

  3. Maxon HR, Thomas SR, Hertzberg VS et al (1983) Relation between effective radiation dose and outcome of radioiodine therapy for thyroid cancer. N Engl J Med 309:937–941

    Article  CAS  PubMed  Google Scholar 

  4. Pacini F, Schlumberger M, Dralle H et al (2006) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803

    Article  CAS  PubMed  Google Scholar 

  5. Hyer S, Vini L, O’Connell M et al (2002) Testicular dose and fertility in men following 131I therapy for thyroid cancer. Clin Endocrinol (Oxf) 56:755–758

    Article  CAS  Google Scholar 

  6. Kloos RT, Duvuuri V, Jhiang SM et al (2002) Nasolacrimal drainage system obstruction from radioactive iodine therapy for thyroid carcinoma. J Clin Endocrinol Metab 87:5817–5820

    Article  CAS  PubMed  Google Scholar 

  7. Mandel SJ, Mandel L (2003) Radioactive iodine and the salivary glands. Thyroid 13:265–271

    Article  CAS  PubMed  Google Scholar 

  8. Sawka AM, Thabane L, Parlea L et al (2009) Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: a systematic review and meta-analysis. Thyroid 19:451–457

    Article  CAS  PubMed  Google Scholar 

  9. Schroeder PR, Haugen BR, Pacini F et al (2006) A comparison of short-term changes in health-related quality of life in thyroid carcinoma patients undergoing diagnostic evaluation with recombinant human thyrotropin compared with thyroid hormone withdrawal. J Clin Endocrinol Metab 91:878–884

    Article  CAS  PubMed  Google Scholar 

  10. Mernagh P, Suebwongpat A, Silverberg J, Weston A (2010) Cost-effectiveness of using recombinant human thyroid-stimulating hormone before radioiodine ablation for thyroid cancer: the Canadian perspective. Value Health 13:180–187

    Article  PubMed  Google Scholar 

  11. Hänscheid H, Lassmann M, Luster M et al (2006) Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J Nucl Med 47:648–654

    PubMed  Google Scholar 

  12. Schlumberger M, Catargi B, Borget I et al (2012) Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 366:1663–1673

    Article  CAS  PubMed  Google Scholar 

  13. Mallick U, Harmer C, Yap B et al (2012) Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med 366:1674–1685

    Article  CAS  PubMed  Google Scholar 

  14. Molinaro E, Giani C, Agate L et al (2013) Patients with differentiated thyroid cancer who underwent radioiodine thyroid remnant ablation with low-activity 131I after either recombinant human TSH or thyroid hormone therapy withdrawal showed the same outcome after a 10-year follow-up. J Clin Endocrinol Metab 98:2693–2700

    Article  CAS  PubMed  Google Scholar 

  15. Castagna MG, Cevenini G, Theodoropoulou A et al (2013) Post-surgical thyroid ablation with low or high radioiodine activities results in similar outcomes in intermediate risk differentiated thyroid cancer patients. Eur J Endocrinol 169(1):23–29

    Article  CAS  PubMed  Google Scholar 

  16. Spencer C, Fatemi S, Singer P et al (2010) Serum basal thyroglobulin measured by a second-generation assay correlates with the recombinant human thyrotropin-stimulated thyroglobulin response in patients treated for differentiated thyroid cancer. Thyroid 20:587–595

    Article  CAS  PubMed  Google Scholar 

  17. Chiovato L, Latrofa F, Braverman LE et al (2003) Disappearance of humoral thyroid autoimmunity after complete removal of thyroid antigens. Ann Intern Med 139:346–351

    Article  CAS  PubMed  Google Scholar 

  18. Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428

    Article  CAS  PubMed  Google Scholar 

  19. DeGroot LJ (1994) Long-term impact of initial and surgical therapy on papillary and follicular thyroid cancer. Am J Med 97:499–500

    Article  CAS  PubMed  Google Scholar 

  20. DeGroot LJ, Kaplan EL, McCormick M et al (1990) Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab 71:414–424

    Article  CAS  PubMed  Google Scholar 

  21. Sawka AM, Brierley JD, Tsang RW et al (2008) An updated systematic review and commentary examining the effectiveness of radioactive iodine remnant ablation in well differentiated thyroid cancer. Endocrinol Metab Clin N Am 37:457–480

