ORIGINAL ARTICLES   

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2016 June;60(2):163-71

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Thyroid remnant ablation success and disease outcome in stage III or IV differentiated thyroid carcinoma: recombinant human thyrotropin versus thyroid hormone withdrawal

Juan A. VALLEJO CASAS ¹, Luisa M. MENA BARES ^{1, 2}, María Á. GÁLVEZ MORENO ³, Estefanía MORENO ORTEGA ¹, Robert J. MARLOWE ⁴, Francisco R. MAZA MURET ¹, María D. ALBALÁ GONZÁLEZ ¹ ✉

¹ Department of Nuclear Medicine, “Reina Sofía” University Hospital, University of Córdoba, Córdoba, Spain; ² Department of Nuclear Medicine, Hospital General Universitario Santa Lucía, Santa Lucía, Spain; ³ Department of Endocrinology, “Reina Sofía” University Hospital, University of Córdoba, Córdoba, Spain; ⁴ Spencer-Fontayne Corporation, Jersey City, NJ, USA

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).
CONCLUSION: 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.