    Article  Google Scholar 

  22. Nixon IJ, Ganly I, Patel SG et al (2013) The results of selective use of radioactive iodine on survival and on recurrence in the management of papillary thyroid cancer, based on Memorial Sloan-Kettering Cancer Center risk group stratification. Thyroid 23:683–694

    Article  CAS  PubMed  Google Scholar 

  23. Schvartz C, Bonnetaine F, Dabakuyo S et al (2012) Impact of overall survival of radioactive iodine in low-risk differentiated thyroid cancer patients. J Clin Endocrinol Metab 97:1526–1535

    Article  CAS  PubMed  Google Scholar 

  24. Pacini F, Ladenson PW, Schlumberger M et al (2006) Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized, controlled study. J Clin Endocrinol Metab 91:926–932

    Article  CAS  PubMed  Google Scholar 

  25. Pacini F, Molinaro E, Castagna MG et al (2002) Ablation of thyroid residues with 30 mCi 131I: a comparison in thyroid cancer patients prepared with recombinant human TSH or thyroid hormone withdrawal. J Clin Endocrinol Metab 87:4063–4068

    Article  CAS  PubMed  Google Scholar 

  26. Barbaro D, Boni G, Meucci G et al (2003) Radioiodine treatment with 30 mCi after recombinant human thyrotropin stimulation in thyroid cancer: effectiveness of postsurgical remnants ablation and possible role of iodine content in l-thyroxine in the outcome of ablation. J Clin Endocrinol Metab 88:4110–4115

    Article  CAS  PubMed  Google Scholar 

  27. Hackshaw A, Harmer C, Mallick U et al (2007) 131I activity for remnant ablation in patients with differentiated thyroid cancer: A systematic review. J Clin Endocrinol Metab 92:28–38

    Article  CAS  PubMed  Google Scholar 

  28. Baudin E, Do Cao C, Cailleux AF et al (2003) Positive predictive value of serum thyroglobulin levels, measured during the first year of follow-up after thyroid hormone withdrawal, in thyroid cancer patients. J Clin Endocrinol Metab 88:1107–1111

    Article  CAS  PubMed  Google Scholar 

  29. Mazzaferri EL, Robbins RJ, Spencer CA et al (2003) A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 88:1433–1441

    Article  CAS  PubMed  Google Scholar 

  30. Kim MH, Ko SH, Bae JS et al (2012) Combination of initial stimulation thyroglobulins and staging system by revised ata guidelines can elaborately discriminate prognosis of patients with differentiated thyroid carcinoma after high-dose remnant ablation. Clin Nucl Med 37:1069–1074

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Unit of Endocrinology, Humanitas Research Hospital, Rozzano, MI, Italy

    Alberto S. Tresoldi, Laura F. Sburlati, Paolo Colombo & Andrea Gerardo Antonio Lania

  2. Nuclear Medicine Department, Humanitas Research Hospital, Via A. Manzoni 56, 20089, Rozzano, MI, Italy

    Marcello Rodari & Arturo Chiti

  3. Leyden University, Leiden, The Netherlands

    Mink Schinkelshoek

  4. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Michela Perrino, Simone De Leo & Laura Fugazzola

  5. Endocrine Unit, Fondazione IRCCS Ca’ Granda, Milan, Italy

    Michela Perrino, Simone De Leo & Laura Fugazzola

  6. Unit of Endocrine Diseases and Diabetology, Ospedale San Giuseppe Multimedica, Milan, Italy

    Laura Montefusco & Maura Arosio

  7. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Laura Montefusco & Maura Arosio

  8. Department of Biotechnologies and Translational Medicine, University of Milan, Milan, Italy

    Andrea Gerardo Antonio Lania

Authors
  1. Alberto S. Tresoldi
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  2. Laura F. Sburlati
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  3. Marcello Rodari
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  7. Laura Montefusco
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  10. Andrea Gerardo Antonio Lania
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  11. Laura Fugazzola
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  12. Arturo Chiti
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Correspondence to Arturo Chiti.

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Tresoldi, A.S., Sburlati, L.F., Rodari, M. et al. Radioiodine ablation with 1,850 MBq in association with rhTSH in patients with differentiated thyroid cancer. J Endocrinol Invest 37, 709–714 (2014). https://doi.org/10.1007/s40618-014-0088-3

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  • DOI: https://doi.org/10.1007/s40618-014-0088-3

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